title: Comorbidity profile and healthcare utilization in elderly patients with serious mental illnesses.
abstract: OBJECTIVE
  Patients with serious mental illness are living longer. Yet, there remain few studies that focus on healthcare utilization and its relationship with comorbidities in these elderly mentally ill patients.
  
  
  METHODS
  Comparative study. Information on demographics, comorbidities, and healthcare utilization was taken from an electronic medical record system.
  
  
  METHODS
  Wishard Health Services senior care and community mental health clinics.
  
  
  METHODS
  Patients age 65 years and older-255 patients with serious mental illness (schizophrenia, major recurrent depression, and bipolar illness) attending a mental health clinic and a representative sample of 533 nondemented patients without serious mental illness attending primary care clinics.
  
  
  RESULTS
  Patients having serious mental illness had significantly higher rates of medical emergency department visits (p = 0.0027) and significantly longer lengths of medical hospitalizations (p <0.0001) than did the primary care control group. The frequency of medical comorbidities such as diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, thyroid disease, and cancer was not significantly different between the groups. Hypertension was lower in the mentally ill group (p <0.0001). Reported falls (p <0.0001), diagnoses of substance abuse (p = 0.02), and alcoholism (p = 0.0016) were higher in the seriously mentally ill. The differences in healthcare utilization between the groups remained significant after adjusting for comorbidity levels, lifestyle factors, and attending primary care.
  
  
  CONCLUSIONS
  Our findings of higher rates of emergency care, longer hospitalizations, and increased frequency of falls, substance abuse, and alcoholism suggest that seriously mentally ill older adults remain a vulnerable population requiring an integrated model of healthcare.
authors.affiliation: Indiana University School of Medicine, Indianapolis; Indiana University Center for Aging Research, Indianapolis; Regenstrief Institute Inc., Indianapolis; Indiana University Department of Psychiatry, Indianapolis. Electronic address: hhendri@iupui.edu.
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Hendrie
authors.forename: Donald
authors.initials: D
authors.lastname: Lindgren
authors.forename: Donald P
authors.initials: DP
authors.lastname: Hay
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: Sujuan
authors.initials: S
authors.lastname: Gao
authors.forename: Christianna
authors.initials: C
authors.lastname: Purnell
authors.forename: Stephanie
authors.initials: S
authors.lastname: Munger
authors.forename: Faye
authors.initials: F
authors.lastname: Smith
authors.forename: Jeanne
authors.initials: J
authors.lastname: Dickens
authors.forename: Malaz A
authors.initials: MA
authors.lastname: Boustani
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology*; D016012:Poisson Distribution; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D012189:Retrospective Studies; D012559:Schizophrenia / Q000453:epidemiology; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology; D013959:Thyroid Diseases / Q000453:epidemiology*
keywords: Comorbidity; elderly patients; healthcare utilization; serious mental illness