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Maust DT, Kales HC, Blow FC. Mental Health Care Delivered to Younger and Older Adults by Office-Based Physicians Nationally. Journal of the American Geriatrics Society. 2015 Jul 3; 63(7):1364-72.
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.