Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-5c6d5d7d68-lvtdw Total loading time: 0 Render date: 2024-08-14T06:31:14.222Z Has data issue: false hasContentIssue false

2 - Patterns of Care for Older People with Schizophrenia

from Section 1 - Epidemiology, Historical Background, Illness Phenomenology, and Diagnostic Issues

Published online by Cambridge University Press:  15 March 2019

By
Donna McAlpine  and
Ellen McCreedy
Edited by
Carl I. Cohen  and
Paul D. Meesters
Carl I. Cohen
Affiliation:
SUNY Downstate Medical Center
Paul D. Meesters
Affiliation:
Friesland Mental Health Services
Get access

Summary

Many people with schizophrenia live well into later life and, with demographic shifts, this population will continue to grow. The needs of older persons with schizophrenia are complex and include treatment of comorbid physical and mental conditions; we describe patterns of service use. Inpatient care in both general and psychiatric hospitals has substantially declined, but hospitalizations still account for more than half of Medicare spending for people with schizophrenia. The rapid decline in inpatient care without appropriate community support continues to drive inappropriate placement in nursing homes. Persons with schizophrenia are at greater risk of being admitted to nursing homes than the general population, even with low levels of disability. Because of their dependence on public insurance, these patients are more likely to be admitted to poorer-quality nursing homes. There are promising developments in health policy that may increase access to care, such as expansion of public insurance programs, mental health parity and models of integrated care. However, there continue to be gaps in service use and underutilization of mental health services, even among Medicare recipients.
Type
Chapter
Information
Schizophrenia and Psychoses in Later Life
New Perspectives on Treatment, Research, and Policy
 , pp. 13 - 26
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hjorthoj, C., Sturup, A. E., McGrath, J. J., et al. Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis. Lancet Psychiatry 2017; 4: 295–301.CrossRefGoogle ScholarPubMed
Berry, K. and Barrowclough, C.. The needs of older adults with schizophrenia: implications for psychological interventions. Clinical Psychology Review 2009; 29(1): 68–76.CrossRefGoogle ScholarPubMed
Cohen, C. I. and GAP Committee on Aging. Practical geriatrics: directions for research and policy on schizophrenia and older adults: summary of the GAP committee report. Psychiatric Services 2000; 51(3): 299–302.CrossRefGoogle ScholarPubMed
Cohen, C. I., Meesters, P. D. and Zhao, J.. New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry 2015; 2(4): 340–50.CrossRefGoogle ScholarPubMed
Whiteford, H. A., Degenhardt, L., Rehm, J., et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013; 382(9904): 1575–86.CrossRefGoogle ScholarPubMed
Chong, H. Y., Teoh, S. L., Wu, D. B., et al. Global economic burden of schizophrenia: a systematic review. Neuropsychiatric Disease and Treatment 2016; 12: 357–73.Google ScholarPubMed
Cloutier, M., Aigbogun, M. S., Guerin, A., et al. The economic burden of schizophrenia in the United States in 2013. Journal of Clinical Psychiatry 2016; 77(6): 764–71.Google ScholarPubMed
Bartels, S. J., Clark, R. E., Peacock, W. J., et al. Medicare and Medicaid costs for schizophrenia patients by age cohort compared with costs for depression, dementia, and medically ill patients. American Journal of Geriatric Psychiatry 2003; 11(6): 648–57.CrossRefGoogle ScholarPubMed
Howard, R., Rabins, P. V., Seeman, M. V., et al. Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. American Journal of Psychiatry 2000; 157(2): 172–8.CrossRefGoogle ScholarPubMed
Keith, S. J., Regier, D. A. and Rae, D. S.. Schizophrenic disorders. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study, ed Robins, L. N. and Regier, D. A.. New York: Free Press, 1991, 33–52.Google Scholar
Palmer, B. W., Heaton, S. C. and Jeste, D. V.. Older patients with schizophrenia: challenges in the coming decades. Psychiatric Services 1999; 50(9): 1178–83.CrossRefGoogle ScholarPubMed
Kessler, R. C., Birnbaum, H., Demler, O., et al. The prevalence and correlates of non-affective psychosis in the National Comorbidity Survey Replication (NCS-R). Biological Psychiatry 2005; 58(8): 668–76.CrossRefGoogle Scholar
Wu, E. Q., Shi, L., Birnbaum, H., et al. Annual prevalence of diagnosed schizophrenia in the USA: a claims data analysis approach. Psychological Medicine 2006; 36(11): 1535–40.CrossRefGoogle Scholar
Mechanic, D., McAlpine, D. D. and Rochefort, D. A.. Mental Health and Social Policy: Beyond Managed Care. Boston, MA: Pearson Education, 2014.Google Scholar
Frank, R. G.. The creation of Medicare and Medicaid: the emergence of insurance and markets for mental health services. Psychiatric Services 2000; 51(4): 465–8.CrossRefGoogle ScholarPubMed
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Mental Health Annual Report: 2014. National Use of Mental Health Services. HHS Publication No.17-5033, 2017.Google Scholar
Manderscheid, R. W., Atay, J. E. and Crider, R. A.. Changing trends in state psychiatric hospital use from 2002 to 2005. Psychiatric Services 2009; 60(1): 29–34.CrossRefGoogle ScholarPubMed
Mechanic, D., McAlpine, D. D. and Olfson, M.. Changing patterns of psychiatric inpatient care in the United States, 1988–1994. Archives of General Psychiatry 1998; 55(9): 785–91.CrossRefGoogle ScholarPubMed
Owens, P., Myers, M., Elixhauser, A., et al. Care of Adults with Mental Health and Substance Abuse Disorders in US Community Hospitals, 2004. HCUP Fact Book No. 10. Rockville, MD: Agency for Healthcare Research and Quality, 2007.Google Scholar
Hoover, D. R., Akincigil, A., Prince, J. D., et al. Medicare inpatient treatment for elderly non-dementia psychiatric illnesses 1992–2002; length of stay and expenditures by facility type. Administration and Policy in Mental Health and Mental Health Services Research 2008; 35(4): 231–40.CrossRefGoogle ScholarPubMed
Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), 2011.Google Scholar
Bowersox, N. W., Szymanski, B. J. and McCarthy, J. F.. Associations between psychiatric inpatient bed supply and the prevalence of serious mental illness in Veterans Affairs nursing homes. American Journal of Public Health 2013; 103(7): 1325–31.CrossRefGoogle ScholarPubMed
Avorn, J., Dreyer, P., Connelly, K., et al. Use of psychoactive medication and the quality of care in rest homes: findings and policy implications of a statewide study. New England Journal of Medicine 1989; 320(4): 227–32.CrossRefGoogle ScholarPubMed
Kruzich, J. M.. The chronically mentally ill in nursing homes: issues in policy and practice. Health and Social Work 1986; 11(1): 5–14.CrossRefGoogle ScholarPubMed
Schmidt, L. J., Reinhardt, A. M. and Kane, R. L.. The mentally ill in nursing homes: new back wards in the community. Archives of General Psychiatry 1977; 34(6): 687–91.CrossRefGoogle ScholarPubMed
Reichman, W. E., Coyne, A. C., Borson, S., et al. Psychiatric consultation in the nursing home: a survey of six states. American Journal of Geriatric Psychiatry 1998; 6(4): 320–7.Google ScholarPubMed
Freedman, R. I. and Moran, A.. Wanderers in a promised land: the chronically mentally ill and deinstitutionalization. Medical Care 1984; 22(12 Suppl): S1–60.CrossRefGoogle Scholar
Institute of Medicine. Improving the Quality of Care in Nursing Homes. Washington, DC: The National Academies Press, 1986.Google Scholar
Hawes, C., Mor, V., Phillips, C. D., et al. The OBRA-87 nursing home regulations and implementation of the Resident Assessment Instrument: effects on process quality. Journal of the American Geriatrics Society 1997; 45(8): 977–85.CrossRefGoogle ScholarPubMed
Mechanic, D. and McAlpine, D. D.. Use of nursing homes in the care of persons with severe mental illness: 1985 to 1995. Psychiatric Services 2000; 51(3): 354–8.CrossRefGoogle ScholarPubMed
Andrews, A. O., Bartels, S. J., Xie, H., et al. Increased risk of nursing home admission among middle aged and older adults with schizophrenia. American Journal of Geriatric Psychiatry 2009; 17(8): 697–705.CrossRefGoogle ScholarPubMed
Shea, D. G., Russo, P. A. and Smyer, M. A.. Use of mental health services by persons with a mental illness in nursing facilities: initial impacts of OBRA87. Journal of Aging and Health 2000; 12(4): 560–78.CrossRefGoogle ScholarPubMed
Llorente, M. D., Olsen, E. J., Leyva, O., et al. Use of antipsychotic drugs in nursing homes: current compliance with OBRA regulations. Journal of the American Geriatrics Society 1998; 46(2): 198–201.CrossRefGoogle ScholarPubMed
Wang, P. S., Lane, M., Olfson, M., et al. Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 2005; 62(6): 629–40.CrossRefGoogle ScholarPubMed
Karlin, B. E., Duffy, M. and Gleaves, D. H.. Patterns and predictors of mental health service use and mental illness among older and younger adults in the United States. Psychological Services 2008; 5(3): 275.CrossRefGoogle Scholar
Dixon, L., Lyles, A., Smith, C., et al. Use and costs of ambulatory care services among Medicare enrollees with schizophrenia. Psychiatric Services 2001; 52(6): 786–92.CrossRefGoogle ScholarPubMed
Laursen, T. M., Nordentoft, M. and Mortensen, P. B.. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology 2014; 10: 425–48.CrossRefGoogle ScholarPubMed
Olfson, M., Gerhard, T., Huang, C., et al. Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 2015; 72(12): 1172–81.CrossRefGoogle ScholarPubMed
Henderson, D. C.. Schizophrenia and comorbid metabolic disorders. Journal of Clinical Psychiatry 2004; 66: 11–20.Google Scholar
Hendrie, H. C., Tu, W., Tabbey, R., et al. Health outcomes and cost of care among older adults with schizophrenia: a 10-year study using medical records across the continuum of care. American Journal of Geriatric Psychiatry 2014; 22(5): 427–36.CrossRefGoogle ScholarPubMed
Lord, O., Malone, D. and Mitchell, A. J.. Receipt of preventive medical care and medical screening for patients with mental illness: a comparative analysis. General Hospital Psychiatry 2010; 32(5): 519–43.CrossRefGoogle ScholarPubMed
Bradford, D. W., Kim, M. M., Braxton, L. E., et al. Access to medical care among persons with psychotic and major affective disorders. Psychiatric Services 2008; 59(8): 847–52.CrossRefGoogle ScholarPubMed
Vahia, I. V., Diwan, S., Bankole, A. O., et al. Adequacy of medical treatment among older persons with schizophrenia. Psychiatric Services 2008; 59(8): 853–9.CrossRefGoogle ScholarPubMed
Lindamer, L. A., Bailey, A., Hawthorne, W., et al. Gender differences in characteristics and service use of public mental health patients with schizophrenia. Psychiatric Services 2003; 54(10): 1407–9.CrossRefGoogle ScholarPubMed
Butler, M., Kane, R. L., McAlpine, D., et al. Integration of mental health/substance abuse and primary care. AHRQ Evidence Report 2008; 173: 1–362.Google Scholar
Reilly, S., Planner, C., Gask, L., et al. Collaborative care approaches for people with severe mental illness. Cochrane Database of Systematic Reviews 2013(11): CD009531.Google ScholarPubMed
Bao, Y., Casalino, L. P. and Pincus, H. A.. Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization. Journal of Behavioral Health Services and Research 2013; 40(1): 121–32.CrossRefGoogle ScholarPubMed
Domino, M. E., Wells, R. and Morrissey, J. P.. Serving persons with severe mental illness in primary care-based medical homes. Psychiatric Services 2015; 66(5): 477–83.CrossRefGoogle ScholarPubMed
Rosenheck, R., Leslie, D., Keefe, R., et al. Barriers to employment for people with schizophrenia. American Journal of Psychiatry 2006; 163(3): 411–7.CrossRefGoogle ScholarPubMed
Khaykin, E., Eaton, W. W., Ford, D. E., et al. Health insurance coverage among persons with schizophrenia in the United States. Psychiatric Services 2010; 61(8): 830–4.CrossRefGoogle ScholarPubMed
Feldman, R., Bailey, R. A., Muller, J., et al. Cost of schizophrenia in the Medicare program. Population Health Management 2014; 17(3): 190–6.CrossRefGoogle ScholarPubMed
Zhang, Y., Baik, S. H. and Newhouse, J. P.. Use of intelligent assignment to Medicare Part D plans for people with schizophrenia could produce substantial savings. Health Affairs 2015; 34(3): 455–60.CrossRefGoogle ScholarPubMed
Li, Y., Cai, X. and Cram, P.. Are patients with serious mental illness more likely to be admitted to nursing homes with more deficiencies in care? Medical Care 2011; 49(4): 397–405.CrossRefGoogle ScholarPubMed
Rahman, M., Grabowski, D. C., Gozalo, P. L., et al. Are dual eligibles admitted to poorer quality skilled nursing facilities? Health Services Research 2014; 49(3): 798–817.CrossRefGoogle ScholarPubMed
Rahman, M., Grabowski, D. C., Intrator, O., et al. Serious mental illness and nursing home quality of care. Health Services Research 2013; 48(4): 1279–98.CrossRefGoogle ScholarPubMed
Mor, V., Gruneir, A., Feng, Z., et al. The effect of state policies on nursing home resident outcomes. Journal of the American Geriatrics Society 2011; 59(1): 3–9.CrossRefGoogle ScholarPubMed
Madden, J. M., Adams, A. S., LeCates, R. F., et al. Changes in drug coverage generosity and untreated serious mental illness: transitioning from Medicaid to Medicare Part D. JAMA Psychiatry 2015; 72(2): 179–88.CrossRefGoogle ScholarPubMed
West, J. C., Wilk, J. E., Rae, D. S., et al. First-year Medicare Part D prescription drug benefits: medication access and continuity among dual eligible psychiatric patients. Journal of Clinical Psychiatry 2010; 71(4): 400–10.Google ScholarPubMed
Beronio, K., Glied, S. and Frank, R.. How the Affordable Care Act and Mental Health Parity and Addiction Equity Act greatly expand coverage of behavioral health care. Journal of Behavioral Health Services and Research 2014; 41(4): 410–28.CrossRefGoogle ScholarPubMed
Goldman, H. H.. Will health insurance reform in the United States help people with schizophrenia? Schizophrenia Bulletin 2010; 36(5): 893–4.CrossRefGoogle ScholarPubMed
Bartlett, J. and Manderscheid, R.. What does mental health parity really mean for the care of people with serious mental illness? Psychiatric Clinics of North America 2016; 39(2): 331–42.CrossRefGoogle ScholarPubMed
Ostrow, L. and Manderscheid, R.. Medicare mental health parity: a high potential change that is long overdue. Journal of Behavioral Health Services and Research 2010; 37(3): 285–90.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×