Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old.
BACKGROUND
Psychotic symptoms are reported to be uncommon in the elderly, and may be underrated in traditional epidemiological studies.


METHODS
Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed using results of psychiatric and physical examinations, key-informant interviews, and medical record reviews in a representative sample of nondemented individuals aged 85 years living in the community or in institutions in Göteborg, Sweden (n = 347). The sample was observed for 3 years regarding psychotic symptoms, mortality, and incident dementia.


RESULTS
The prevalence of any psychotic symptom was 10.1% (95% confidence interval [CI], 7.1%-13.7%); hallucinations, 6.9% (95% CI, 4.5%-10.1%); and delusions, 5.5% (95% CI, 3.3%-8.4%). The prevalence of paranoid ideation was 6.9% (95% CI, 4.5%-10.1%). Stepwise logistic regression analyses showed that hallucinations were associated with major depressive syndrome (odds ratio [OR], 3.9; 95% CI, 1.3-11.9), disability in daily life (OR, 5.2; 95% CI, 1.8-14.9), and visual deficits (OR, 3.4; 95% CI, 1.0-11.1). Delusions were associated with disability in daily life (OR, 4.9; 95% CI, 1.8-13.3). Paranoid ideation was associated with visual deficits (OR, 3.6; 95% CI, 1.2-10.5) and myocardial infarction (OR, 4.6; 95% CI, 1.7-12.6). Hallucinations (OR, 3.1; 95% CI, 1.4-6.8), delusions (OR, 2.9; 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7; 95% CI, 1.2-6.2) were each related to increased incidence of dementia from 85 to 88 years of age. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men.


CONCLUSIONS
We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported, and these symptoms were associated with a poor prognosis.
Ostling
Svante
S
Göteborg University, Institute of Clinical Neuroscience, Psychiatry Section, Sahlgrenska University Hospital/S, SE 413 45 Göteborg, Sweden. svante.ostling@neuro.gu.se
Skoog
Ingmar
I
D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D010259:Paranoid Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012494:Sampling Studies; D016019:Survival Analysis; D013548:Sweden