Older Adults Are More Likely to Receive Prescriptions for Depression, Anxiety
Abstract
Per capita, adults aged 65 and over were prescribed these medications at around twice the rate of younger adults. Seniors also received fewer psychotherapy visits on average.
Adults aged 65 and over are receiving prescriptions for some psychiatric medications at more than twice the rate of younger adults—though they’re less likely to be getting these prescriptions from a psychiatrist, according to a study published July 29 in the Journal of the American Geriatrics Society.
“The big worry used to be that seniors were not being treated enough for mental health issues,” said Donovan Maust, M.D., a geriatric psychiatrist at the University of Michigan who led this study.
“Now, the results suggest that psychotropic medication is becoming pervasive among older adults.”
Maust and his colleagues at Michigan and the Veterans Administration Ann Arbor Healthcare System examined outpatient data from 2007 to 2010 that was obtained from the Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey.
They found that on a per capita basis, older adults (aged 65 and older) received a mental health–related diagnosis at about the same rate as younger adults (aged 21 to 64). However, older adults had around 121 medical visits annually per 100 people that resulted in the prescription or renewal of a psychotropic medication compared with a rate of 57 such visits per 100 people per year for younger adults.
Key Points
Researchers analyzed more than 100,000 visits to office-based physicians in the United States from 2007 to 2010 and compared the prevalence of visits related to mental health (for example, visit to a psychiatrist or any visit resulting in a psychotropic prescription) between older (65 and up) and younger adults.
Older and younger adults had a similar number of annual visits resulting in a mental health diagnosis (32.01 and 28.12 visits per 100 people, respectively).
Older adults were more than twice as likely to receive a new or refilled psychotropic prescription (121.14 versus 56.77).
Older adults were less likely to visit a psychiatrist (6.32 vs. 11.82) or receive psychotherapy (4.34 versus 6.78).
Bottom Line: On a per-population basis, older adults receive less care from psychiatrists, less psychotherapy for mental health issues, and a far higher number of psychotropic prescriptions than younger adults.
Among seniors, only 4 percent of the visits that resulted in a prescription for a psychotropic medication were with a psychiatrist compared with 17 percent in younger adults.
There was no real difference in the rates of prescriptions of stimulants, mood stabilizers, or antipsychotics between the two groups; antidepressants and anti-anxiety medications, though, were prescribed roughly twice as much for older adults.
Maust believes that many of the prescriptions for antidepressants and anxiolytics are likely for mild cases of depression and anxiety that could be more safely treated with psychotherapy. According to the study data, older adults had a lower rate of therapy-related visits than their younger peers (4.3 annual visits per 100 people compared with 6.8).
“This pattern of resorting to psychotropic medications instead of expert psychiatric care and specifically the use of psychotherapy for older adults with mental illnesses reflects, at least in part, both the prevalent ageism and a tendency for a quick fix with medications,” said Dilip Jeste, M.D., former APA president and Distinguished Professor of Psychiatry and Neurosciences at the University of California, San Diego.
“There is a commonly held belief, even among primary care physicians, that older adults do not respond to psychosocial interventions. The literature actually shows that appropriate psychotherapeutic management is useful in older adults, and that overuse of medications may cause more harm than good, given the high risk of pharmacokinetic and pharmacodynamic changes associated with aging,” Jeste continued.
Interestingly, 20 percent of the psychotherapy visits attended by older adults were handled by a primary care doctor—more than twice as high as that seen in younger adults.
“It’s encouraging that primary care physicians are trying to help provide psychotherapy, but realistically we can’t ask them to do that with everything else that they have going on,” Maust told Psychiatric News.
Maust suggested that if social workers were trained to conduct brief psychotherapy courses, they might be able to help fill in this gap. Additionally, seniors who may be reluctant to see a psychiatrist might be more willing to consider psychotherapy with a social worker, he said.
Psychiatrists can still play a role to help reduce this high rate of medicine usage, though. “Ultimately, the push for collaborative care is an important one,” Maust said. “Psychiatrists could serve as consultants at a care center, work with primary care doctors to oversee a group of patients, and provide their expertise without disrupting the doctor-patient relationship.”
The work was funded with support from the National Institute on Aging, the American Federation for Aging Research, the John A. Hartford Foundation, and the Atlantic Philanthropies. ■
An abstract for "Mental Health Care Delivered to Younger and Older Adults by Office-Based Physicians Nationally" can be accessed here.
