Health outcomes and cost of care among older adults with schizophrenia: A 10-year study using medical records across the continuum of care

Hugh C. Hendrie, Wanzhu Tu, Rebeka Tabbey, Christianna E. Purnell, Roberta J. Ambuehl, Christopher M. Callahan

Research output: Contribution to journalArticle

30 Scopus citations


Objectives: The population of older patients with schizophrenia is increasing. This study describes health outcomes, utilization, and costs over 10 years in a sample of older patients with schizophrenia compared with older patients without schizophrenia. Methods: An observational cohort study of 31,588 older adults (mean age: 70.44 years) receiving care from an urban public health system, including a community mental health center, during 1999-2008. Of these, 1,635 (5.2%) were diagnosed with schizophrenia and 757 (2.4%) had this diagnosis confirmed in the community mental health center. Patients' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Dataset, and the Outcome and Assessment Information Set. Information on medication use was not available. Measurements: Rates of comorbid conditions, healthcare utilization, costs, and mortality. Results: Patients with schizophrenia had significantly higher rates of congestive heart failure (45.05% versus 38.84%), chronic obstructive pulmonary disease (52.71% versus 41.41%), and hypothyroidism (36.72% versus 26.73%) than the patients without schizophrenia (p <0.001). They had significantly lower rates of cancer (30.78% versus 43.18%) and significantly higher rates of dementia (64.46% versus 32.13%). The patients with schizophrenia had significantly higher mortality risk (hazard ratio: 1.25, 95% confidence interval: 1.07-1.47) than the patients without schizophrenia. They also had significantly higher rates of healthcare utilization. The mean costs for Medicare and Medicaid were significantly higher for the patients with schizophrenia than for the patients without schizophrenia. Conclusions: The management of older adult patients with schizophrenia is creating a serious burden for our healthcare system, requiring the development of integrated models of healthcare.

Original languageEnglish (US)
Pages (from-to)427-436
Number of pages10
JournalAmerican Journal of Geriatric Psychiatry
Issue number5
StatePublished - May 2014



  • Cancer
  • Comorbidity
  • Dementia
  • Hospital care
  • Mortality
  • Nursing home

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Geriatrics and Gerontology
  • Medicine(all)

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