Social Networks and Residential Status in Community-Dwelling Older Adults With Schizophrenia: Compensation by Reconfiguration?

Loneliness in older persons with schizophrenia

BACKGROUND

In tandem with the rise in numbers of older adults in the general population, more people with schizophrenia (PwS) are also living longer. This vulnerable population has several trajectories of ageing driven by a number of social determinants of health, including the experience of loneliness and they may be more at risk of experiencing loneliness.

AIM

This study aimed to examine demographic, psychosocial and clinical variables and their relative contribution to the loneliness of older PwS (OPwS) in a large New Zealand community sample.

METHOD

New Zealanders 65 years and older who completed their first interRAI assessment during the study period were included. Data from 1,883 OPwS participants was analysed [mean age, 75.1 + 7.7 years; 1,132 (60.3%) females]. The majority were of European ethnicity (64.8%; Māori 15.7%, Pacifica 5.7%) and only a minority were married (20.6%). Chi-square analysis was used to examine relationships between loneliness and demographic and psychosocial variables. Logistic regression was used to measure the relative contribution of these variables to loneliness.

RESULTS

Being lonely was reported for 25.9% of OPwS, a significantly higher rate than that reported in the general population of people over 65 years-of-age. A relationship with loneliness was found for marital status, depression and living arrangements but not gender, ethnicity or social engagement. Co-morbid depression and not being in a marital-type partnership were identified as significant predictors of being lonely. Conversely, living with someone predicted being not lonely.

CONCLUSIONS

Older community dwelling PwS experience higher rates of loneliness than older adults in a general population. Addressing loneliness, as well as its correlates, co-morbid depressive symptoms and living arrangements, is crucial to supporting the wellbeing of OPwS.

New horizons in schizophrenia in older people

People aged 65 years and older will soon constitute more than a quarter of the total population with schizophrenia, challenging the existing systems of care. For a long time, research into schizophrenia in later life was very limited. However, recent years have seen an encouraging surge in novel and high-quality studies related to this stage of life. Older people with schizophrenia consist of those who had an early onset and aged with the disorder, and of a smaller but sizeable group with a late onset or a very late onset. With ageing, physical needs gain importance relative to psychiatric needs. Medical comorbidity contributes to a markedly higher mortality compared to the general population. In many persons, symptoms and functioning fluctuate with time, leading to deterioration in some but improvement in others. Of note, a substantial number of older people may experience subjective well-being in spite of ongoing symptoms and social impairments. The majority of individuals with schizophrenia reside in the community, but when institutionalization is required many are placed in residential or nursing homes where staff is often ill-equipped to address their complex needs. There is a clear need for implementation of new models of care in which mental health and general health systems cooperate. This review provides a state-of-the-art overview of current knowledge in late life schizophrenia and related disorders, with a focus on themes with clinical relevance.

Examining the social networks of older adults receiving informal or formal care: a systematic review

PURPOSE

To address the care needs of older adults, it is important to identify and understand the forms of care support older adults received. This systematic review aims to examine the social networks of older adults receiving informal or formal care and the factors that influenced their networks.

METHODS

A systematic review was conducted by searching six databases from inception to January 31, 2023. The review included primary studies focusing on older adults receiving long-term care, encompassing both informal and formal care. To assess the risk of bias in the included studies, validated appraisal tools specifically designed for different study types were utilized. Network analysis was employed to identify the grouping of study concepts, which subsequently formed the foundation for describing themes through narrative synthesis.

RESULTS

We identified 121 studies relating to the formal and informal care of older adults' networks. A variety of social ties were examined by included studies. The most commonly examined sources of care support were family members (such as children and spouses) and friends. Several factors were consistently reported to influence the provision of informal care, including the intensity of networks, reciprocity, and geographical proximity. In terms of formal care utilization, older age and poor health status were found to be associated with increased use of healthcare services. Additionally, physical limitations and cognitive impairment were identified as factors contributing to decreased social engagement.

CONCLUSION

This review found that older people were embedded within a diverse network. The findings of this review emphasize the importance of recognizing and incorporating the diversity of social networks in care plans and policies to enhance the effectiveness of interventions and improve the overall well-being of older adults.