Abstract
ObjectivesOlder adults with psychiatric disorders have a substantially lower life expectancy than age‐matched controls. Knowledge of risk factors may lead to targeting treatment and interventions to reduce this gap in life expectancy. In this study, we investigated whether frailty independently predicts mortality in older patients following an acute admission to a geriatric psychiatry hospital.MethodsClinical cohort study with a 5‐year follow‐up of 120 older patients admitted to a psychiatric hospital between February 2009 and September 2010. On admission, we assessed frailty with a frailty index (FI). We applied Cox regression analyses with time to death as the dependent variable, to examine whether the FI was a predictor for mortality, adjusted for age, sex, level of education, multimorbidity (Cumulative Illness Rating Scale for Geriatrics, CIRS‐G scores), functional status (Barthel Index), neuropsychiatric symptoms (NPS), and severity of psychiatric symptoms at admission (Clinical Global Impressions Scale of Severity).ResultsOf the 120 patients, 63 (53%) patients were frail (FI ≥ 0.25), and 59 (49%) had died within 5 years. The FI predicted mortality with a hazard ratio (HR) of 1.78 (95% CI, 1.06‐2.98) per 0.1 point increase, independent of the covariates. Co‐morbidity measured by the CIRS‐G and functional status measured by the Barthel Index were not significantly associated.ConclusionsFrailty was a strong predictor of mortality, independent of age, gender, multimorbidity, and functional status. This implies that frailty may be helpful in targeting inpatient psychiatric treatment and aftercare according to patients' life expectancy.
Highlights
ObjectivesOlder adults with psychiatric disorders have a substantially lower life expectancy than age-matched controls
It is well recognized that adults with severe psychiatric disorders have on average a life expectancy of about 10 years less and a mortality rate two times higher than age-matched controls.[1,2,3] The excess mortality is mostly due to somatic co-morbidity: especially cardiovascular and infectious, endocrine, pulmonary, and oncologic diseases.[1,2,4,5]A substantial loss in life expectancy persists in older adults with psychiatric disorders,[6,7] but risk factors may be different from those at younger age
This implies that frailty may be helpful in targeting inpatient psychiatric treatment and aftercare according to patients' life expectancy
Summary
Older adults with psychiatric disorders have a substantially lower life expectancy than age-matched controls. We investigated whether frailty independently predicts mortality in older patients following an acute admission to a geriatric psychiatry hospital. We applied Cox regression analyses with time to death as the dependent variable, to examine whether the FI was a predictor for mortality, adjusted for age, sex, level of education, multimorbidity (Cumulative Illness Rating Scale for Geriatrics, CIRS-G scores), functional status (Barthel Index), neuropsychiatric symptoms (NPS), and severity of psychiatric symptoms at admission (Clinical Global Impressions Scale of Severity). Conclusions: Frailty was a strong predictor of mortality, independent of age, gender, multimorbidity, and functional status. This implies that frailty may be helpful in targeting inpatient psychiatric treatment and aftercare according to patients' life expectancy.
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