Ageing well with psychosis

There are approximately 70,000 adults (aged ≥ 50) in England living with a diagnosis of schizophrenia or psychosis related disorder. With an increase in life expectancy, and an ageing population this figure is likely to double in the next decade (Vahia & Cohen, 2008). The needs of older adults change across the lifecourse for example with health comorbidities and neurocognitive decline. As such older adults with psychosis represent a large burden to the NHS. It is therefore imperative to understand what it means for this population to 'age well' and what interventions are available to help to further support wellbeing in older age. Paper 1 presents a systematic review of studies examining the effectiveness of psychosocial interventions for older adults with psychosis at improving social functioning. A literature search was conducted using the following electronic databases: Web of Science, PsycINFO, Embase, CINAHL and Medline. Seventeen studies were identified that satisfied inclusion criteria for the review. The review found evidence for the use of skills training interventions, both with respect to social skills and psychiatric and physical health skills training. There was not enough evidence to recommend any other psychosocial interventions. Overall, the review revealed a need for more robust research about interventions that have been shown to be effective in other age groups. Paper 2 presents a qualitative study exploring what the concept of 'ageing well' means to mid to older aged adults with psychosis. Sixteen participants, aged 50-74 (Mage = 61), diagnosed with psychosis related disorders (i.e. schizophrenia, schizoaffective disorder etc.), were interviewed about their views about ageing well, and how this can be best supported. Recordings were transcribed verbatim and then analysed using thematic analysis. Four themes were identified from the data: i) engaging with life, ii) attitude to life and ageing, iii) maintaining wellbeing and iv) having good relationships. This study showed that people with psychosis can consider themselves to be ageing well. Unlike previous literature participants also reported the importance of their relationships with professionals, developing a mastery over their mental health difficulties and the continued impact of stigma on ageing well. Therapeutic approaches that target these domains may therefore facilitate ageing well with this population. Paper 3 is a critical reflection of the systematic review, the empirical paper and the research process as a whole. It aims to provide justification for, and explanations of key decisions that were made and outline clinical and future research implications.