ABSTRACT
By the year 2050, the US population over age 65 will double and the population over age 85 will increase 5-fold.
A large and increasing number of older people with schizophrenia will need more effective services. Older adults
with schizophrenia are at risk for cognitive and functional decline leading to premature institutionalization. Over
the past two decades, we developed Cognitive Behavioral Social Skills Training (CBSST) and established its
efficacy for preventing functional decline in people with schizophrenia. In longitudinal studies, older participants
with schizophrenia receiving CBSST did not improve significantly in functioning but did remain stable over 1-2
years, whereas older participants in treatment as usual and supportive contact (SC) experienced decline in
functioning. CBSST is now recommended by SAMSHA as an evidence-based psychosocial intervention to
prevent functional decline in middle-age to older adults with schizophrenia. Our prior work focused primarily on
middle-aged adults, but our recent pilot data also showed that CBSST can prevent decline in functioning in adults
with schizophrenia aged 60 or above (mean age (SD) = 65.3 (5.3)). In this late-life schizophrenia clinical trial, we
also observed: (1) patients who showed larger improvement in CBSST Skills Learning showed significant
improvement, not just stability, in functioning at 1-year follow-up; and (2) CBSST Skills Learning was predicted
by baseline executive function. These findings suggest that CBSST Skills Learning is an important mechanism
of change in functioning in CBSST and that boosting executive function could boost CBSST Skills Learning,
which could improve rather than only stabilize functioning. Our group has also developed an Executive Function
Training program that improves executive function but has only modest impact on functioning in mid-life adults
with schizophrenia. Thus, given (1) the extensive evidence that CBSST maintains but does not improve
functioning in mid- and late-life adults with schizophrenia; (2) Executive Function Training improves executive
function but has limited effect on functioning; and (3) CBSST Skills Learning is associated with executive
function, we propose a two-site R61/R33 to test among adults with late-life schizophrenia whether combining
Executive Function Training with CBSST (E-CBSST) will result in better CBSST Skills Learning, and in turn,
improve rather than only maintain functioning. If successful, we will test E-CBSST in a larger confirmatory trial
and if successful E-CBSST would be the first psychosocial intervention to lead to such improvement in late-life
schizophrenia. There is no doubt that stronger effective treatments for functional disability in late-life individuals
living with schizophrenia would have a profound effect on patients, family members, society and the economy.