Most people with schizophrenia are diagnosed before age 40. But soon, adults ages 65 or older will make up more than 25 percent of people with schizophrenia, research suggests.
If you or a loved one has schizophrenia, you may wonder how the condition will impact you as you age. Even with treatment, schizophrenia can affect your brain and body in different ways as you get older, says Sham Singh, MD, a psychiatrist at Winit Clinic in Santa Monica, California, who treats people with schizophrenia.
In general, the brain changes with age. Some areas of the brain shrink, and others don’t communicate as well. Blood flow in the brain may decrease as you get older, and inflammation may increase. All of these changes can affect how well your brain functions. For people with schizophrenia, this normal brain aging happens at an even faster rate.
Schizophrenia can age the body more quickly, too. Research shows that people with a mental health condition like schizophrenia have more age-related physical illnesses that can lead to early death than those without a mental health condition.
Here’s how aging can affect symptoms, treatment, and overall health among people with schizophrenia.
How Schizophrenia Can Affect Older Adults
Age-related changes often vary from person to person and may include:
Changing Schizophrenia Symptoms
“As people with schizophrenia age, their symptoms may either improve or worsen,” says Joel Frank, PsyD, clinical psychologist and neuropsychologist at Duality Psychological Services in Sherman Oaks, California. This can be influenced by factors such as overall health, treatment adherence, social support, and lifestyle choices, he says.
Some people may notice fewer symptoms like hallucinations and delusions, says Dr. Frank. But they may also see a rise in other symptoms like social withdrawal and detachment.
In general, aging can cause the brain to slow down, leading to problems with memory, focus, and decision-making — cognitive functions that are already impacted by schizophrenia itself.This decline can interact with schizophrenia symptoms in older adults, increasing existing difficulties with decision-making and memory that are common among people with schizophrenia.
“When cognitive decline combines with the existing cognitive impairments linked to schizophrenia, it can create substantial obstacles in handling daily tasks,” says Frank. These may include taking medications on time, bathing, dressing, and having social interactions, he says.
Increased Risk of Dementia
Older adults with schizophrenia have a much higher risk for dementia — a progressive brain disease that affects memory, thinking, problem-solving, language, personality, and the ability to care for oneself — than older adults who don’t have schizophrenia, research shows.
In a study of more than eight million U.S. older adults, about 28 percent of those with schizophrenia had dementia by age 66 compared to just over 1 percent without schizophrenia. By age 80, about 70 percent of people with schizophrenia had dementia compared to about 11 percent of people without schizophrenia.
Experts don’t know exactly what causes this increased risk for dementia. Some researchers believe that people with schizophrenia have a decreased cognitive reserve that, when combined with age-related cognitive decline, raises their risk for dementia as they age. Cognitive reserve is the brain’s ability to adapt to age-, disease-, or injury-related changes.
Increased Risk for Age-Related Physical Illnesses
Brain health isn’t the only thing that changes as you age with schizophrenia. Older adults with schizophrenia experience many physical health aspects of aging, too. “[These] can make dealing with schizophrenia symptoms even more challenging,” says Dr. Singh.
In general, aging can lead to physical health changes like trouble seeing and hearing well, and an increased risk for chronic diseases like heart disease, diabetes, or cancer. These risks are especially pronounced in people with schizophrenia. Those with mental health conditions like schizophrenia have a 1.4 to 2 times higher risk for heart disease and diabetes, for instance, than those without a mental health condition, research shows.
By and large, people with schizophrenia have a shorter life expectancy by 14.5 years in men and 13.2 years in women than people without the condition. Age-related diseases like heart disease and diabetes most likely account for the majority of early deaths among people with schizophrenia, research suggests.
Higher Risk for Medication Side Effects
All kinds of medication — including schizophrenia treatments — can affect you differently as you age. “Older adults need a lower dosage of antipsychotic medication because of the changed metabolism and increased sensitivity to side effects,” says Singh.
Organs like the liver and kidneys, which help break down medications in the body, change with older age. The cells in these organs wear down over time and don’t work as efficiently.
As a result, your body may break down medications more slowly, which means they stay in your body longer. This is a problem because, when you take your next dose, some of the previous dose could still be in your system. Too much of any medication in your system can mean you experience more side effects.
One large meta-analysis found older adults with dementia and a serious mental health condition like schizophrenia had an increased risk of serious side effects from their antipsychotic medications. Participants in the study were 50 or older. These side effects included:
Medications should also be adjusted as needed to account for any other medical conditions you have and medications you’re on, Singh adds. Older adults with schizophrenia are more likely to be taking multiple medications at once alongside their antipsychotics (known as polypharmacy), which raises the risk of negative side effects and drug interactions.
Higher Odds of Social Isolation
Social withdrawal is a common symptom of schizophrenia, and social isolation can make other symptoms of schizophrenia worse.
This can be compounded by the increased risk for social isolation among older adults in general. People over 50 may be at risk for social isolation because of health changes, chronic illness, the loss of loved ones, retirement, income changes, and loss of independence.
Signs That Schizophrenia Is Getting Worse as You Age — and What to Do About It
Distinguishing between symptoms of worsening schizophrenia and typical aging can be challenging. Singh suggests watching for the following signs of worsening schizophrenia in older adults:
Increased social withdrawal
Severe mental confusion
Inability to perform basic self-care or remember appointments
A return or increase in the intensity of delusions or hallucinations
Heightened emotional distress
Increased irritability
Changes in behavior and lower ability to cope with symptoms
Increased cognitive problems
“Recognizing and addressing these signs early can lead to a better quality of life,” says Frank. If you notice these signs and symptoms in yourself or a loved one, be sure to let your or your loved one’s healthcare provider know. It’s important to work together with your healthcare team to meet changing health needs throughout life in ways like adjusting medications as you age and monitoring your cognitive and physical health.
Eat a nutritious diet rich in fruits, vegetables, and whole grains, and low in heavily processed foods like deli meats, hot dogs, or chips.
Exercise regularly and maintain a healthy weight. Most adults should aim for 150 to 300 minutes of moderate activity or 75 to 150 minutes of vigorous activity each week. This could translate to 30 minutes of exercise each day, for example.
Avoid smoking.
Limit or avoid alcohol.
Try to avoid social isolation by staying connected with loved ones. “Strengthening social support can be crucial for reducing isolation and improving daily functioning,” says Frank.
The Takeaway
Schizophrenia can accelerate normal brain aging, which can worsen symptoms like social withdrawal, attention issues, and memory problems, among others.
People with schizophrenia have an increased risk of age-related chronic diseases that can lead to an early death, such as heart disease and diabetes.
Signs schizophrenia may be worsening in an older adult include social withdrawal, increased confusion, irritability or emotional distress, and a return of or increase in hallucinations or delusions.
If you notice these signs and symptoms in yourself or a loved one, talk to your or your loved one’s healthcare provider.
Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.
A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.
Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.
Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.
She and her husband are avid travelers and have been to over 55 countries and territories.
Abby McCoy is an experienced registered nurse who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She is a married mother of four and loves the circus — that is her home! She has family all over the world, and loves to travel as much as possible.
McCoy has written for publications like Remedy Health Media, Sleepopolis, and Expectful. She is passionate about health education and loves using her experience and knowledge in her writing.
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Stroup TS et al. Age-Specific Prevalence and Incidence of Dementia Diagnoses Among Older US Adults With Schizophrenia. JAMA Psychiatry. March 10, 2021.
Das-Munshi J et al. How do ethnicity and deprivation impact on life expectancy at birth in people with serious mental illness? Observational study in the UK. Psychological Medicine. May 2020.
Mok PL et al. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ. April 2024.
Lunghi C et al. Psychiatric and non-psychiatric polypharmacy among older adults with schizophrenia: Trends from a population-based study between 2000 and 2016. Frontiers in Pharmacology. February 2023.
Andreu-Bernabeu Á et al. Polygenic Contribution to the Relationship of Loneliness and Social Isolation With Schizophrenia. Nature Communications. January 2022.
