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Illness Awareness in Older Adults with Schizophrenia

Am J Geriatr Psychiatry; ePub 2018 Oct 21; Cohen, et al

Illness awareness (IA) in older adults with schizophrenia (OAS) is often unstable in later life, with nearly one-fourth of persons showing fluctuations, a recent study found. Although younger age predicted IA over time, other factors associated with aging, such as cognitive functioning and physical disorders, had additional independent effects on IA. The impact of IA on clinical and functional variables attenuated over time, suggesting that for many OAS, IA may have a limited role in enhancing long-term outcomes. This sample consisted of 103 persons derived from an initial sample of 250 community-dwelling persons aged ≥55 with early-onset schizophrenia spectrum disorder. Mean follow-up was 53 months. Researchers found:

  • 23% of persons transitioned between presence and absence of IA, 62% had persistent IA, and 15% never had IA.
  • At baseline, fewer negative symptoms (blunted affect), higher cognitive functioning (conceptualization), younger age, higher educational levels, and more physical disorders were associated significantly with higher rates of IA at follow-up.
  • Baseline IA did not predict any variables at follow-up.


Cohen CI, Mani A, Ghezelaiagh B. A longitudinal study of illness awareness in older adults with schizophrenia. [Published online ahead of print October 21, 2018]. Am J Geriatr Psychiatry. doi:10.1016/j.jagp.2018.10.007.

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