Caring for the whole person: Integrated health care for older adults with severe mental illness and medical comorbidity
Caring for the whole person: Integrated health care for older adults with severe mental illness and medical comorbidity
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DOI：
10.1111/j.1532-5415.2004.52601.x
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发表时间：
2004-12-01
影响因子：
6.3
通讯作者：
Bartels, SJ
中科院分区：
文献类型：
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作者：
Bartels, SJ
精神分裂症患者的寿命比一般人短20%，而且患慢性疾病（包括糖尿病、高血压、心脏病和肺气肿）的几率也很高。最近的研究表明，精神分裂症的过早死亡和过度的身体残疾与多种潜在可预防的外部风险因素有关，包括不健康的生活方式、精神药物的代谢和神经副作用以及不良的医疗保健。严重精神疾病（SMI）患者人口的老龄化进一步导致了医疗合并症发生率的上升。预计到2030年，患有严重精神疾病的老年人数量将增加一倍以上。本文概述了有关精神分裂症和其他重度精神分裂症患者共病的患病率和原因的选定研究结果，目前提供高质量医疗保健的挑战，以及为重度精神分裂症老年人提供综合护理模式的建议方向。大约3%的美国成年人患有重度精神分裂症，其中1%患有精神分裂症，2%患有难以治疗的抑郁症或双相情感障碍。4在老年人中，精神分裂症和双相情感障碍的患病率分别下降到约0.5%和0.2%，而重度抑郁症的患病率则从不到1%到5%不等。5,6老年人精神分裂症患病率较低很可能是由于精神病症状缓解7,8对一些人和过早死亡。精神分裂症患者的预期寿命比一般人群短20%。男性精神分裂症患者的寿命比非精神分裂症患者短10年，而女性精神分裂症患者的寿命比非精神分裂症患者短9年左右。9-12导致精神分裂症患者过早死亡和预后不良的因素
Schizophrenia is associated with a 20% shorter life span than for the general population1 and high rates of chronic medical illnesses, including diabetes mellitus (DM), hypertension, heart disease, and emphysema. 2 Recent research suggests that premature mortality and excess physical disability in schizophrenia is associated with a variety of extrinsic risk factors that are potentially preventable, including unhealthy lifestyles, metabolic and neurological side effects of psychiatric medications, and poor health care. The aging of the population of persons with severe mental illness (SMI) further contributes to growing rates of medical comorbidity. The number of older adults with major psychiatric illness is predicted to more than double by 2030. 3 This paper provides an overview of selected research findings on the prevalence and causes of medical comorbidity in schizophrenia and other SMIs, current challenges to providing quality health care, and suggested directions for integrated models of care for the older person with a SMI.EARLY MORTALITY AND RESEARCH ON MEDICAL COMORBIDITY IN SMI Approximately 3% of American adults have SMI, including 1% with schizophrenia and 2% with depression or bipolar disorder that is refractory to treatment. 4 In older adults, the prevalence of schizophrenia and bipolar disorder decreases to approximately 0.5% and 0.2%, respectively, whereas the prevalence of major depression ranges from less than 1% to 5%. 5, 6 The lower prevalence of schizophrenia in older persons is most likely due to remission of psychotic symptoms7, 8 for some individuals and premature mortality. Schizophrenia is associated with a 20% shorter life expectancy than for the general population. 1 The lives of men with schizophrenia are 10 years shorter than those of men without schizophrenia, whereas the lives of women with schizophrenia are about 9 years shorter than those of women without schizophrenia. 9–12 Factors that contribute to premature death and poor outcomes for persons with schizo-