Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study.

Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (ß = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.

Long-term care utilization within older adults with schizophrenia: Associated factors in a multicenter study.

OBJECTIVE: Data are scarce regarding the clinical factors associated with utilization of long-term care facilities among older adults with schizophrenia. In this multicenter study, we sought to examine potential clinical differences between older adults with schizophrenia who are living in a long-term care facility and their community-dwelling counterparts. METHOD: We used data from the French Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia (N = 353). RESULTS: The prevalence of long-term care utilization was 35.1% of older patients with schizophrenia. Living in a long term care facility was significantly and independently associated with higher level of depression (Adjusted odds ratio (AOR) [95%CI]=1.97 [1.06-3.64]), lower cognitive (AOR [95%CI]=0.94 [0.88-0.99]) and global functioning (AOR [95%CI]=0.97 [0.95-0.99]), greater lifetime number of hospitalizations in a psychiatric department (AOR [95%CI]=2.30 [1.18-4.50]), not having consulted a general practitioner in the past year (AOR [95%CI]=0.28 [0.0.14-0.56]), urbanicity (AOR [95%CI]=2.81 [1.37-5.80]), and older age (AOR [95%CI]=1.08 [1.03-1.13]). DISCUSSION: Older patients with schizophrenia who live in long-term care facilities appear to belong to a distinct group, marked by a more severe course of illness with higher level of depression and more severe cognitive deficits than older patients with schizophrenia living in other settings. Our study highlights the need of early assessment and management of depression and cognitive deficits in this population and the importance of monitoring closely this vulnerable population.