Objective: The objective of the present study is to examine the relationship between cognitive status and adaptive life skills in a group of elderly persons with schizophrenia. Over twenty years ago, Serban & Gidynski (1979) concluded that deficits in adaptive life functioning comprised the major negative outcome for this population. Harvey et al., (1997) developed the Social Adaptive Functioning Evaluation (SAFE) scale to evaluate overall adaptive dysfunction and found that elderly persons with schizophrenia had adaptation scores that were strongly associated with severity of cognitive impairment and that cognitive function was more important than psychiatric symptoms in predicting adaptive function. Other researchers have found that memory and attention are the most important cognitive domains related to adaptive living skills in subjects with schizophrenia. The objective of the present study builds upon the findings of Harvey et al., by evaluating specific cognitive domains and examining their relationship to levels of adaptive life skills.
Design/Methods: Evaluation of 77 elderly nursing home residents with early onset schizophrenia, ranging in age from 50-90, provided data for the present study. The Cognitive Abilities Screening Instrument (CASI) was used to evaluate cognitive status. The CASI contains 25 items that are grouped into cognitive domains including attention, concentration, orientation, long-term memory, short-term memory, language, visual construction, fluency and abstraction/judgment. Cronbach's alpha was calculated for the sample and a coefficient of 0.93 was obtained. An adaptive functioning scale was constructed by combining all of the items from the Barthel ADL Index (BAI) measuring physical adaptive function and selected items from the Lehman Quality of Life Index that measure social/emotional adaptation. The constructed scale showed good internal reliability.
Results: Our preliminary results suggest a positive relationship between cognitive status and adaptive life skills in a group of elderly persons with schizophrenia, as measured by CASI and a constructed adaptation scale.
Conclusions: Literature has reported a lack of validated instruments that can be used to obtain a clear clinical picture of elderly persons with schizophrenia. A clinical description in behavioral and functional terms is more meaningful than diagnosis per se in describing this population. Our preliminary results suggest that a scale can be constructed from the BAI and selected items from the Lehman Quality of Life Index that is sensitive in assessing adaptive life skills in a group of elderly persons with schizophrenia.
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