Individuals with schizophrenia tend to have longer hospice stays than those without mental illness but are less likely to receive palliative care at the end of life, according to a study in the Journal of the American Geriatrics Society.Why It’s Relevant
People who have severe mental illness such as schizophrenia have higher rates of chronic, life-limiting medical conditions such as diabetes and cancer, yet they experience significant inequities in end-of-life care. Understanding the patterns of hospice and palliative care use in this population can guide more equitable end-of-life care.
By the Numbers
- Researchers analyzed data from 288,566 Medicare beneficiaries in Texas who died between 2016 and 2022 and had a chronic, life-limiting medical condition 13 to 24 months prior to death. Among the beneficiaries, 41.8% had at least one mental illness 13 to 24 months prior to death while 58.2% did not.
- Individuals with mental illness had longer hospice stays on average than those without mental illness (except for those with PTSD or alcohol/substance use). The largest disparity was among individuals with schizophrenia and related psychotic disorders (SRPD), who had average stays of 116 days versus 69 days in those without mental illness.
- Individuals with SRPD were also about three times as likely as those without mental illness to enroll in hospices early (>300 days before death) but slightly less likely to enroll within six months of death. However, individuals with SRPD were about 10% less likely to receive palliative care consultations.
The Other Side
The 13-to-24-month ascertainment window may not distinguish chronic psychiatric illness from episodic illness. In addition, some diagnoses (particularly depression) may reflect adjustment reactions to serious medical illness rather than pre-existing serious mental illness.
Takeaway Message
The differential enrollment pattern seen for individuals with SRPD highlights the need to develop better stage-specific interventions. “Clinicians should evaluate whether early referrals reflect appropriate recognition of limited prognosis or prognostic uncertainty better served by palliative care consultation alone,” the researchers wrote. For patients closer to the end of life, there is a need to address late-stage access barriers through systematic screening protocols and enhanced coordination between mental health and medical providers.
Related Information
Source
Sean O’Mahony, et al. Utilization of hospice and palliative care among patients with mental illness: a retrospective cohort study. Journal of the American Geriatrics Society. Published online July 11, 2026. doi:10.1111/jgs.70583
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