Mental Health Care Delivered to Younger and Older Adults by Office-Based Physicians Nationally

Authors

  • Donovan T. Maust MD, MS,

    Corresponding author
    1. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
    2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
    3. Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    • Address correspondence to Donovan T. Maust, Department of Psychiatry, NCRC, 2800 Plymouth Road, Building 16, Room 222W, University of Michigan, Ann Arbor, MI 48109. E-mail: maustd@umich.edu

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  • Helen C. Kales MD,

    1. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
    2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
    3. Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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  • Frederic C. Blow PhD

    1. Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
    2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
    3. Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Abstract

Objectives

To compare the provision of mental health care to older adults with that provided to younger adults.

Design

Analysis of the National Ambulatory Medical Care Survey.

Setting

Visits to office-based physicians in the United States, 2007 to 2010 (n = 100,661 visits).

Participants

Individuals with an outpatient visit resulting in a mental health diagnosis or treatment, defined as a visit resulting in a mental disorder diagnosis, at which a psychotropic medication was prescribed, to a psychiatrist, or including psychotherapy.

Measurements

The number of each type of mental healthcare visit was estimated according to participant age (21 to 64, ≥65), along with the percentage this represented of all office-based care and the annual visit rate per 100 population. Within each visit type, age groups were compared according to clinical and demographic characteristics such as sex, diagnosed mental illness, and use of psychotropic agents.

Results

Older adults had a smaller proportion than younger adults of visits with a mental disorder diagnosis (4.8% vs 9.5%, chi-square = 228.21, P < .001), to a psychiatrist (0.9% vs 4.0%, chi-square = 233.76, P < .001), and including psychotherapy (0.6% vs 2.3%, chi-square = 57.65, P < .001). The percentage of older adult psychotropic visits was slightly smaller than of younger adult visits (18.1% vs 19.2%, chi-square = 5.33, P = .02). Older adults had a higher rate of psychotropic visits (121.4 per 100 population) than younger adults (56.8 per 100 population).

Conclusion

Less care of older adults is from psychiatrists or incorporates psychotherapy. Older adults have a far higher rate of psychotropic use than younger adults on a per-population basis. Addressing the mental healthcare needs of older adults will require care in nonspecialty settings.

Ancillary