Health outcomes and cost of care among older adults with schizophrenia: a 10-year study using medical records across the continuum of care.
OBJECTIVE
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 with older patients without schizophrenia.


METHODS
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. Of these, 1,635 (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.


METHODS
Rates of comorbid conditions, healthcare utilization, costs, and mortality.


RESULTS
Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare 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 healthcare system, requiring the development of integrated models of healthcare.
Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN. Electronic address: hhendri@iupui.edu.
Hugh C
HC
Hendrie
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
Wanzhu
W
Tu
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.
Rebeka
R
Tabbey
Indiana University Center for Aging Research, Indianapolis, IN.
Christianna E
CE
Purnell
Regenstrief Institute, Inc., Indianapolis, IN.
Roberta J
RJ
Ambuehl
Indiana University School of Medicine, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN.
Christopher M
CM
Callahan
D017668:Age of Onset; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data* / Q000639:trends; D006304:Health Status; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D008499:Medical Records; D006278:Medicare / Q000191:economics; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000191:economics* / Q000453:epidemiology / Q000401:mortality; D014481:United States / Q000453:epidemiology
Comorbidity; cancer; dementia; hospital care; mortality; nursing home