Aging is a natural phenomenon of life, and with it comes impairments to our physical abilities and deteriorating cognitive functions. Studies have shown that the rate of mental decline in people with schizophrenia is the same as that of people who do not have the disorder—despite their higher risk of developing physical illnesses due to aging.

This points to a greater resilience than previously thought. Individuals with schizophrenia retain an inherent ability to cope, regardless of external factors that could age them faster than others. [1]

What causes schizophrenia to get worse?

Veering off the treatment plan

Dealing with schizophrenia can be a challenging experience, and it isn't made any easier when symptoms make it difficult to follow a treatment plan. Medication adherence can be a problem in patients with troubled thoughts. This can lead to a worsening of the mental illness in the long run.

If left unchecked, psychotic episodes and disabling behaviors associated with the mental health disorder can happen more frequently or become more severe. Patients with chronic medication adherence issues might be given long-acting injectable medications instead of oral medications. [2]

Increased complications

Co-morbidities, polypharmacy (the taking of several medications at the same), and increased frailty in the elderly are all issues that may affect their active participation in their treatment. That is, as people age, or if the condition worsens (even at a younger age), patients may be less capable of making decisions about the treatment proposed by healthcare professionals. [3]

Additionally, older patients tend to experience more side effects from their medications, which may cause them to stop taking them, worsening schizophrenia symptoms. [4]

Treatment might get less effective

As patients get older, the effectiveness of their medications sometimes decreases. The exact reason for this is unknown, but is thought to be due to changes in the brain's structure. Older patients might be socially isolated, and the reduced effectiveness of their medications may not be apparent to others.

Dementia

Schizophrenic patients have a 2-fold risk of dementia compared to the average population. Cognitive decline affects medication adherence and poses further health threats in areas already problematic in patients with schizophrenia, such as social isolation. [5]

Decreased support

As life circumstances change, people with schizophrenia may become unable to cope. This might happen when young adults find themselves with increased responsibilities like maintaining a job or living alone or with a spouse.

Support networks may dwindle as people grow older. For example, those who were previously cared for by their children may suffer as the child moves out and gains independence. Progressive social withdrawal, a symptom of uncontrolled schizophrenia, needs to be tackled in psychotherapy. [6]

Does schizophrenia worsen as you get older?

Aging patients with schizophrenia cannot be treated as merely chronologically older adults. In schizophrenic patients with a lower life expectancy than those not affected by schizophrenia, 'older' may require a different definition. People with schizophrenia in their forties or fifties may need to be treated, medically, like patients in their sixties or seventies in the general population.

Patients with late-onset schizophrenia (illness starting after age 40) have a better prognosis and require lower medication doses for the condition to be considered under control. In patients with early-onset schizophrenia, aging can be associated with improved symptoms; an enhanced ability to perform everyday tasks has been observed. Generally, as schizophrenic patients get older, there is less substance abuse, fewer positive symptoms (e.g., hallucinations and delusions), and improved mental health. This comes with an associated improvement in quality of life.

Therefore, even though schizophrenic patients age faster physically and have increased co-morbidities compared to the general population, their mental decline is not faster, and their condition may improve with age. While the reason is not apparent, it may be a combination of effects such as the neuroplasticity of aging and better use of coping techniques. Medications may affect brain structure to produce lasting benefits. [4], [7]

Best ways to treat schizophrenia

As people with schizophrenia get older, their illness may become more challenging to manage without proper treatment. Research shows that early and consistent treatment of the psychiatric disorder can help minimize the severity of its symptoms and reduce the chances of long-term effects.

Treatment options should be tailored to individual needs. Still, they usually include psychotherapy, medications and other lifestyle changes that can significantly improve functioning. Additionally, social support from family members, friends or even support groups can substantially help individuals with schizophrenia cope with their condition and reduce its impact on their lives.

  • Cognitive behavioral therapy and social skills training improves the overall functioning of schizophrenic patients over 45 years.
  • Functional Adaptation Skills Training is a program that runs over 24 weeks. It targets six areas to improve day-to-day management – social skills, medication management, organization and planning, communication skills, transportation, and financial management. This enhances everyday skills but requires follow-up to maintain benefits in the long term.
  • Helping Older People Experience Success is another program that tackles social rehabilitation and integrated healthcare. It aims at improving social skills, everyday functioning, and self-efficacy while decreasing negative symptoms (lack of expression or emotion). [4]

What is the outlook for people with schizophrenia?

While there is no cure for schizophrenia, patients can lead full and meaningful lives with treatment that controls symptoms and encourages better coping skills. Effective treatments are best provided by a team and need to include medications, behavioral therapy, social services, and counseling.

As with most diseases and mental health conditions, early detection and treatment are crucial to be able to minimize suffering and stabilize symptoms of schizophrenia. It is estimated that approximately 50% of patients either recover ten years after diagnosis or improve enough to work, live, and function in society. Others need the help of a support network to get by, and a smaller percentage may need to be recovered and under observation.

It is not a success story for all, unfortunately. Despite advances in medicine and other therapies over the past 50 years, outcomes for individuals with schizophrenia have not improved in parallel. Long-term success also depends on the patient's condition, including their social and work circumstances, before the onset of the disease. The goal for the future is to improve outcomes of functional recovery and care for patients holistically, taking into consideration their mental and physical well-being. [8]

Resources:

  1. Cepla, E. (2014). Schizophrenia and getting older. National Alliance on Mental Illness. Retrieved December 4, 2022, from https://www.nami.org/About-NAMI/NAMI-News/2014/Schizophrenia-and-Getting-Older
  2. Greene, M., Yan, T., Chang, E., Hartry, A., Touya, M., & Broder, M. S. (2018). Medication adherence and discontinuation of long-acting injectable versus oral antipsychotics in patients with schizophrenia or bipolar disorder. Journal of Medical Economics, 21(2), 127–134. https://doi.org/10.1080/13696998.2017.1379412
  3. Folsom, D. P., Lebowitz, B. D., Lindamer, L. A., Palmer, B. W., Patterson, T. L., & Jeste, D. V. (2006). Schizophrenia in late life: Emerging issues. Dialogues in Clinical Neuroscience, 8(1), 45–52.
  4. Jeste, D. V., & Maglione, J. E. (2013). Treating older adults with schizophrenia: Challenges and opportunities. Schizophrenia Bulletin, 39(5), 966–968. https://doi.org/10.1093/schbul/sbt043
  5. Fenger-Grøn, M., Vestergaard, C., Ribe, A., Johnsen, S.,  Frost, L., Sandbæk, A., & Davydow, D.S.  (2021). Association between bipolar disorder or schizophrenia and oral anticoagulation use in Danish adults with incident or prevalent atrial fibrillation. JAMA Network Open, 4(5):e2110096. doi:10.1001/jamanetworkopen.2021.10096
  6. Dziwota, E., Stepulak, M. Z., Włoszczak-Szubzda, A., & Olajossy, M. (2018). Social functioning and the quality of life of patients diagnosed with schizophrenia. Annals of Agricultural and Environmental Medicine: AAEM, 25(1), 50–55. https://doi.org/10.5604/12321966.1233566
  7. Jeste, D. V., Wolkowitz, O. M., & Palmer, B. W. (2011). Divergent trajectories of physical, cognitive, and psychosocial aging in schizophrenia. Schizophrenia Bulletin, 37(3), 451–455. https://doi.org/10.1093/schbul/sbr026
  8. Webber, M. A., & Marder, S. R. (2008). Better pharmacotherapy for schizophrenia: What does the future hold? Current Psychiatry Reports, 10(4), 352–358. https://doi.org/10.1007/s11920-008-0056-8