The incidence of very late-onset psychotic disorders: a systematic review and meta-analysis, 1960–2016

Abstract

A substantial subset of people with psychotic disorders are first diagnosed in old age, yet little is known about the epidemiology of very late-onset schizophrenia-like psychosis. We investigated the incidence of affective and non-affective psychotic disorders in those aged 65 and above, and examined variation related to potential risk factors via systematic literature review. We searched PubMed, PsychInfo, Web of Science and bibliographies and directly contacted authors to obtain citations published between 1960 and 2016 containing (derivable) incidence data. Cases were those diagnosed with non-organic psychotic disorders after age 65. Findings were presented narratively, and random-effects meta-analyses were used to obtain pooled incidence rates. From 5687 citations, 41 met inclusion criteria. The pooled incidence of: affective psychoses was 30.9 per 100 000 person-years at risk (100 kpy) [95% confidence interval (CI) 11.5-83.4; I2 = 0.99], and schizophrenia was 7.5 per 100 kpy (95% CI 6.2-9.1; I2 = 0.99), with some evidence of higher schizophrenia rates in women [odds ratio (OR) = 1.6; 95% CI 1.0-2.5, p = 0.05]. We found narrative evidence of increasing incidence rates of non-affective psychoses with age, and higher rates amongst migrants than baseline populations, but no evidence that incidence varied by study quality or case ascertainment period (quality OR = 1.04; 95% CI 0.74-1.48; time period OR = 1.00; 95% CI 0.95-1.05). Substantial heterogeneity in the incidence of very late-onset schizophrenia-like psychoses was observed. No identified studies examined possible risk factors which may account for such variation, including socio-economic status, sensory impairment, traumatic life events, or social isolation.

Ethnic inequalities in the incidence of diagnosis of severe mental illness in England: a systematic review and new meta-analyses for non-affective and affective psychoses

“…In line with others [11,15,21,23], we followed a pragmatic classification of psychosis types due to changing diagnostic categories over time and between studies. We included a wide range and broad classifications of nonaffective psychoses (clinical evaluation or diagnostic criteria such as Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD), e.g.…”

“…We first searched for previous reviews through to 03.07.17 with no publication date restriction in nine databases: MEDLINE; Embase; PsycINFO; CINAHL; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects (DARE); The Campbell Collaboration Online Library; NHS Evidence; and National Institute for Health Research's (NIHR) Journals Library and Policy Research Programme; as well as King's Fund reference lists. In PROSPERO we identified ongoing reviews and contacted authors (the authors of a review [21] forwarded their paper in December 2017). We also conducted backward and forward citation searches (in Google Scholar).…”

“…After screening reviews, we checked the reference lists of included meta-analytic reviews on the incidence of psychotic disorders (n = 8) [8,9,11,15,[19][20][21][22] to identify relevant primary studies for further assessment of ethnic variations in psychosis risk in England. The most comprehensive search for primary studies covering both nonaffective and affective psychoses specifically in England and by different ethnic groups considered literature only up to 2009 [11], so we also supplemented the primary study literature obtained from previous reviews with an additional search for primary studies from 2010 until the end of 2018 in three databases: MEDLINE; Embase; and PsycINFO, as well as contacted experts in the field to identify recent studies.…”

“…Previous meta-analyses have tended to aggregate data from a diversity of settings and ethnic groups [8,9,[19][20][21][22][23] combining ethnic minority people regardless of diverse identities and pre-and post-migrant experiences [19,22,23]-against a 'native' reference population. Although some reviewers have synthesised and reported summary estimates for studies conducted in the UK [9] or England more specifically [11,15], data for some ethnic groups has not been pooled largely due to the limited evidence base (i.e.…”

Late-onset schizophrenia: from Manfred Bleuler to the present

“…It is estimated that 23% (15.4-32.0%) of schizophrenia cases have a late onset, with a mean age at onset of 60.7 years-old [7]. Global incidence is estimated to be 7.5 per 100,000 person-years [8]. However, these patients are not frequently seen in hospitals maybe due to their pre-morbid personalities and functioning.…”