Clinical Review Article
Social Functioning Among Older Community-Dwelling Patients With Schizophrenia: A Review

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Social dysfunction is a hallmark of schizophrenia and a major constituent of its burden of disease. There is a need for more data on social functioning of older schizophrenic patients, because their numbers are rapidly growing and most are residing within the community. This article reviews existing evidence on social functioning in community-dwelling schizophrenic patients older than 55 years, focusing on social roles, social support, and social skills. Thirty-six publications proved fit for inclusion in the review. Studies from outside the United States were underrepresented. The available data suggest that the majority of older schizophrenic patients are well behind their healthy age-peers with respect to various aspects of social functioning. At the same time, a considerable heterogeneity among patients can be found. Cognitive abilities feature as a factor of major impact on social functioning, outweighing clinical symptoms. When evaluating social functioning both objective and subjective appraisals should be taken into account, because they may highlight different aspects of social functioning. Social support, impact of gender, and specific characteristics of older-old patients figure among areas that should be given priority in future research of social functioning in late life schizophrenia.

Section snippets

METHODS

The online database PubMed was searched on May 15, 2009, for potentially relevant English, German, French, and Dutch publications. The search had no date limits. Both controlled (MeSH) and free search terms were used and placed in three categories. The first category enclosed terms for schizophrenia and related disorders (schizophrenia, psychotic disorders, paranoid disorders, schizophrenic psychology, and schizophreni*). The second category enclosed terms for older age (aged, age of onset, age

RESULTS

Five longitudinal studies on social outcomes were identified. All other studies had a cross-sectional design: 10 studies on social outcomes, 8 studies on social support, and 13 studies on social skills. In the next part, we consider these studies in detail.

DISCUSSION

Social functioning is widely regarded as one of the most relevant domains in schizophrenia, both from the perspective of patients, significant others, and society as a whole. Given the substantial and rapidly growing number of older people with schizophrenia, the importance of paying attention to their social vicissitudes is self-evident. This review demonstrates the scarcity and limitations of the existing literature relevant to this topic. The total number of studies qualifying for this

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      In the New York City sample described previously, 28% moved between high and low categories on follow-up, whereas 32% and 40% of the sample were in the high and low QOL categories, respectively, at both points in time.64 A review by Meesters and colleagues24 concluded, “The majority of older schizophrenic patients are well behind their healthy age peers with respect to various aspects of social functioning such as social roles, social support, and social skills.” At the same time considerable heterogeneity among patients can be found, and cognitive functioning had a major impact on social functioning, outweighing clinical symptoms.

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    The authors thank Ingrid I. Riphagen, Medical Librarian, for her assistance in the search process for this review.

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