title: Mortality and Its Determinants in Late-Life Schizophrenia: A 5-Year Prospective Study in a Dutch Catchment Area.
abstract: OBJECTIVE
  It is uncertain if the raised mortality in schizophrenia persists in later life. Register-based studies suggest that excess mortality continues, although at a lower level than in younger age groups. However, prospective follow-up studies of older schizophrenia samples are lacking.
  
  
  METHODS
  A cohort of 157 older patients (mean age at study entry: 68 years) diagnosed with schizophrenia or schizoaffective disorder in a psychiatric catchment area in Amsterdam, the Netherlands was studied. Standardized mortality rate (SMR) was estimated at a 5-year follow-up, in referral to the same age group in the general catchment area population. The impact on survival time of a range of independent demographic and clinical predictors was evaluated.
  
  
  RESULTS
  The cohort had an all-cause SMR of 1.89 (95% CI: 1.28-2.70). SMR was higher in men (2.60; 95% CI: 1.42-4.37) than in women (1.78; 95% CI: 1.02-2.90). All deaths were from natural causes. Reduced survival was associated with higher age (HR: 1.10; 95% CI: 1.05-1.16), male gender (HR: 3.94; 95% CI: 1.87-8.31), and having had one or more compulsory admissions in the past (HR: 2.61; 95% CI: 1.46-4.68). In contrast, no mortality associations were found with diagnosis (schizophrenia versus schizoaffective disorder), age at onset of the disorder, or current prescription of antipsychotics.
  
  
  CONCLUSIONS
  The excess mortality in schizophrenia continues into late life, affecting men more often than women. Given the poor insight into the underlying mechanisms of this disquieting finding, there is a need to identify modifiable clinical and social risk factors.
authors.affiliation: GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: p.meesters@ggzingeest.nl.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Meesters
authors.affiliation: GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hannie C
authors.initials: HC
authors.lastname: Comijs
authors.affiliation: GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes H
authors.initials: JH
authors.lastname: Smit
authors.affiliation: GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.affiliation: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Lieuwe
authors.initials: L
authors.lastname: de Haan
authors.affiliation: GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002391:Catchment Area, Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011618:Psychotic Disorders / Q000401:mortality*; D012559:Schizophrenia / Q000401:mortality*
keywords: cause of death; elderly; gender; geriatric psychiatry; life expectancy; mortality; schizophrenia