LAUSR

Abstract Background Whilst there is considerable focus on early intervention for young people with psychotic disorders, there is little research looking at older people. Although some of these individuals have a recent onset, most will have been living with psychosis for many years. The older population has increased risks of cardiometabolic complications and this is likely to be complicated by psychosis. Methods The Australian Survey of People Living with Psychosis included 1478 participants aged 18–49 years, and 346 participants aged 50–64 years. The two groups were compared across a range of demographic, diagnostic, physical health, substance abuse and lifestyle factors. Results The older group contained significantly more women (48.3% vs 38.6%, p<0.0001). There was a smaller proportion of people with ICD-10 schizophrenia (36.1% vs 45.4% p<0.012), and higher proportions with schizoaffective disorder and affective psychoses. Significantly fewer of the older participants were prescribed clozapine (11.0% vs 16.8%, p < 0.0001). The mean age of onset was later in the older group (30.05 vs 22.23 years, p < 0.0001). There was a striking difference in rates of drug and alcohol abuse. The older group had lower rates of hazardous, harmful or dependent drinking (15.3% vs 35.9%, p < 0.0001), lifetime cannabis use (35.6% vs 74.1%, p < 0.0001), past year cannabis use (11.1% vs 38.1%, p < 0.0001), lifetime amphetamine use (12.8% vs 47.0%, p < 0.0001), and past year amphetamine use (2.9% vs 14.9%, p < 0.0001). The older group were also less likely to currently smoke tobacco (56.9% vs 68.9%, p < 0.0001). Older people were more likely to live alone (45.1% vs 28.6%, p < 0.000). They were less likely to experience food poverty; in the last year 19.5% of older people and 30.7% of younger people had run out of food and did not have money to buy more. Cognitive function was poorer with slower processing speed in the older group, with the NART error score indicating premorbid intelligence was lower in the older group. Older people were more likely to be overweight or obese (80.6% vs 74.3%, p < 0.0001), as well as being more likely to have metabolic syndrome (56.1% vs 48.5%, p = 0.034). There was a greater proportion with very low exercise in the older group (41.6% vs 31.7% p = 0.003). Discussion Older people with psychosis are more likely to be female and more likely to be diagnosed with an affective psychosis. The poorer cognitive function and higher rates of obesity and metabolic syndrome are consistent with changes seen in aging in the normal population. The older group have much lower rates of both lifetime and current drug and alcohol abuse, and smoking. Whilst there is considerable attention to cardiovascular health as a determinant of premature mortality, our results suggest that lifetime alcohol, cannabis and amphetamine use may also be associated with failure to survive into older age.