Cambridgeshire and Peterborough NHS Foundation Trust, University of Cambridge, Cambridge, UK.
University of Cambridge, Cambridge, UK.
Int J Geriatr Psychiatry. 2021 Apr;36(4):573-582. doi: 10.1002/gps.5455. Epub 2020 Nov 4.
Previous studies have shown increased rates of death and dementia in older people in specific serious mental illnesses (SMI) such as bipolar disorder or depression. We examined the rates of death and dementia in older people referred into a secondary care psychiatric service across a range of SMIs.
We used an anonymised dataset across 6 consecutive years with 28,340 patients aged 65 years and older from a single secondary care psychiatric trust in the United Kingdom. We identified deaths and incident dementia in patients with bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders. We compared mortality and dementia rates between these diagnostic groups and in different treatment settings. We also examined mortality rates and dementia rates compared with general population rates.
Patients with schizophrenia showed the highest hazard rate for death compared to other groups with SMIs (hazard ratio, 1.58; 95% confidence interval (CI), 1.18-2.1, with anxiety group the reference). Survival was reduced in patients referred to liaison psychiatry services. There were no significant differences between the SMI groups in terms of rates of dementia. However, risks of death and dementia were significantly increased compared to the general population (standardized mortality rates with 95% CI, 2.6(2.0-3.3), 3.5(2.6-4.5), 2.5(2.0-3.0) and 1.8 (1.4-2.2) and standardized dementia incidence rates with 95% CI, 2.7(1.5-4.1), 2.9(1.5-4.7), 3.8(2.6-5.2) and 4.3 (3.0-5.7) for bipolar disorder/mania, schizophrenia, recurrent depression and anxiety disorders respectively.
Older adults referred into an old age psychiatry service show higher rates of dementia and death than those reported for the general population.
先前的研究表明，在某些严重精神疾病（SMI）中，如双相情感障碍或抑郁症，老年人的死亡率和痴呆率较高。我们研究了在英国一家二级保健精神病学信托机构中，一系列 SMI 患者的老年患者的死亡率和痴呆率。
我们使用了一个连续 6 年的匿名数据集，其中包括来自英国单一二级保健精神病学信托机构的 28340 名 65 岁及以上的患者。我们在双相情感障碍/躁狂症、精神分裂症、复发性抑郁症和焦虑症患者中确定了死亡和新发痴呆病例。我们比较了这些诊断组之间以及不同治疗环境中的死亡率和痴呆率。我们还比较了与一般人群相比的死亡率和痴呆率。
与其他 SMI 组相比，精神分裂症患者的死亡风险最高（危险比，1.58；95%置信区间[CI]，1.18-2.1，以焦虑组为参照）。转介到联络精神病学服务的患者生存能力降低。在痴呆率方面，SMI 组之间没有显著差异。然而，与一般人群相比，死亡和痴呆的风险显著增加（标准化死亡率，95%CI 为 2.6（2.0-3.3），3.5（2.6-4.5），2.5（2.0-3.0）和 1.8（1.4-2.2），标准化痴呆发病率，95%CI 为 2.7（1.5-4.1），2.9（1.5-4.7），3.8（2.6-5.2）和 4.3（3.0-5.7），分别用于双相情感障碍/躁狂症、精神分裂症、复发性抑郁症和焦虑症）。
转介到老年精神病学服务的老年患者的痴呆和死亡率高于一般人群报告的水平。
