Healthcare systems carry schizophrenia comorbidity burden
medwireNews: Increased rates of comorbid conditions among older adults with schizophrenia could create a significant healthcare burden, say researchers.
Their study of data from the Older Adult Transitions Study, which gave them access to medical records across the continuum of care, showed that older adults with schizophrenia had significantly higher rates of comorbid conditions, such as congestive heart failure and chronic obstructive pulmonary disease, than individuals without the disorder.
This contributed to a significant 25% increased risk for death, primarily from heart disease and pulmonary disease, and higher rates of healthcare use, with significantly increased mean costs for Medicare and Medicaid.
"This analysis reinforces the concept that the increasing numbers of older seriously mentally ill, particularly older patients with schizophrenia, will create a serious burden for our health system that will require the development of new integrated models of healthcare involving links between the health and mental health system," say Hugh Hendrie (Indiana University Center for Aging Research, Indianapolis, USA) and colleagues.
In all, 1635 patients with schizophrenia, of 31,588 individuals (mean age 70.44 years), were studied. They had significantly higher rates of congestive heart failure (45.1 vs 38.8%), chronic obstructive pulmonary disease (52.7 vs 41.4%), and hypothyroidism (36.7 vs 26.7%) than individuals without schizophrenia.
By comparison, rates of cancer were significantly lower in patients with schizophrenia than other individuals, at 30.8% versus 43.2%, a difference that the researchers say is "striking." They note, particularly, the lack of difference in lung cancer rates between the two groups, despite higher rates of smoking among patients with schizophrenia.
The dementia rate was doubled in patients with schizophrenia, at 64.5% versus 32.1% in individuals without schizophrenia. The number of patients with dementia who had Alzheimer's disease did not differ between those with and without schizophrenia, however.
The researchers say in The American Journal of Geriatric Psychiatry that the "possible link between increased incidence of dementia in older patients with schizophrenia is particularly disturbing and justifies further comprehensive study."
Overall, rates of healthcare use were significantly higher among patients with schizophrenia than individuals without. After adjusting for demographics, comorbidities, and lifestyle differences, schizophrenia patients had significantly more nursing home days, and among individuals receiving home healthcare, patients with schizophrenia accrued significantly more days and stayed longer than did individuals without the disorder.
Given this finding, Hendrie and team say that "research is needed to better design systems of care to deliver high-quality efficient care to this population across the continuum of care."
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lucy Piper, Senior medwireNews Reporter