Brink Maria, Green Anders, Bojesen Anders Bo, Lamberti J Steven, Conwell Yeates, Andersen Kjeld
Research Unit of Psychiatry, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Institute of Clinical Research and OPEN [Odense Patient data Explorative Network], Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Am J Geriatr Psychiatry. 2017 May;25(5):500-509. doi: 10.1016/j.jagp.2016.12.015. Epub 2017 Jan 9.
In light of the excess early mortality in schizophrenia, mainly due to physical illnesses, we investigated medical comorbidity, use of medication, and healthcare utilization among individuals with schizophrenia who survived into older ages to uncover potential factors contributing to their longevity.
A nationwide register-based case-control study comparing 70-year-olds with and without schizophrenia.
Cases were drawn from the Danish Psychiatric Central Register. Age- and sex-matched controls were drawn from the general population via the Civil Registration System.
All Danish inhabitants who were diagnosed and registered with early onset schizophrenia in 1970-1979 and still alive at age 70 years. Controls alive at age 70 years.
Chronic medical comorbidity, medications, and inpatient and outpatient healthcare utilization extracted from Danish healthcare registers.
Older adults with schizophrenia did not differ from controls with regard to registered chronic medical illnesses, but were significantly less likely to receive medication for cardiovascular diseases (OR: 0.65; 99.29% CI: 0.50, 0.83) and more likely to be treated with analgesics (OR: 1.46; 99.29% CI: 1.04, 2.05). Overall, hospital admissions and number of days hospitalized were equal to controls, but with significantly fewer general medical outpatient contacts (RR: 0.37; 98.75% CI: 0.24, 0.55).
Because the literature suggests that excess mortality continues into old age, it is possible that medical diseases were under-registered and/or under-treated. Focus on adequate medical treatment, in particular for cardiovascular disease, is needed. Future integration of psychiatric and general medical healthcare, especially outpatient care, might further optimize health outcomes for older adults with schizophrenia.
鉴于精神分裂症患者过早死亡率过高，主要是由于躯体疾病，我们调查了存活至老年的精神分裂症患者的合并症、药物使用情况及医疗服务利用情况，以揭示有助于他们长寿的潜在因素。
一项基于全国登记系统的病例对照研究，比较70岁有和没有精神分裂症的人群。
病例来自丹麦精神病学中央登记系统。年龄和性别匹配的对照通过民事登记系统从普通人群中选取。
所有在1970 - 1979年被诊断并登记为早发性精神分裂症且70岁时仍存活的丹麦居民。70岁时存活的对照。
从丹麦医疗登记系统中提取慢性合并症、药物使用情况以及住院和门诊医疗服务利用情况。
患有精神分裂症的老年人在登记的慢性躯体疾病方面与对照组无差异，但接受心血管疾病药物治疗的可能性显著降低（比值比：0.65；99.29%可信区间：0.50, 0.83），而使用镇痛药治疗的可能性更高（比值比：1.46；99.29%可信区间：1.04, 2.05）。总体而言，住院次数和住院天数与对照组相当，但普通内科门诊就诊次数显著减少（相对危险度：0.37；98.75%可信区间：0.24, 0.55）。
由于文献表明过高死亡率持续至老年，可能存在躯体疾病登记不足和/或治疗不足的情况。需要关注充分的医疗治疗，尤其是心血管疾病的治疗。未来精神科和普通内科医疗服务的整合，特别是门诊服务，可能会进一步优化老年精神分裂症患者的健康结局。
