Two hundred fifty-five individuals had information from all 3 sources 55, from the psychiatric examination and the key-informant interview 30, from the psychiatric examination and medical records and 7, from the psychiatric examination only. Medical records from all major hospitals, geriatric and psychiatric institutions, and outpatient services in Göteborg were found for 283 individuals and reviewed by trained psychiatrists. Participants (n =305) and nonparticipants (n = 42) in the key-informant interview did not differ regarding the prevalence of psychotic symptoms in the psychiatric examination(data not shown).

Forty of the participants and key informants for 2 participants refused the key-informant interview, leaving 305 individuals for this examination. 17 Demented subjects (n= 147) were excluded in this study, leaving 347 individuals. This sample was representative of its population base with regard to sex, marital status, status as psychiatric outpatients or inpatients, institutionalization rate, and 3-year mortality. Forty-three individuals died before the psychiatric examination, leaving an effective sample of 783 individuals, of whom 494 (63.1%) were examined by a psychiatrist. Those with numbers 1, 2, 11, 12, or14 (n = 826) were selected for a psychiatric examination. 17 - 19 All individuals in the census register were consecutively (after date of birth) given a number from 1 to 5 or 11 to 15. 15, 16 We examined the prevalence of psychotic symptoms and paranoid ideation in relation to psychosocial risk factors, psychiatric and somatic disorders, sensory impairments, cognitive and daily living functioning, mortality rate, development of dementia, and symptom stability over time in a representative sample of nondemented subjects aged 85 years using information from psychiatric examinations, key-informant interviews, and medical records.įrom January 1, 1986, through December 31, 1987, all individuals born July 1, 1901, to June 30, 1902, and registered for census purposes in Göteborg, Sweden (N = 1502, living in the community or in institutions), were invited to participate in a health survey, the Longitudinal Gerontological and Geriatric Population Study (project leader for 1971-1987, Alvar Svanborg, MD, PhD for1988, Bertil Steen, MD, PhD). Studies of demented individuals report that information from caregivers yields higher rates of psychopathology than do the results of clinical examinations alone. 14 Thus, it is necessary to collect information from collateral sources, eg, key informants and medical records, to obtain more accurate estimates. 12, 13 It has been suggested that this prevalence is underrated because the elderly persons may be reluctant to report psychotic symptoms. POPULATION studies reporting psychotic symptoms and paranoid ideation in elderly persons indicate a low prevalence of these symptoms, 1 - 11 although frequencies may be higher in the very old. Hallucinations and paranoid ideation were associated with increased 3-year mortality in women but not in men.Ĭonclusions We found a higher prevalence of psychotic symptoms and paranoid ideation in the elderly than previously reported, and these symptoms were associated with a poor prognosis. Hallucinations (OR, 3.1 95% CI, 1.4-6.8), delusions(OR, 2.9 95% CI, 1.2-6.9), and paranoid ideation (OR, 2.7 95% CI, 1.2-6.2) were each related to increased incidence of dementia from 85 to 88 years of age. Paranoid ideation was associated with visual deficits (OR, 3.6 95% CI, 1.2-10.5) and myocardial infarction(OR, 4.6 95% CI, 1.7-12.6). Delusions were associated with disability in daily life (OR, 4.9 95% CI, 1.8-13.3). Stepwise logistic regression analyses showed that hallucinations were associated with major depressive syndrome (odds ratio, 3.9 95% CI, 1.3-11.9), disability in daily life (OR, 5.2 95% CI, 1.8-14.9), and visual deficits (OR, 3.4 95% CI, 1.0-11.1). The sample was observed for 3 years regarding psychotic symptoms, mortality, and incident dementia.

Methods Psychotic symptoms, physical disorders, disability in daily life, and sensory impairments were assessed using results of psychiatric and physical examinations, key-informant interviews, and medical record reviews in a representative sample of nondemented individuals aged 85 years living in the community or in institutions in Göteborg, Sweden (n = 347). Shared Decision Making and Communicationīackground Psychotic symptoms are reported to be uncommon in the elderly, and may be underrated in traditional epidemiological studies.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.