Research — 03 August 2015

Older adults are given drug prescriptions for mental health issues at twice the rate of younger adults, according to a new study published in the Journal of the American Geriatrics Society. Yet this group is significantly less likely to receive mental health care from a psychiatrist.

This raises the question of whether primary care doctors may need more support to care for older people with depression, anxiety, and other mental health issues. The researchers are also concerned about whether older adults could be at greater risk for bad drug combinations and negative side effects.

“We need to pay special attention to polypharmacy, or multiple drugs taken at once, when prescribing psychotropic drugs in this population, because so many older adults are already on multiple medications,” says Maust, an assistant professor in the University of Michigan Department of Psychiatry.

The study, conducted by a team of researchers at the University of Michigan Medical School and VA Ann Arbor Healthcare System, is the first to compare overall outpatient mental health treatment in adults over age 65 with that of patients between ages of 18 and 64.

The concern of previous decades — that the nation’s seniors weren’t receiving attention for mental health problems — may now need to shift, says Donovan Maust, M.D., M.S., the geriatric psychiatrist who led the analysis.

“Our findings suggest that psychotropic medication use is widespread among older adults in outpatient care, at a far higher rate than among younger patients,” he says.

“In many cases, especially for milder depression and anxiety, the safer treatment for older adults who are already taking multiple medications for other conditions might be more therapy-oriented, but very few older adults receive this sort of care.”

Medication use is particularly concerning for seniors, because the risk/benefit balance can shift as they become more likely to experience side effects or other adverse events.

For example, anti-anxiety benzodiazepine drugs such as Valium, Xanax, Klonopin, and Ativan (and their generic counterparts) may be relatively safe for younger adults, but carry a higher risk of car accidents, falls, fractures, and a decline of thinking ability or memory for seniors.

Antidepressants can interact with blood thinners and painkillers and can raise blood pressure, all of which are more likely to be problems for older adults, who are generally on more medications than their younger counterparts.

The researchers looked at more than 100,000 outpatient doctor visits between 2007 and 2010 collected by the National Ambulatory Medical Care Survey.

They observed four types of visits: ones where patients received a mental health diagnosis; saw a psychiatrist; received psychotherapy; and/or received a prescription or renewal of a psychotropic medication (including antidepressants, anxiety-calming drugs called anxiolytics, mood stabilizers, antipsychotics, or stimulant drugs).

Visits related to antidepressant and anti-anxiety drug use among older adults occurred at nearly double the rates of such visits by younger adults. In contrast, older adults see psychiatrists at about half the rate of younger adults.

“While it’s still true that we have patients who are not getting treated for mental health concerns, these data suggest that we also need to be mindful of the possibility of overtreatment, especially given the changing balance of risk and benefit as patients age,” says Maust.

“Collaborative care efforts in primary care that seek to create structure and support for these patients, along with appropriate reimbursement for this type of service, could be key.”

This article first appeared on ‘Psych Central’ on 31 July 2015.

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