International Psychogeriatrics

Research Article

Mental distress and service utilization among help-seeking, community-dwelling older adults

Adam Simninga1, Thomas M. Richardsona1a2, Bruce Friedmana1a2, Lisa L. Boylea2, Carol Podgorskia2 and Yeates Conwella2 c1

a1 Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.

a2 Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.

ABSTRACT

Background: This study aimed to characterize healthcare and human services utilization among mentally distressed and non-distressed clients receiving in-home care management assessment by aging services provider network (ASPN) agencies in the U.S.A.

Methods: A two-hour research interview was administered to 378 English-speaking ASPN clients aged 60+ years in Monroe County, NY. A modified Cornell Services Index measured service utilization for the 90 days prior to the ASPN assessment. Clients with clinically significant anxiety or depressive symptoms were considered distressed.

Results: ASPN clients utilized a mean of 2.93 healthcare and 1.54 human services. The 42% of subjects who were distressed accessed more healthcare services (e.g. mental health, intensive medical services) and had more outpatient visits and days hospitalized than the non-distressed group. Contrary to expectations, distressed clients did not receive more human services. Among those who were distressed, over half had discussed their mental health with a medical professional in the past year, and half were currently taking a medication for their emotional state. A far smaller proportion had seen a mental health professional.

Conclusions: In the U.S.A., aging services providers serve a population with high medical illness burden and medical service utilization. Many clients also suffer from anxiety and depression, which they often have discussed with a medical professional and for which they are receiving medications. Few, however, have seen a mental health specialist preceding intake by the ASPN agency. Optimal care for this vulnerable, service intensive group would integrate primary medical and mental healthcare with delivery of community-based social services for older adults.

(Received November 03 2009)

(Revised February 18 2010)

(Revised March 09 2010)

(Accepted March 11 2010)

(Online publication May 18 2010)

Correspondence:

c1 Correspondence should be addressed to: Yeates Conwell, MD, University of Rochester School of Medicine and Dentistry, 300 Crittenden Blvd., Rochester, NY 14642, U.S.A. Phone: +1 (585) 275-6739; Fax: +1 (585) 273-1066. Email: yeates_conwell@urmc.rochester.edu.

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