Understanding and Addressing Interpersonal Relationships Needs Among Older Adults with Schizophrenia

While central to the well-being of all persons, the presence and quality of interpersonal relationships is of particular concern for older adults with schizophrenia, a growing but under-researched population (Bankole et al., 2008; Jeste & Nasrallah, 2003). Because 50-70% of persons diagnosed with schizophrenia experience the illness with symptoms that require ongoing treatment extending into older adulthood (Bankole et al., 2008; C. Cohen, personal communication, May 21, 2012), and with diverse illness courses (Carpenter & Kirckpatrick, 2005; Davidson & McGlashan, 2005), subjective recovery definitions are needed to promote effective, meaningful treatment for persons with schizophrenia across all stages of the life course, including in later life (Davidson & Stayner, 1997; Flannagan, et al., 2007; Strauss, 2008). Although social integration and positive interpersonal relationships with family, mental health treatment providers, and mentally ill peers and other friends are central to existing person-centered definitions of recovery (Davison, 2003; Davidson & Stayner, 1997; Davidson et al., 2001; Ware et al., 2007; Ware et al., 2008; Ware, Tugenberg & Dickey, 2004), the subjective experience of interpersonal relationships and related interpersonal needs among older adults with schizophrenia has not been closely examined to date. This study serves to address that research gap.

Thematic narrative analysis, life history calendars, and time diary methods were cross-pollinated to generate and analyze shared themes from 35 interviews with seven older adults with schizophrenia. Informed by the developmental life course perspective, the multi-phased research process focused the broad initial research question onto how older adults with schizophrenia understand and express life-course and present-time relational narratives and interpersonal needs. The importance and complexity of interpersonal relationships was illuminated by the topic’s consistent generation of thick description, as well as the perceived importance of relational challenges by persons who had experienced other severe hardships, including those that threatened their safety, survival and well-being such as the severe symptoms of schizophrenia; the experience of homelessness; and/or extended periods of joblessness. Strong relationships were connected to feelings of safety and life satisfaction.

In this presentation, shared themes connected to interpersonal relationships across the life courses of older adults with schizophrenia will be identified as they appeared in first-person life history narratives and discussed in depth. The themes of relational losses, relational voids, relational adjustments, relational adaptations, and the need for solitude will be defined and located as they occurred in patterns across the life course. While relational challenges and the need for solitude marked the participant’s narratives, equally present were their later life efforts towards relational repair, suggesting that later life relational behaviors might at times aim to compensate for earlier relational adversities. While later life is typically a time of fewer but stronger social ties (Lang, 2001), broad social recovery remained a priority for the study participants. Implications of the findings underline the importance of the development of social work interventions that address interpersonal relationship challenges and needs of older adults with schizophrenia, as well as to support life course relational resilience.