Comparison of older people with psychosis living in the community and in care homes

AIMS AND METHOD To compare two groups of older people with chronic schizophrenia or delusional disorder living in the community and in care homes, along the domains of morbidity suggested by prior research. From the case-load of one old age psychiatrist, 22 individuals with chronic psychosis residing in care homes were compared to 23 living in their own homes. The measures used were: the Positive and Negative Symptom Score (PANSS; Kay et al, 1987); the Mini Mental State Examination (MMSE; Folstein et al, 1975); the Burvill Physical Illness Scale (Burvill et al, 1990); and an Activities of Daily Living Scale (IADL; Lawton et al, 1969). RESULTS Those in care homes had significantly higher PANSS scores (38.9 v. 21.0, P < 0.01), largely accounted for by significantly more deficit symptoms (14.2 v. 5.6, P < 0.01). They also had poorer cognition and significantly greater impairment in daily-lifeactivities but their medical condition was not significantly worse. Most were seen only by a psychiatrist. CLINICAL IMPLICATIONS The greater morbidity and disablement of older people with chronic schizophrenia or delusional disorder living in care homes is likely to be intrinsic to the disorder but does not appear to be taken into account in current service planning or delivery.