Increased risk of nursing home admission among middle aged and older adults with schizophrenia

Abstract

Objective: Cross-sectional data indicate that persons with serious mental illness have increased risk of institution-based care, yet little is known about the long-term course of nursing home placement for persons with schizophrenia. This study describes nursing home entrance over a 10-year period among community residing Medicaid enrollees with schizophrenia compared with Medicaid enrollees with no mental illness.

Methods: The authors analyzed claims of 7,937 New Hampshire Medicaid beneficiaries aged 40 and older. Claims were followed annually from 1996 to 2005 to determine nursing home admission. Schizophrenia was identified from International Classification of Diseases: 9th Edition codes and used to model nursing home admission controlling for medical severity, physical disability, sex, and age. Cox proportional hazard models were run for the entire sample and then separately for middle-aged (40-64 years) and older-aged (65 years and older) subgroups.

Results: Persons with schizophrenia enter nursing homes earlier (median age 65) than persons with no mental illness (median age: 80). The greatest relative disparity occurs at middle age (40-64 years), where nursing home admission risk was 3.90 (95% confidence interval = 2.86-5.31) times greater for persons with schizophrenia than for persons with no mental illness.

Conclusions: Middle-aged persons with schizophrenia have almost four times greater likelihood of early institutionalization in nursing homes compared with their same age peers with no mental illness. Efforts to prevent/reduce unwarranted nursing home admission among persons with schizophrenia should focus on health status in the fifth decade of life.

FIGURE 1. Schizophrenia Versus No Mental Illness: Hazard Plots

Each of the plots is drawn on a separate scale. The cumulative hazard (Y axis) across the time period (X axis) for individuals over age 65 is higher (0.1– 0.7) than the cumulative hazard for the middle-aged group (0.01– 0.13), indicating the overall greater risk of nursing home entrance among older adults compared with middle-aged persons. However, the slopes of the lines within each age-group chart show the relative likelihood of nursing home entrance for persons with schizophrenia compared with those persons with no mental illness.