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Somatische Risiken bei alt gewordenen Menschen mit schweren psychiatrischen Erkrankungen

Somatic risks in elderly people with severe psychiatric illnesses

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Zusammenfassung

Hintergrund

Patienten mit schweren psychiatrischen Erkrankungen („severe mental illness“, SMI) zeichnen sich durch ein hohes Maß an funktioneller Beeinträchtigung, aber auch durch eine hohe somatische Multimorbidität aus. Bislang existieren kaum systematische Untersuchungen zu dieser Patientengruppe in hohem Lebensalter. Der vorliegende Review fasst die wichtigsten somatischen Komorbiditäten zusammen und erwägt Konsequenzen für die Versorgung dieser Patientengruppe im hohen Lebensalter.

Methodik

Selektive Übersichtsarbeit auf der Basis einer PubMed-Recherche, Beobachtungen aus klinischer Praxis

Ergebnisse

Die Lebenserwartung von Menschen mit SMI ist im Mittel um etwa 10 Jahre verkürzt. Grund hierfür sind vor allem somatische Komorbiditäten, insbesondere Lungen- und Atemwegserkrankungen, das metabolische Syndrom mit konsekutiven kardiovaskulären Erkrankungen sowie Osteoporose und Frakturen mit kompliziertem Verlauf. Trotz der verkürzten Lebenserwartung nimmt die Zahl geriatrischer Patienten mit SMI zu und erfordert besondere Aufmerksamkeit bezüglich der ambulanten psychosozialen Versorgung, des Selbstmanagements von somatischen Erkrankungen und der altersadäquaten Fortsetzung der psychiatrischen Behandlung.

Schlussfolgerungen

Menschen mit SMI haben aufgrund ihrer typischen somatischen Komorbidität eine stark verkürzte Lebenserwartung, erreichen aber im Rahmen der allgemein verbesserten Behandlungsmöglichkeiten immer häufiger ein hohes Lebensalter. Sie benötigen häufig besondere Aufmerksamkeit bei der Diagnostik und Unterstützung im Management ihrer Behandlung. Vernetzte internistisch-geriatrische und gerontopsychiatrische Behandlungseinrichtungen sind hilfreich für die notwendige interdisziplinäre Behandlung.

Abstract

Background

Aged patients with severe mental illness (SMI) suffer from a high risk for functional impairment and a high load of somatic comorbidities. Until now, there has been a lack of systematic studies on this patient population in later life. This review summarizes the most significant somatic comorbidities and discusses the consequences for the medical care of this elderly group of patients.

Methods

A selective narrative review based on PubMed research and observations in clinical practice.

Results

Life expectancy is shortened by approximately 10 years in patients with SMI. The main reasons are somatic comorbidities, particularly lung and respiratory tract disorders, metabolic syndrome with its subsequent cardiovascular complications, in addition to osteoporosis and fractures with a complicated clinical course. Although life expectancy is shortened, the number of geriatric patients with SMI is increasing and requires special attention to be given to out-patient psychosocial care, self-management of somatic diseases, and to age-appropriate continuation of psychiatric treatment.

Conclusion

The life expectancy of patients with SMI is reduced because of their typically somatic comorbidity, but they are reaching increasingly advanced ages as a consequence of improved treatment possibilities. They often require special attention in their diagnostic work-up and support in the management of their treatment. Collaborative care linking medical geriatric and geronto-psychiatric treatment facilities is helpful in the the interdisciplinary therapy required.

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Authors and Affiliations

  1. Geriatrische Klinik, Zentrum für klinische Psychologie und Psychotherapie, Kath. Marienkrankenhaus gGmbH, Alfredstraße 9, 22087, Hamburg, Deutschland

    Daniel Kopf

  2. Klinik für Gerontopsychiatrie, Klinikum Christophsbad, Göppingen, Deutschland

    Walter Hewer

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Correspondence to Daniel Kopf.

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D. Kopf und W. Hewer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kopf, D., Hewer, W. Somatische Risiken bei alt gewordenen Menschen mit schweren psychiatrischen Erkrankungen. Z Gerontol Geriat 51, 779–784 (2018). https://doi.org/10.1007/s00391-018-1458-9

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