title: Correlates of change in functional status of institutionalized geriatric schizophrenic patients: focus on medical comorbidity.
abstract: OBJECTIVE
  Impairment in basic self-care skills is common in patients with schizophrenia and is even more severe in elderly patients with a chronic course of institutional care. While cognitive impairment has proven to be a major predictor of overall functional deficit in schizophrenia, other potential factors, such as medical comorbidity, need to be considered.
  
  
  METHODS
  Geriatric institutionalized schizophrenic patients (N=124) were assessed three times over 4 years to determine levels of positive and negative symptoms, impairment in activities of daily living, impairment in cognitive functioning, and medical problems. Path analysis was used to determine which variables best predicted changes in self-care functions.
  
  
  RESULTS
  Functional status, negative symptoms, cognitive functions, and health status all significantly worsened during the follow-up. The path analyses showed that change in health status did not predict change in activities of daily living after the analysis accounted for negative symptoms and cognitive functions.
  
  
  CONCLUSIONS
  The results highlight the relative importance of cognitive impairments in the functional impairments of older schizophrenic patients with increased medical burden.
authors.affiliation: Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA. jfriedman1@rcn.com
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Friedman
authors.forename: Philip D
authors.initials: PD
authors.lastname: Harvey
authors.forename: Susan R
authors.initials: SR
authors.lastname: McGurk
authors.forename: Leonard
authors.initials: L
authors.lastname: White
authors.forename: Michael
authors.initials: M
authors.lastname: Parrella
authors.forename: Tenko
authors.initials: T
authors.lastname: Raykov
authors.forename: Thomas
authors.initials: T
authors.lastname: Coleman
authors.forename: David N
authors.initials: DN
authors.lastname: Adler
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Davis
mesh_terms: D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology; D000368:Aged; D002908:Chronic Disease; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology; D012565:Schizophrenic Psychology; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data