Treatment costs and use of community mental health services for schizophrenia by age cohorts

Cuffel, Brian J.; Jeste, Dilip V.; Halpain, Maureen C.; Pratt, Carlos W.; Tarke, Henry; Patterson, Tess

doi:10.1176/ajp.153.7.870

Cited by 68 publications

(9 citation statements)

References 24 publications

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“…(3–5) The cost of mental health services for these patients has been reported to be particularly high. (6) In an era of strained health care resources, the significance of these trends extends beyond geriatric mental health care and is likely to have public health implications.…”

Section: Objectivementioning

confidence: 99%

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Health Outcomes and Cost of Care Among Older Adults with Schizophrenia: A 10-Year Study Using Medical Records Across the Continuum of Care

Hendrie

Tabbey

et al. 2014

The American Journal of Geriatric Psychiatry

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Objectives The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared to older patients without schizophrenia. Design, Setting, Participants An observational cohort study of 31,588 older adults (mean age 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999–2008. 1635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients’ electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements Rates of comorbid conditions, health care utilization, costs, and mortality. Results Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% v. 38.84%), chronic obstructive pulmonary disease (52.71% v. 41.41%), and hypothyroidism (36.72% v. 26.73%) than the patients without schizophrenia (p<0.001). They had significantly lower rates of cancer (30.78% v. 43.18%) and significantly higher rates of dementia (64.46% v. 32.13%). The patients with schizophrenia had significantly higher mortality risk (HR: 1.25, CI: 1.07–1.47) than the patients without schizophrenia. They also had significantly higher rates of health care utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions The management of older adult patients with schizophrenia is creating a serious burden for our health care system, requiring the development of integrated models of health care.

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Section: Objectivementioning

confidence: 99%

“…Yet there have been few comprehensive studies of the health status of these older patients and the results of these few studies have been inconsistent. (7–13, 6). We identified one study of health care utilization among older adults with schizophrenia which included costs.…”

Section: Objectivementioning

confidence: 99%

Health Outcomes and Cost of Care Among Older Adults with Schizophrenia: A 10-Year Study Using Medical Records Across the Continuum of Care

Hendrie

Tabbey

et al. 2014

The American Journal of Geriatric Psychiatry

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“…Functional disability contributes up to half of the costs in the treatment of schizophrenia (2) and these costs are particularly high as individuals with schizophrenia grow old (3). Considering that by 2025, 20% of individuals with schizophrenia will be age 65 or older (4), characterizing cognitive function and determining whether cognitive aging is accelerated in older individuals with schizophrenia, has a critical public health significance.…”

Section: Objectivementioning

confidence: 99%

Cognitive Performance of Individuals With Schizophrenia Across Seven Decades: A Study Using the MATRICS Consensus Cognitive Battery

Rajji¹,

Voineskos²,

Butters³

et al. 2013

The American Journal of Geriatric Psychiatry

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Objectives The objectives of this study are to determine the effect of aging, schizophrenia, and their interaction on cognitive function. Design Cross-sectional controlled study. Setting Community-living. Participants 235 subjects with schizophrenia aged 19-79 and 333 comparison subjects aged 20-81. Measurements The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Results Older age was associated with poorer performance on 9 of 10 MCCB tests in both subjects with schizophrenia and comparison subjects. Subjects with schizophrenia were impaired relative to comparison subjects on each of the 10 tests. However, there was no interaction between aging and schizophrenia on any test. Essentially the same results were observed when analyzing performance on the seven MCCB cognitive domains and MCCB global composite score. Conclusions Consistent with other reports, schizophrenia appears to be a disorder marked by generalized cognitive dysfunction. However, the rate of cognitive decline appears to be similar to that observed in healthy comparison subjects. They do not experience acceleration in cognitive aging which supports the hypothesis that schizophrenia is a syndrome of premature aging. Longitudinal studies including very old patients are needed to confirm and extend these findings.

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“…The ECA reported a lifetime prevalence of schizophrenia among people aged 45–64 of 1.0% and among people aged 65 years and older of 0.3% [11]. Several methodological limitations of this study likely resulted in an underestimation of late-life schizophrenia, including lack of age-appropriate diagnostic interview questions; additionally, there may be a premature death rate among persons with schizophrenia that lowers the prevalence in later life [8, 10, 12–14]. …”

Section: Late-life Schizophreniamentioning

confidence: 99%

“…The healthcare costs of late-life schizophrenia are estimated to be at least as much as those among teenagers and young adults with schizophrenia [8, 14]. Although the lifetime prevalence of schizophrenia is 1% (versus, for example, 20–25% in major depression), schizophrenia across all age groups accounts for the greatest proportion of mental health care expenditures [8, 15].…”

Section: Late-life Schizophreniamentioning

confidence: 99%

New Wine in Old Bottle: Late-life Psychosis

Iglewicz

Meeks

Jeste

2011

Psychiatric Clinics of North America

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Psychosis is common in late life and exacts enormous costs to society, affected individuals, and their caregivers. A multitude of etiologies for late-life psychosis exist, the two most prototypical being schizophrenia and psychosis of Alzheimer’s Disease (AD). As such, this review will focus on the non-affective, neuropsychiatric causes of chronic psychosis in the elderly, specifically schizophrenia, delusional disorder, and the psychosis of AD and other dementias. As evidenced in this review, the current research regarding the onset and course of late-life schizophrenia reflects a more favorable prognosis than that painted by the Kraepelinian notion of schizoprenia as “dementia praecox.” Antipsychotics are useful in controlling the symptoms of late-life schizophrenia, but their use among older adults warrants increased vigilance because of older adults’ increased proclivity to side effects. Psychosocial interventions can be effective, usually in conjunction with medication. Meanwhile, psychosis of AD occurs in nearly half of people with AD and is associated with increased hospitalizations, institutionalization, caregiver distress, and mortality. Despite the profound consequences of psychotic symptoms associated with dementias, the extant literature does not afford clinicians clear, consistent guidance on how to provide optimal treatment to specific patients. Second generation antipsychotics are usually the choice treatment for psychosis, but the black box warning regarding their associated 1–2% increased absolute risk in stroke and overall mortality in patients with dementia complicates their use. Using second generation antipsychotics in low doses for brief periods and discontinuing them when possible is the best clinical practice for dementia-related psychosis. Psychosocial interventions for the treatment of psychosis with AD appear promising in empirical research, but more rigorous study is needed.

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Treatment costs and use of community mental health services for schizophrenia by age cohorts

Abstract: The economic burden of late-life schizophrenia to the public mental health system is at least as high as that of schizophrenia in younger adults.

Cited by 68 publications

References 24 publications

Health Outcomes and Cost of Care Among Older Adults with Schizophrenia: A 10-Year Study Using Medical Records Across the Continuum of Care

Health Outcomes and Cost of Care Among Older Adults with Schizophrenia: A 10-Year Study Using Medical Records Across the Continuum of Care

Cognitive Performance of Individuals With Schizophrenia Across Seven Decades: A Study Using the MATRICS Consensus Cognitive Battery

New Wine in Old Bottle: Late-life Psychosis

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