Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia

Abstract

Objectives: Comorbid illness burden signifies a poor prognosis in schizophrenia. The aims of this study were to estimate the severity of comorbidities in elderly patients with schizophrenia, determine risk factors associated with mortality, and establish a reliable nomogram for predicting 1-, 3- and 5-year mortality and survival. Methods: This population-based study rigorously selected schizophrenia patients (≥65 years) having their first admission due to schizophrenia during the study period (2000–2013). Comorbidity was scored using the updated Charlson Comorbidity Index (CCI). Results: This study comprised 3827 subjects. The mean stay of first admission due to schizophrenia was 26 days. Mean numbers of schizophrenia and non-schizophrenia-related hospitalization (not including the first admission) were 1.80 and 3.58, respectively. Mean ages at death were 73.50, 82.14 and 89.32 years old, and the mean times from first admission to death were 4.24, 3.33, and 1.87 years in three different age groups, respectively. Nearly 30% were diagnosed with ≥3 comorbidities. The most frequent comorbidities were dementia, chronic pulmonary disease and diabetes. The estimated 1-, 3- and 5-year survival rates were 90%, 70%, and 64%, respectively. Schizophrenia patients with comorbid diseases are at increased risk of hospitalization and mortality (p < 0.05). Conclusion: The nomogram, composed of age, sex, the severity of comorbidity burden, and working type could be applied to predict mortality risk in the extremely fragile patients.

Relationship Between Cognitive Functions and Decision-Making Capacity in Older Institutionalized Patients with Schizophrenia: A Preliminary Study

“… 33 In addition, mental healthcare systems in Japan are facing the problems of an increasing number of elderly patients with schizophrenia as the population ages. 31 Because increasing age in patients with schizophrenia could increase physical comorbidities, 34 assessment of patients’ decision-making competence could be more necessary for physicians and psychiatrists.…”

Schizophrenie im Alter

“…▶ Tab. 2 Merkmale der Schizophrenie [2,3,7,19,20,21,22,64]. der SCI und MCI unter den milden Verhaltensauffälligkeiten den stärksten Prädiktor einer kognitiven Verschlechterung dar [12,30].…”

“…Die Schizophrenie ist auch im Alter mit erhöhter Mortalität assoziiert [21]. Signifikante Unterschiede in der standardisierten Mortalitätsrate (SMR) zwischen VLOSLP und früher beginnender Schizophrenie im Alter wurden nicht gefunden.…”

Mortality prediction in Mexican older COVID-19 patients using the Charlson comorbidity index: a case- control study from a reconverted COVID-19 hospital

“…We demonstrate that when comparing COVID-19 pneumonia patients with non-COVID-19 pneumonia patients a signi cant association with mortality was observed in COVID-19 pneumonia patients with a CCI score of less than 3, rather than the moderate or high-risk category, which was originally described by Charlson and colleagues in 1987 (Charlson et al 1987a). Other studies have also categorized older patients in < 3 and ≥ 3 CCI score (Hsu et al 2021), and it has been reported in that in certain cases a CCI of ≥ 2 in a risk factor for death (Cao et al 2021). A study in India that included 50,668 patients ≥ 60 years of age also categorized patients as 0, 1 and ≥ 2 (32).…”