Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses
Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses
复制标题
DOI：
10.1016/j.jagp.2013.01.056
复制
发表时间：
2013-12-01
影响因子：
7.2
通讯作者：
Callahan, Christopher M.
中科院分区：
文献类型：
--
作者：
Hendrie, Hugh C.;Lindgren, Donald;Callahan, Christopher M.
目的：患有严重精神疾病的患者寿命更长。然而，仍然有一些研究集中在医疗保健利用及其与这些老年精神病患者的合并症的关系。设计：对比研究。有关人口统计学、合并症和医疗保健利用的信息取自电子病历系统。设置：Wishard健康服务高级护理和社区心理健康诊所。参会人员：年龄≥ 65岁的患者-255例患有严重精神疾病（精神分裂症、重性复发性抑郁症和双相情感障碍）的患者在精神健康诊所就诊，533例无严重精神疾病的非痴呆患者在初级保健诊所就诊。结果如下：与初级保健对照组相比，患有严重精神疾病的患者有显著更高的急诊就诊率（p - 0.0027）和显著更长的住院时间（p < 0.0001）。糖尿病、冠状动脉疾病、充血性心力衰竭、慢性阻塞性肺疾病、甲状腺疾病和癌症等内科合并症的发生率在两组之间没有显著差异。精神病患者组的高血压发生率较低（p < 0.0001）。报告的福尔斯（p < 0.0001）、药物滥用（p - 0.02）和酗酒（p - 0.0016）在严重精神病患者中更高。在调整了合并症水平、生活方式因素和参加初级保健后，两组之间的医疗保健利用差异仍然显著。结论：我们的调查结果显示，更高的急诊率、更长的住院时间以及福尔斯、药物滥用和酗酒的频率增加，表明患有严重精神疾病的老年人仍然是需要综合医疗保健模式的弱势群体。
Objectives: 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. Design: Comparative study. Information on demographics, comorbidities, and healthcare utilization was taken from an electronic medical record system. Setting: Wishard Health Services senior care and community mental health clinics. Participants: 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.