MORTALITY AND MEDICAL COMORBIDITY IN OLDER ADULTS WITH SCHIZOPHRENIA: A LITERATURE REVIEW

Introduction By 2025, the population of adults with schizophrenia over the age of 55 will reach 1.1?million. By 2050, this population may reach 10?million. Few studies have examined the physical comorbidities and mortality of Older Adults with Schizophrenia (OAS). Recent national register studies have begun to yield compelling data on the medical issues facing this emerging demographic. These studies as well as other population based studies provide an opportunity to broadly assess whether this population's risk for specific medical disorders is increased compared to healthy peers and younger adults with schizophrenia. Methods Recent prominent register studies in the Netherlands, Denmark, Finland, United Kingdom, Sweden, Manitoba, Canada and Indiana, United States were reviewed in detail. The search term "Older Adults with Schizophrenia" was searched on PsycInfo, Google Scholar, Psychiatry Online with the following terms added: "mortality," "cancer," "cardiovascular disease ""diabetes," "respiratory disease," "healthcare utilization." "antipsychotics." Approximately 112 journal articles, book chapters were selected for this review, prioritizing register studies, large population studies and journal articles focused on schizophrenic patients above the age of 55. . After removing redundant selections, approximately 93 articles were determined to be appropriate for this review. Results Recent register studies across nations and health care systems have demonstrated an approximate 2.0 to 2.5 increase in all-cause mortality in OAS compared to age peers. The all-cause mortality risk broadly appears to be improved compared to middle-aged and younger schizophrenics. The risk of suicide trends downward in OAS patients after the age of 60, further decreasing past the age of 70. Female OAS patients appear to have a higher suicide risk than males. OAS patients are still at significant risk of suicide compared to age peers without schizophrenia. Among OAS there is increased mortality for respiratory disease compared to the general population, but reduced compared to younger persons with schizophrenia. Increased prevalence of respiratory diseases in OAS has not been demonstrated consistently. There has been no demonstrated increase in mortality or prevalence of diabetes in the OAS population. OAS patients have a declining mortality from cardiovascular disease as they age compared to their younger counterparts, but still elevated compared to their age peers. Survival bias cannot be ruled out. Antipsychotic medication may play a role in increased cardiovascular mortality in OAS patients,(e.g., a U-shaped mortality curve pattern at no, low, and high doses) and suggests more research is needed to optimize dosing in this population. Population studies suggest a paradox where cancer incidence among persons with schizophrenia appears to be the same or lower than their age peers, but their mortality rate is higher; indeed, a screening and treatment gap exists in OAS patients with respect to cancer, which may account for lower incidence rates and higher mortality rates. A health care utilization gap for outpatient care exists for OAS patients across nations and health care systems. Integrated health care models show promise in bridging primary and psychiatric care. Conclusions Older Adults with Schizophrenia is an emerging demographic in the schizophrenic population. Their healthcare outcomes appear to be unique when compared to younger individuals with schizophrenia and compared to their age peers without schizophrenia. This review evidences an increase in all-cause mortality for OAS patients compared to healthy age peers and this increase in mortality may extend to respiratory and cardiovascular diseases. OAS patients appear to have improved mortality rates for all-cause, respiratory disease, cardiovascular disease and suicide risk when compared to younger peers with schizophrenia; however, further study to understand what modifiable risk factors are influencing the mortality data is needed. This review also argues for a healthcare utilization gap in this population which may explain some of the modifiable risk affecting this population. This research was funded by: None