Cardiovascular disease in older people with serious mental illness: Current challenges and future directions

By 2050, it is projected that the population of over 60 years old will reach 2.1 billion, from 900 million in 2015 (1). A total of 20% of this cohort have a neurological or mental health disorder, which is expected to rise in line with these changing population demographics (2). Anxiety, substance abuse disorders, schizophrenia and bipolar disorder are also seen commonly in older people. Serious mental illness (SMI) is a term used to group several common psychiatric disorders (schizophrenia, bipolar affective disorder and major depressive disorder) which significantly affect functional abilities (3). While the mortality gap remains significant between people living with SMI and the general population, older people with SMI are routinely cared for by old age psychiatrists and have distinct challenges from the younger SMI population (4). These challenges include greater frailty, high levels of physical health morbidity, polypharmacy, and greater levels of cognitive and functional impairments (1). A recent study found that 17.5% of 65–84 year olds have both a physical and mental health condition, rising to ∼30% of over 85 year olds (5). There is a substantial interplay between physical and mental health and people with SMI have a 10–20 year reduction in life expectancy compared to those without (6, 7).