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Chronic Physical Conditions in Older Adults with Mental Illness and/ or Substance Use Disorders

Authors

  • Wen-Chieh Lin PhD,

    Corresponding author
    1. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Shrewsbury, Massachusetts
    • Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts
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  • Jianying Zhang MD, MPH,

    1. Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts
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  • Gary Y. Leung PhD,

    1. Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts
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  • Robin E. Clark PhD

    1. Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, Massachusetts
    2. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Shrewsbury, Massachusetts
    3. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Shrewsbury, Massachusetts
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  • Related paper presentation: Findings from the initial analysis for this manuscript were presented at the 63rd Annual Scientific Meeting of the Gerontological Society of America, New Orleans, LA, November 2010.

Address correspondence to Wen-Chieh Lin, Center for Health Policy and Research and Department of Family Medicine and Community Health, University of Massachusetts Medical School, Shrewsbury, MA 01545. E-mail: wen.lin@umassmed.edu

Abstract

Objectives

To examine the association between mental illness and chronic physical conditions in older adults and investigate whether co-occurring substance use disorders (SUDs) are associated with greater risk of chronic physical conditions beyond mental illness alone.

Design

A retrospective cross-sectional study.

Setting

Medicare and Medicaid programs in Massachusetts.

Participants

Massachusetts Medicare and Medicaid members aged 65 and older as of January 1, 2005 (N = 679,182).

Measurements

Diagnoses recorded on Medicare and Medicaid claims were used to identify mental illness, SUDs, and 15 selected chronic physical conditions.

Results

Community-dwelling older adults with mental illness or SUDs had higher adjusted risk for 14 of the 15 selected chronic physical conditions than those without these disorders; the only exception was eye diseases. Moreover, those with co-occurring SUDs and mental illness had the highest adjusted risk for 11 of these chronic conditions. For residents of long-term care facilities, mental illness and SUDs were only moderately associated with the risk of chronic physical conditions.

Conclusion

Community-dwelling older adults with mental illness or SUDs, particularly when they co-occurred, had substantially greater medical comorbidity than those without these disorders. For residents of long-term care facilities, the generally uniformly high medical comorbidity may have moderated this relationship, although their high prevalence of mental illness and SUDs signified greater healthcare needs. These findings strongly suggest the imminent need for integrating general medical care, mental health services, and addiction health services for older adults with mental illness or SUDs.

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