Age-related changes often vary from person to person and may include:
Changing Schizophrenia Symptoms
“As people with schizophrenia age, their symptoms may either improve or worsen,” says Joel Frank, PsyD, clinical psychologist and neuropsychologist at Duality Psychological Services in Sherman Oaks, California. This can be influenced by factors such as overall health, treatment adherence, social support, and lifestyle choices, he says.
Some people may notice fewer symptoms like hallucinations and delusions, says Dr. Frank. But they may also see a rise in other symptoms like social withdrawal and detachment.
In general, aging can cause the brain to slow down, leading to problems with memory, focus, and decision-making — cognitive functions that are already impacted by schizophrenia itself.This decline can interact with schizophrenia symptoms in older adults, increasing existing difficulties with decision-making and memory that are common among people with schizophrenia.
“When cognitive decline combines with the existing cognitive impairments linked to schizophrenia, it can create substantial obstacles in handling daily tasks,” says Frank. These may include taking medications on time, bathing, dressing, and having social interactions, he says.
Increased Risk of Dementia
Older adults with schizophrenia have a much higher risk for dementia — a progressive brain disease that affects memory, thinking, problem-solving, language, personality, and the ability to care for oneself — than older adults who don’t have schizophrenia, research shows.
In a study of more than eight million U.S. older adults, about 28 percent of those with schizophrenia had dementia by age 66 compared to just over 1 percent without schizophrenia. By age 80, about 70 percent of people with schizophrenia had dementia compared to about 11 percent of people without schizophrenia.
Experts don’t know exactly what causes this increased risk for dementia. Some researchers believe that people with schizophrenia have a decreased cognitive reserve that, when combined with age-related cognitive decline, raises their risk for dementia as they age. Cognitive reserve is the brain’s ability to adapt to age-, disease-, or injury-related changes.
Increased Risk for Age-Related Physical Illnesses
Brain health isn’t the only thing that changes as you age with schizophrenia. Older adults with schizophrenia experience many physical health aspects of aging, too. “[These] can make dealing with schizophrenia symptoms even more challenging,” says Dr. Singh.
In general, aging can lead to physical health changes like trouble seeing and hearing well, and an increased risk for chronic diseases like heart disease, diabetes, or cancer. These risks are especially pronounced in people with schizophrenia. Those with mental health conditions like schizophrenia have a 1.4 to 2 times higher risk for heart disease and diabetes, for instance, than those without a mental health condition, research shows.
By and large, people with schizophrenia have a shorter life expectancy by 14.5 years in men and 13.2 years in women than people without the condition. Age-related diseases like heart disease and diabetes most likely account for the majority of early deaths among people with schizophrenia, research suggests.
Higher Risk for Medication Side Effects
All kinds of medication — including schizophrenia treatments — can affect you differently as you age. “Older adults need a lower dosage of antipsychotic medication because of the changed metabolism and increased sensitivity to side effects,” says Singh.
Organs like the liver and kidneys, which help break down medications in the body, change with older age. The cells in these organs wear down over time and don’t work as efficiently.
As a result, your body may break down medications more slowly, which means they stay in your body longer. This is a problem because, when you take your next dose, some of the previous dose could still be in your system. Too much of any medication in your system can mean you experience more side effects.
One large meta-analysis found older adults with dementia and a serious mental health condition like schizophrenia had an increased risk of serious side effects from their antipsychotic medications. Participants in the study were 50 or older. These side effects included:
Medications should also be adjusted as needed to account for any other medical conditions you have and medications you’re on, Singh adds. Older adults with schizophrenia are more likely to be taking multiple medications at once alongside their antipsychotics (known as polypharmacy), which raises the risk of negative side effects and drug interactions.
Higher Odds of Social Isolation
Social withdrawal is a common symptom of schizophrenia, and social isolation can make other symptoms of schizophrenia worse.
This can be compounded by the increased risk for social isolation among older adults in general. People over 50 may be at risk for social isolation because of health changes, chronic illness, the loss of loved ones, retirement, income changes, and loss of independence.
