The paper assesses whether the needs of people with schizophrenia over 65 years differ from those of younger adults with the diagnosis. It reviews studies comparing older and younger adults and older adults with schizophrenia and non-clinical or clinical controls on measures of psychosocial functioning. It also considers how psychological interventions can be best designed to cater for the specific needs of older adults. There are relatively few studies assessing how the needs of people with schizophrenia change over the life course and studies comparing the needs of older and younger adults. However, compared to same age peers older adults with schizophrenia have needs in relation to symptoms, cognitive functioning, social functioning, psychological resilience factors, social support, quality of life, physical health and medication adherence. Psychosocial interventions for this group therefore need to target these areas and there is evidence from three groups of researchers in the USA to suggest that cognitive behavioural or social skills interventions can be successfully adapted for older people. The paper concludes by summarising recommendations for future research and treatment.