Mental health service use by the elderly in nursing homes

Objectives. Because current Omnibus Budget Reconciliation Act regulations influence the disposition of US nursing home residents who have mental illness, National Nursing Home Survey (1985) data are analyzed for predictors of mental health service use. Methods. Elderly residents' rates of mental health service use are presented. Logistic regression yielded odds ratios for treatment by both mental health specialists and general practitioners for client and service system variables. Results. Among the two thirds of elderly residents with a mental disorder (including dementia), only 4.5% receive any mental health treatment in a 1-month period. The ratio of specialist to general practitioner care is approximately 1:1. Patients seen by a specialist are likely to be younger (aged 65 to 74); live in the Northeast; and have diagnosis of schizophrenia (13:1), dementia (3:1), or other mental disorders (5:1). Prior residence in a psychiatric hospital predicts care by both health professional types. Rural location, nonpropriety ownership of the nursing home, and aggressive behavior point to general physician care. Conclusions. Our findings indicate significant neglect of the mental health needs of older nursing home residents underscore the importance of monitoring the regulations for screening and treatment of mental disorders under the Omnibus Budget Reconciliation Act. (AmJ Public Health. 1993;83:331-337)
Elderly nursing home residents may need more screening and treatment for mental disorders. Among 4,646 residents of a nursing home, 51% were suffering from dementia, 4% from schizophrenia or another psychosis and 11% from other types of mental disorders. Fewer than 5% of these patients received any type of treatment for mental health disorders over a one-month period. The number of patients who received treatment from a general practitioner was equal to the number who received treatment from a specialist. Patients between 64 and 75 years old were more likely to be treated by a specialist than those over 75 years old. Patients suffering from schizophrenia, dementia or other mental disorders were more likely to be treated by a specialist than those suffering from other disorders. Patients treated by a general practitioner were more likely to reside in a rural area or exhibit aggressive behavior than those treated by a specialist.