Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
Am J Geriatr Psychiatry. 2014 May;22(5):427-36. doi: 10.1016/j.jagp.2012.10.025. Epub 2013 Apr 6.
The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia.
An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available.
Rates of comorbid conditions, healthcare utilization, costs, and mortality.
Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia.
The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.
老年精神分裂症患者的人数正在增加。本研究描述了在一个样本中，与没有精神分裂症的老年患者相比，10 年内老年精神分裂症患者的健康结果、利用和成本。
这是一项对 1999-2008 年间从城市公共卫生系统（包括社区心理健康中心）接受治疗的 31588 名老年人（平均年龄：70.44 岁）进行的观察性队列研究。其中，1635 人（5.2%）被诊断为精神分裂症，757 人（2.4%）在社区心理健康中心得到了确诊。患者的电子病历与医疗保险索赔、医疗补助索赔、最小数据集和结果与评估信息集进行了合并。没有提供关于药物使用的信息。
合并症发生率、医疗保健利用、成本和死亡率。
与没有精神分裂症的患者相比，精神分裂症患者充血性心力衰竭（45.05%比 38.84%）、慢性阻塞性肺疾病（52.71%比 41.41%）和甲状腺功能减退症（36.72%比 26.73%）的发生率明显更高（p<0.001）。他们癌症的发生率明显更低（30.78%比 43.18%），痴呆的发生率明显更高（64.46%比 32.13%）。与没有精神分裂症的患者相比，精神分裂症患者的死亡风险明显更高（风险比：1.25，95%置信区间：1.07-1.47）。他们的医疗保健利用率也明显更高。医疗保险和医疗补助的平均费用精神分裂症患者明显高于没有精神分裂症的患者。
老年精神分裂症患者的管理给我们的医疗系统带来了严重负担，需要开发综合的医疗保健模式。
