Adaptive Competence Impairment and Cognitive Deficits in Acutely Ill Schizophrenia Patients Residing in Nursing Homes

doi:10.1097/JGP.0b013e3181ffeb32

The American Journal of Geriatric Psychiatry

Volume 19, Issue 8, August 2011, Pages 752-756

https://doi.org/10.1097/JGP.0b013e3181ffeb32 Get rights and content

Objectives:

The loss of long-term inpatient psychiatric hospital beds over the years has caused schizophrenia patients of all ages to be increasingly placed in nursing home environments that were traditionally reserved for elderly patients. Consequently, many nongeriatric patients with chronic schizophrenia are now residing in nursing home settings. The objective of this article is to determine whether many of these nongeriatric patients are placed in nursing homes because of chronicity of illness and severity of impairment, or because of the limited alternative viable housing options.

Design:

Multiple and stepwise regressions examined predictors of cognitive ability, adaptive competence, social skills and inpatient social and adaptive functioning, and clinical symptomatology.

Setting:

Inpatient psychiatric unit in a general hospital.

Participants:

Fifty acutely ill geriatric and nongeriatric patients with schizophrenia who reside in nursing homes.

Measurements:

Participants' clinical symptoms, cognitive ability, adaptive functioning, social skills, and inpatient social and adaptive functioning were assessed.

Results:

Findings revealed that patients' cognitive impairment and age of admission to the nursing home, irrespective of patients' current age, were predictors of impaired adaptive competence.

Conclusions:

Examination of cognitive and adaptive deficits with assessment of symptom severity, independent of patients' current age, may aide in the determination of appropriate residential placements for individuals with schizophrenia.

Section snippets

Participants

Fifty nursing home residents with schizophrenia were recruited from and tested at an inpatient psychiatric unit in New York City. All patients met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for schizophrenia as determined by the treating psychiatrist and medical records, and residential placement in their nursing home. All participants provided written informed consent. There was no compensation for participation.

Procedure

Following consent, participants were

Symptom Assessment

The severity of symptoms was assessed via the Positive and Negative Syndrome Scale (PANSS).⁷ PANSS ratings were conducted via patient interview by the examiner and either an inpatient psychiatric nurse or a treating psychiatrist and the two raters coming to a consensus for best fit. This study examined factors from the pentagonal model, which includes positive, negative, dysphoric, activation/aggression and cognitive/autistic factors.⁸

Analyses

To examine predictors of social and adaptive skills, a series of simultaneous multiple regression analyses were computed using cognitive composite index, adaptive competence (UPSA-B), social skills (SSPA), and inpatient social and adaptive functioning (SAFE) as the dependent variables, respectively. Predictor variables for patients' cognitive composite index included age, age at first psychiatric hospital admission and age at admission to nursing home, years living in a nursing home, level of

RESULTS

The mean age of the sample was 58.3 years (SD: 8.66), and approximately half (52%) were female. The sample consisted of African Americans (48%), Caucasians (40%), and Hispanics (6%). None of the participants were currently married, and most reported having never married (58%), to be divorced (32%) or widowed (10%). The mean years of education was 11.26 years (SD: 2.70), with 24% reporting never being employed. Mean years employed was 5.36 (SD: 6.86). The mean age for first psychiatric

CONCLUSION

The results revealed that clinical symptoms, cognitive impairment, adaptive competence, social competence, and inpatient social and adaptive functioning were all unrelated to patients' current age. We also found that patients' age of admission to their nursing home was predictive of their adaptive competence. These data suggest that, regardless of chronological age, assessment of independent living skills is an important endeavor when considering residential placement.⁹ It may be the case that

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: The authors thank Dana Smidt for her valuable assistance.

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Brief ReportAdaptive Competence Impairment and Cognitive Deficits in Acutely Ill Schizophrenia Patients Residing in Nursing Homes