Schizophrenia Into Later Life: Treatment, Research, and Policy

The editor of Schizophrenia Into Later Life succinctly illustrates the significance of this topic by noting in his introduction that 2 percent of the elderly population suffers from a chronic mental illness and that over the next 30 years this number will double. He then states that our health and social service systems "may be ill prepared to deal with them." For those of us working with patients who suffer from schizophrenia, our patients are getting older. For those of us working in geriatric psychiatry, public-sector psychiatry, and consultation-liaison psychiatry, this volume describes and discusses important issues related to the population of seriously mentally ill patients headed our way.

This book is a collection of 16 chapters on older people with schizophrenia that are divided into five parts that cover epidemiology and background, biology and medical aspects, gender and sociocultural issues, treatment and service issues, and future directions. The chapters are well written by highly knowledgeable authors in their respective areas. The chapters are well formatted and quite readable.

A major strength of this book is the breadth of the topics covered. Interesting and imaginative chapters that range from "Biological Changes in Older Adults With Schizophrenia" to "Mental Health Policy and Financing of Services for Older Adults With Severe Mental Illness" are assembled in a single volume and provoke substantial thought about the specific niches of care for these special patients. In addition, a major strength of this book is the mixture of chapters on specific issues about the illness schizophrenia and its treatments along with policy discussions. Thus the reader will have the opportunity to be informed about new medications as well as the systems or lack thereof in which to deliver the care.

Possible weaknesses of this book lie not with the authors but with the relatively small amount of empirical research performed with elderly patients with schizophrenia. Frequently, authors note that they are extrapolating findings in the general population of patients with schizophrenia to the elderly population. If anything, the book provides a wake-up call to our field that a complex group of patients with mental, cognitive, and medical problems whose caregivers may be elderly and whose reimbursements are confusing will be challenging us soon.

This valuable volume provides specific and timely information for clinicians and people in leadership or planning positions. Examples of interest include a discussion of how an analysis of follow-up studies may allow the field to determine factors associated with better outcomes among elderly patients with psychoses and a creative assessment of the interaction of the biology of aging and schizophrenia. Newer measures of cognitive functioning that have been most valuable independently in aging studies and in schizophrenia studies are well described and assist in assessing the heterogeneity seen among these patients. Discussions of mental health policy bring important issues to the forefront—for example, the impact of lack of parity for Medicare patients.

In summary, Schizophrenia Into Later Life is creatively assembled to juxtapose up-to-date knowledge on the nature and treatment of schizophrenia in the elderly population. This information is integrated into thoughtful chapters on policies and social systems that are thought provoking and informative as our field prepares for the arrival of this group of patients.