Older adults diagnosed with schizophrenia (OADWS) have unique needs for care and live longer today than their forebears who were diagnosed with schizophrenia. As a result, nurses need to be prepared for the specific care of individuals who live with schizophrenia as they age. Together, Life Course Theory and holistic nursing suggest a good fit in the quest for successful solutions and/or outcomes for the unique problems that OADWS face. Holistic nursing views the patient as a whole person, considering all aspects of the patient’s experiences within life’s broader environment. The life course paradigm offers an effective way for nurses to understand issues that patients face throughout their lives, thus enhancing holistic nursing with a historical perspective. This is especially important for the care of OADWS, who face unique disparities as well as physical and psychological comorbidities over their life course. This article is intended to initiate a discussion of OADWS, focused with Life Course Theory as a holistic lens. Literature pertinent to the life course of OADWS is reviewed, followed by an analysis of the life course paradigm in relation to OADWS’ unique experiences. Conclusions support the holistic use of Life Course Theory in research and interventions for OADWS.
AdamsC. E.AwadG. A.RathboneJ.ThornleyB.Sores-WeiserK. (2014). Chlorpromazine versus placebo for schizophrenia. Cochrane Database of Systematic Reviews, 2014(1), CD000284. doi:10.1002/14651858.CD000284.pub3
2.
Al JurdiR. K.RejS.SajatovicM. (2014). Aging with serious mental illness: An overview and implications for service delivery. Generations, 38(3), 14-22.
3.
AlmeidaO. P.HankeyG. J.YeapB. B.GolledgeJ.NormanP. E.FlickerL. (2014). Mortality among people with severe mental disorders who reach old age: A longitudinal study of a community-representative sample of 37,892 men. PLoS One, 9, e111882. doi:10.1371/journal.pone.0111882
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
6.
BanT. A. (2004). Neuropsychopharmacology and the genetics of schizophrenia: A history of the diagnosis of schizophrenia. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 28, 753-762. doi:10.1016/j.pnpbp.2004.05.021
7.
BeachS. R. H.WintersK. C.WeintraubS. (1986). Marital dissolution and distress in a psychiatric population: A longitudinal design. Behavioral Residential Treatment, 1, 217-229. doi:10.1002/bin.2360010402
8.
BilderR. M.ReiterG.BatesJ.LenczT.SzeszkoP.GoldmanR. S.. . . KaneJ. M. (2006). Cognitive development in schizophrenia: Follow-back from the first episode. Journal of Clinical and Experimental Neuropsychology, 28, 270-282. doi:10.1080/13803390500360554
9.
BlitzC. L.WolffN.ShiJ. (2008). Physical victimization in prison: The role of mental illness. International Journal of Law and Psychiatry, 31, 385-393. doi:10.1016/j.ijlp.2008.08.005
10.
BrainC.KymesS.DiBenedettiD. B.BrevigT.VelliganD. I. (2018). Experiences, attitudes, and perceptions of caregivers of individuals with treatment-resistant schizophrenia: A qualitative study. BMC Psychiatry, 18, 253. doi:10.1186/s12888-018-1833-5
11.
BraunC. A. (2018). Integrating complementary therapies into education. In LindquistR.TracyM. F.SnyderM. (Eds.), Complementary and alternative therapies in nursing (8th ed., pp. 463-476). New York, NY: Springer.
12.
BrinkM.GreenA.BojensenA. B.LambertiJ. S.ConwellY.AndersenK. (2017). Physical health, medication, and healthcare utilization among 70-year-old people with schizophrenia: A nationwide Danish register study. American Journal of Geriatric Psychiatry, 25, 500-509.
13.
BrissosS.VeguillaM. R.TaylorD.Balanzá-MartinezV. (2014). The role of long-acting injectable antipsychotics in schizophrenia: A critical appraisal. Therapeutic Advances in Psychopharmacology, 4, 198-219. doi:10.1177/2045125314540297
14.
BrooksJ. M.BlakeJ.SánchezJ.MpofuE.WuJ.-R.ChenX.. . . BartelsS. J. (2019). Self-reported pain intensity and depressive symptoms among community-dwelling older adults with schizophrenia spectrum disorders. Community Mental Health Journal, 55, 1298-1304. doi:10.1007/s10597-019-00403-x
15.
Brown-O’HaraT. (2013). Geriatric syndromes and their implications for nursing. Nursing, 43(1), 1-3. doi:10.1097/01.NURSE.0000423097.95416.50
16.
BuchananT. M.McConnellA. R. (2017). Family as a source of support under stress: Benefits of greater breath of family inclusion. Self and Identity, 16, 97-122. doi:10.1080/15298868.2016.1226194
17.
BurbachF. R. (2018). Family therapy and schizophrenia: A brief theoretical overview and a framework for clinical practice. BJPsych Advances, 24, 225-234. doi:10.1192/bja.2017.32
18.
CarpenterW. T.Jr.DavisJ. M. (2012). Another view of the history of antipsychotic drug discovery and development. Molecular Psychiatry, 17, 1168-1173. doi:10.1038/mp.2012.121
19.
CesariM.MarzettiE.CanevelliM.GuaraldiG. (2016). Geriatric syndromes: How to treat. Virulence, 8, 577-585. doi:10.1080/21505594.2016.1219445
20.
ChengS.-L.SunH.-F.YehM.-L. (2017). Effects of an 8-week aerobic dance program on health-related fitness in patients with schizophrenia. Journal of Nursing Research, 25, 429-435. doi:10.1097/jnr.0000000000000200
21.
ClarkR. E.RickettsS. K.McHugoG. J. (1999). Legal system involvement and costs for persons in treatment for severe mental illness and substance use disorders. Psychiatric Services, 50, 641-647. doi:10.1176/ps.50.5.641
22.
CohenC. I.AbdallahC. G.DiwanS. (2010). Suicide attempts and associated factors in older adults with schizophrenia. Schizophrenia Research, 119, 253-257, doi:10.1016/j.schres.2010.03.010
23.
CohenC. I.MeestersP. D.ZhaoJ. (2015). New perspectives on schizophrenia in later life: Implications for treatment, policy, and research. Lancet Psychiatry, 2, 340-350. doi:10.1016/S2215-0366(15)00003-6
24.
ColijnM. A.NittaB. H.GrossbergG. T. (2015). Psychosis in later life: A review and update. Harvard Review of Psychiatry, 23, 254-367. doi:10.1097/HRP.0000000000000068
25.
CowlingW. R. (2018a). The social justice context of holistic nursing. Journal of Holistic Nursing, 36, 208-209. doi:10.1177/0898010118788759
26.
CowlingW. R. (2018b). Where is holistic nursing?Journal of Holistic Nursing, 36(1), 4-5. doi:10.1177/0898010118758426
27.
CrawfordM. J.JayakumarS.LemmeyS. A.ZalewskaK. (2018). Assessment and treatment of physical health problems among people with schizophrenia: National cross-sectional study. British Journal of Psychiatry, 205, 473-477. doi:10.1192/bjp.bp.113.142521
28.
DelaneyC.McCaffreyR. G.BarrereC.MooreA. K.DunnD. J.MillerR. J.. . . ZhuX. S. (2018). Trends in contemporary holistic nursing research: 2010-2015. Journal of Holistic Nursing, 36, 385-394. doi:10.1177/0898010117750451
DeVylderJ. E.LehmannM.ChenF. (2015). Social and clinical correlates of the persistence of psychotic experiences in the general population. Schizophrenia Research, 169, 286-291. doi:10.1016/j.schres.2015.08.039
31.
ElderG. H.Jr. (1996). Human lives in changing societies: Life course and developmental insights. In CairnsR. B.ElderG. H.Jr.CostelloE. J. (Eds.), Developmental science (pp. 31-62). New York, NY: Cambridge University Press.
32.
ElderG. H.Jr.GieleJ. Z. (2009). Life course studies: An evolving field. In ElderG. H.Jr.GieleJ. Z. (Eds.), The craft of life course research (pp. 1-24). New York, NY: Guilford Press.
33.
ErvinN. E.KulbokP. A. (2018). Advanced public and community health nursing practice: Population assessment, program planning, and evaluation (2nd ed.). New York, NY: Springer.
34.
FazelS.KhoslaV.DollH.GeddesJ. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Medicine, 5, e225. doi:10.1371/journal.pmed.0050225
35.
GauillardJ. (2016). Treating chronically psychotic patients in nursing homes. European Psychiatry, 33(Suppl.), S37. doi:10.1016/j.eurpsy.2016.01.875
36.
GDB 2016 Disease and Injury Incidence and Prevalence Collaborators. (2017). Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet, 390, 1211-1259. doi:10.1016/S0140-6736(17)32154-2
37.
GellerJ. L. (2000). The last half-century of psychiatric services as reflected in psychiatric services. Psychiatric Services, 51, 41-67. doi:10.1176/ps.51.1.41
38.
HaneyC. (2017). “Madness” and penal confinement: Some observations on mental illness and prison pain. Punishment & Society, 19, 310-326. doi:10.1177/1462474517705389
39.
HarrisonT. (2003). Women aging with childhood onset disability: A holistic approach using the life course paradigm. Journal of Holistic Nursing, 21, 242-259. doi:10.1177/0898010103254917
40.
HarrisonT.AngelJ.MannA. (2008). Mexican American women aging with childhood-onset paralytic polio. Qualitative Health Research, 18, 767-774. doi:10.1177/1049732308318751
41.
HendrieH. C.LindgrenD.HayD. P.LaneK. A.GaoS.PurnellC.. . . CallahanC. M. (2013). Comorbidity profile and healthcare utilization in elderly patients with serious mental illness. American Journal of Geriatric Psychiatry, 21, 1267-1276. doi:10.1016/j.jagp.2013.01.056
42.
HendrieH. C.TuW.TabbeyR.PurnellC. E.AmbuehlR. J.CallahanC. M. (2012). Health outcomes and cost of care among older adults with schizophrenia: A 10-year study using medical records across the continuum of care. American Journal of Geriatric Psychiatry, 22, 427-436. doi:10.1016/j.jagp.2012.10.025
43.
JerrellJ. M.McIntyreR. S.DerocherC. B. (2017). Diagnostic clusters associated with an early onset schizophrenia diagnosis among children and adolescents. Human Psychopharmacology: Clinical & Experimental, 32, e2589. doi:10.1002/hup.2589
44.
JohnsonD. A. W. (2009). Historical perspective on antipsychotic long-acting injections. British Journal of Psychiatry, 195(Suppl. 52), S7-S12. doi:10.1192/bjp.195.52.s7
45.
KasckowJ.GolshanS.ZisookS. (2011). Does age moderate the relationship between depressive symptoms and suicidal ideation in middle-aged and older patients with schizophrenia and subthreshold depression?American Journal of Geriatric Psychiatry, 22, 437-441. doi:10.1016/j.jagp.2013.01.039
46.
KavakF.ÜnalS.YilmazE. (2016). Effects of relaxation exercises and music therapy on the psychological symptoms and depression levels of patients with schizophrenia. Archives of Psychiatric Nursing, 30, 508-512. doi:10.1016/j.apnu.2016.05.003
47.
KimD.-Y. (2016). Psychiatric deinstitutionalization and prison population growth: A critical literature review and its implications. Criminal Justice Policy Review, 27, 3-21. doi:10.1177/0887403414547043
48.
KinchenE. V.LoerzelV. (2019). Nursing students’ attitudes and use of holistic therapies for stress relief. Journal of Holistic Nursing, 37, 6-17. doi:10.1177/0898010118761910
49.
KugathasanP.LaursenT. M.GrøntvedS.JensenS. E.AagaardJ.NielsenR. E. (2018). Increased long-term mortality after myocardial infarction in patients with schizophrenia. Schizophrenia Research, 199, 103-108. doi:10.1016/j.schres.2018.03.015
50.
KurebayashiY.OtakiJ. (2017). Association between altered physical activity and neurocognitive function among people with schizophrenia: A minimum 6-months’ follow-up study. Comprehensive Psychiatry, 77, 45-52. doi:10.1016/j.comppsych.2017.06.001
51.
LacommeM.LaboritH.Le LorierG.PommierM. (1952). Obstetric analgesia potentiated by associated intravenous Dolosal with RP 4560. Bulletin de la Fédération Des Sociétés de Gynécologie et D’obstétrique De Langue Française, 4, 558-562.
52.
LarsonJ. E.SheehanL.RyanC.LempS.DrandorffL. (2014). Practitioner perspectives on individual placement and support (IPS) for individuals with serious mental illness. Journal of Vocational Rehabilitation, 41, 225-235. doi:10.3233/JVR-140715
53.
LaursenT. M.NordentoftM.MortensenP. B. (2014). Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 10, 425-448. doi:10.1146/annurev-clinpsy-032813-153657
54.
LeCompteJ. D. (2015). When cruel becomes the usual: The mistreatment of mentally ill inmates in South Carolina prisons. South Carolina Law Review, 66, 751-784.
55.
LeutwylerH.HubbardE. M.SlaterM.JesteD. V. (2014). “It’s good for me”: Physical activity in older adults with schizophrenia. Community Mental Health Journal, 50, 75-80. doi:10.1007/s10597-013-9613-7
56.
LimS.SongJ.-A. (2019). Maintenance of continuity in older adulthood: Concept analysis. International Journal of Nursing Knowledge, 30, 106-113. doi:10.1111/2047-3095.12207
57.
MadrasB. K. (2013). History of the discovery of the antipsychotic dopamine D2 receptor: A basis for the dopamine hypothesis of schizophrenia. Journal of History of the Neurosciences, 22, 62-78. doi:10.1080/0964704X.2012.678199
58.
MarcumJ. A. (2017). Multimorbidity, P4 medicine and holism. Journal of Evaluation in Clinical Practice, 23, 213-215. doi:10.1111/jep.12588
59.
MausbachB. T.HoJ. (2015). Schizophrenia in late life. In LichtenbergP. A.MastB. T. (Eds.), APA handbook of clinical geropsychology: Vol. 2. Assessment, treatment, and issues of later life (pp. 95-119). Washington, DC: American Psychological Association.
60.
MeestersP. D.ComijsM. L.de HaanL.SmitJ. H.EikelenboomP.BeekmanA. T. F.StekM. L. (2013). Subjective quality of life and its determinants in a catchment area based population of elderly schizophrenia patients. Schizophrenia Research, 147, 275-280. doi:10.1016/j.schres.2013.04.030
61.
MeestersP. D.StekM. L.ComijsH. C.de HaanL.PattersonT. L.EikelenboomP.BeekmanA. T. F. (2010). Social functioning among older community-dwelling patients with schizophrenia: A review. American Journal of Geriatric Psychiatry, 18, 862-878. doi:10.1097/JGP.0b013e3181e446ff
62.
MooreS.ShiersD.DalyB.MitchellA. J.GaughranF. (2015). Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatrica Scandinavica, 132, 109-121. doi:10.1111/acps.12431
63.
MuralidharanA.FinchA.BowieC. R.HarveyP. D. (2018). Thought, language, and communication deficits and association with everyday functional outcomes among community-dwelling middle-aged and older adults with schizophrenia. Schizophrenia Research, 196, 29-34. doi:10.1016/j.schres.2017.07.017
NorrisC. (2017). A history of madness: Four venerable Virginia lunatic asylums. Virginia Magazine of History & Biography, 125, 138-182. Retrieved from https://www.jstor.org/stable/26322605
67.
NugentK. L.DanielsA. M.AzurM. J. (2012). Correlates of schizophrenia spectrum disorders in children and adolescents cared for in community settings. Child and Adolescent Mental Health, 17, 101-108. doi:10.1111/j.1475-3588.2011.00618.x
68.
O’BrienM. E. (2018). Spirituality in nursing: Standing on holy ground. Burlington, MA: Jones & Bartlett Learning.
69.
OgdenL. P. (2014a). Interpersonal relationship narratives of older adults with schizophrenia-spectrum diagnoses. American Journal of Orthopsychiatry, 84, 674-684. doi:10.1037/ort0000035
70.
OgdenL. P. (2014b). “Waiting to go home”: Narratives of homelessness, housing and home among older adults with schizophrenia. Journal of Aging Studies, 29, 53-65. doi:10.1016/j.jaging.2014.01.002
71.
OlfsonM.GerhardT.HuangC.CrystalS.StroupT. S. (2015). Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry, 72, 1172-1181. doi:10.1001/jamapsychiatry.2015.1737
72.
O’RandA. M. (2009). Cumulative processes in the life course. In ElderG. H.Jr.GieleJ. Z. (Eds.), The craft of life course research (pp. 121-140). New York, NY: Guilford Press.
73.
PearmanA.BatraA. (2012). Late-onset schizophrenia: A review for clinicians. Clinical Gerontologist, 35, 126-147. doi:10.1080/07317115.2011.642943
74.
PenkunasM. J.FriedmanA.Hahn-SmithS. (2015). Characteristics of older adults with serious mental illness enrolled in a publicly funded in-home mental health treatment program. Home Health Care Management & Practice, 27, 224-229. doi:10.1177/1084822315571531
75.
PhillipsS. L. (2018). Schizophrenia. In FitzpatrickJ. J.AlfesC. M.HickmanR. L.Jr. (Eds.), A guide to mastery in clinical nursing: The comprehensive reference (pp. 706-707). New York, NY: Springer.
76.
PrinceJ. D.AnsbrowJ.BennedictA.DiCostanzoJ.MoraO.SchonebaumA. D. (2017). Making connections: Severe mental illness and closeness with other people. Social Work in Mental Health, 15, 1-13doi:10.1080/15332985.2016.1148095
77.
PruessnerM.CullenA. E.AasM.WalkerE. F. (2017). The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities. Neuroscience & Biobehavioral Reviews, 73, 191-218. doi:10.1016/j.neubiorev.2016.12.013
78.
RamsayC. E.StewartT.ComptonM. T. (2012). Unemployment among patients with newly diagnosed first-episode psychosis: Prevalence and clinical correlates in a US sample. Social Psychiatry & Psychiatric Epidemiology, 47, 707-803. doi:10.1007/s00127-011-0386-4
79.
RobisonD.McInnis-PerryG.WeeksL. E.FoleyV. (2018). Dignity in older adults with schizophrenia residing in assisted living facilities. Journal of Psychosocial Nursing and Mental Health Services, 56(2), 20-28. doi:10.3928/02793695-20170929-01
80.
RobustelliB. L.NewberryR. E.WhismanM. A.MittalV. A. (2017). Social relationships in young adults at ultra high risk for psychosis. Psychiatry Research, 247, 345-351. doi:10.1016/j.psychres.2016.12.008
81.
SachdevP. S.MohanA.TaylorL.JesteD. V. (2015). DSM-5 and mental disorders in older individuals: An overview. Harvard Review of Psychiatry, 23, 320-328. doi:10.1097/HRP.0000000000000090
82.
SamaraM. T.CaoH.HelferB.DavisJ. M.LeuchtS. (2014). Chlorpromazine versus every other antipsychotic for schizophrenia: A systematic review and meta-analysis challenging the dogma of equal efficacy of antipsychotic drugs. European Neuropsychopharmacology, 24, 1046-1055. doi:10.1016/j.euroneuro.2014.03.012
83.
SeowL. S. E.ChongS. A.WangP.ShafieS.OngH. L.SubramaniamM. (2017). Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care. Comprehensive Psychiatry, 74, 196-203. doi:10.1016/j.comppsych.2017.01.017
84.
SharmaE. R.DebsikdarA. V.NaphadeN. M.ShettyJ. V. (2014). Very late-onset schizophrenia like psychosis: Case series and future directions. Indian Journal of Psychological Medicine, 36, 208-210. doi:10.4103/0253-7176.130999
85.
SiddiS.NuñezC.SeniorC.PretiA.Cuevas-EstebanJ.OchoaS.. . . Stephan-OttoC. (2019). Depression, auditory-verbal hallucinations, and delusions in patients with schizophrenia: Different patterns of association with prefrontal and white matter volume. Psychiatry Research: Neuroimaging, 283, 55-63. doi:10.1016/j.pscychresns.2018.12.001
86.
SimonG. E.StewartC.YarboroughB. J.LynchF.ColemanK. J.BeckA.. . . HunkelerE. M. (2018). Mortality rates after the first diagnosis of psychotic disorder in adolescents and young adults. JAMA Psychiatry, 75, 254-260. doi:10.1001/jamapsychiatry.2017.4437
87.
SinghU.SinghB.Sweta. (2018). Assessment and management of socio-occupational functioning of persons with chronic schizophrenia: Effect of social skills training. Journal of Psychosocial Research, 13, 189-198.
SmithE. M.ShahA. A. (2017). Screening for geriatric syndromes. Clinics in Geriatric Medicine, 34(1), 55-67. doi:10.1016/j.cger.2017.08.002
90.
SolmiM.PigatoG.KaneJ. M.CorrellC. U. (2018). Clinical risk factors for the development of tardive dyskinesia. Journal of the Neurological Sciences, 389, 21-27. doi:10.1016/j.jns.2018.02.012
91.
SorianoR.ChowM.O’BrienA. (2017). Leveraging the power of interprofessional EHR data to prevent delirium: The Kaiser Permanente story. In DelaneyC. W.WeaverC. A.WarrenJ. J.ClancyT. R.SimpsonR. L. (Eds.), Big data–enabled nursing: Education, research and practice (pp. 301-312). Cham, Switzerland: Springer International.
92.
StainH. J.BrønnickK.HegelstadeW. T. V.JoaI.JohannessenJ. O.LangeveldJ.. . . LarsenT. K. (2014). Impact of interpersonal trauma on the social functioning of adults with first-episode psychosis. Schizophrenia Bulletin, 40, 1491-1498. doi:10.1093/schbul/sbt166
93.
StrugstadB.LauB.ØieM. G. (2018). Associations between cognition and internalizing problems in young adults with early-onset schizophrenia: A 13-year follow-up study. Psychiatry Research, 265, 161-166. doi:10.1016/j.psychres.2018.04.033
94.
TealJ. S.RutledgeD. N.RobertsonS.CruzE. (2018). Supportive care nursing clinical protocol incorporates holism in a public acute care hospital. Holistic Nursing Practice, 34, 182-188. doi:10.1097/HNP.0000000000000274
95.
ThompsonA. D.NelsonB.YuenH. P.LinA.AmmingerG. P.McGorryP. D.. . . YungA. R. (2014). Sexual trauma increases the risk of developing psychosis in an ultra high-risk “prodromal” population. Schizophrenia Bulletin, 40, 697-706. doi:10.1093/schbul/sbt032
96.
UntuI.MoisaS. M.BurleaS. L.CiubaraA.LupuV. V.Anton-PaduraruD.-T. (2015). Very early and early onset schizophrenia spectrum disorders—diagnostic challenge. Revista Româna de Pediatrie, 64, 24-27.
97.
WalidM. S.ZaytsevaN. V. (2011). Which neuropsychiatric disorder is more associated with divorce?Journal of Divorce & Remarriage, 52, 220-224. doi:10.1080/10502556.2011.556976
98.
WalkerJ. S. (2015). A theory of change for positive development approaches to improving outcomes among emerging adults with serious mental health conditions. Journal of Behavioral Health Services & Research, 42, 131-149. doi:10.1007/s11414-015-9455-x
99.
WalshJ. (2018). The appropriateness of physical contact with clients who have schizophrenia. Social Work in Mental Health, 16(1), 34-35. doi:10.1080/15332985.2017.1304497
YoungL.VandykA. D.JacobJ. D.McPhersonC.MurataL. (2019). Being parent caregivers for adult children with schizophrenia. Issues in Mental Health Nursing, 40, 297-303. doi:10.1080/01612840.2018.1524531
103.
ZiffK. K.ThomasD. O.BeamishP. M. (2008). Asylum and community: The Athens Lunatic Asylum in nineteenth-century Ohio. History of Psychiatry, 19, 409-432. doi:10.1177/0957154X07082618
