Age at Onset Predicts Longevity in Long-Term Care of Schizophrenia

A new investigation sought to clarify the predictors of longevity in long-term care facility residents with schizophrenia, finding an older age at onset, longer length of stay, and lower activities of daily living (ADL) scores were significant indicators of longevity.¹

This retrospective cross-sectional study evaluated the clinical records of nearly 150 patients with schizophrenia who died in a psychiatric long-term care facility between 2015 and 2017 in Taiwan.

“Management addressing modifiable risk factors is effective in enhancing life expectancy in schizophrenia, especially for males,” wrote the investigative team, led by Tsung-Cheng Hsieh, PhD, institute of medical sciences, Tzu-Chi University. “Considering the common characteristics among individuals with longevity, the age at onset may play an important role in reflecting the lifespan of schizophrenia.”

Schizophrenia impairs an individual’s cognitive and physical ability to function in daily life, but can also increase the risk for physical comorbidities.² Mortality in schizophrenia is more than 3.5-fold greater than in the general population, with age, gender, and psychotropic medication known factors to affect an individual’s life expectancy.³

A focus on addressing physical health conditions could be effective in reducing excess mortality rates in schizophrenia, as aging pronounces the impact of physical requirements, compared with mental health needs. In this analysis, Hsieh and colleagues noted the clear need for the implementation of care models wherein mental health and general healthcare systems collaborate on the evolving needs of patients with schizophrenia.¹

The team’s primary goal was to clarify real-world factors of longevity in patients with schizophrenia under long-term care, with secondary goals to elaborate on shared traits among this population. Overall, after a review of clinical records, 138 adults with schizophrenia were identified and classified into the longevity group (n = 45) and the control group (n = 93).

Utilizing life tables drawn from the Taiwan National Health Insurance Research Database (NHIRD) 2015–2017, Hsieh and colleagues defined longevity as a lifespan at or beyond the age corresponding to the 90th survival percentile specific to the contemporary population with schizophrenia. Cluster analysis evaluated shared traits among individuals with longevity, using significant predictors identified in a multivariable logistic regression analysis.

The full study population was, on average, 68 years at death, while the 45 participants in the longevity group achieved an average age of 80.5 years. Those in the longevity group had a significantly older age at onset (P = .010), longer length of stay (P <.001), lower daily dosages of antipsychotic medications (P <.001), and comprised a higher proportion of males ( P = .047).

Results of multivariate logistic regression analysis revealed the predictors significantly associated with longevity, including an older age at onset (adjusted odds ratio [aOR], 1.09; 95% CI, 1.02–1.17; P = .009), longer length of stay (aOR, 1.10; 95% CI, 1.04–1.15; P <.001), and hypertension diagnosis (aOR, 3.35; 95% CI, 1.11–10.13; P = .032). On the other hand, the ADL score within 1 year of death had an aOR of 0.98 (95% CI, 0.96–0.99; P =.001), suggesting a lower ADL score increased the likelihood of living longer.

Cluster analysis was used to identify two distinct groups among patients with schizophrenia, showing that despite poorer health indicators (mean ADL score, 54.51), Group 1 lived longer (P <.001) and had higher longevity (P = .002) than Group 2 (mean ADL score, 65.00).

Assessing the cause of fatalities, compared with pneumonia (mean, 68 years), Hsieh and colleagues found the age at death was significantly lower for cancer (mean, 63.2 years) and choking (mean, 61.4 years) fatalities.

In their summary, Hsieh and colleagues called for further research to validate these results and address the ideal balance between long-term residential care and community-based care for individuals with schizophrenia in later life.

“While these results seem contrary to conventional understanding, they can be clarified through the implementation of comprehensive long-term care involving coordination between mental health and general healthcare systems,” they wrote.

References

1. _{Yu C-H, Hsieh T-C. Predictors and shared traits of longevity within 1 year before death in patients with schizophrenia receiving long-term care: 3-year retrospective cross-sectional study. BJPsych Open. 2024;10(5):e166. doi:10.1192/bjo.2024.796}
2. _{Marder SR, Cannon TD. Schizophrenia. N Engl J Med. 2019;381(18):1753-1761. doi:10.1056/NEJMra1808803}
3. _{Olfson M, Gerhard T, Huang C, Crystal S, Stroup TS. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry. 2015;72(12):1172-1181. doi:10.1001/jamapsychiatry.2015.1737}