Mental Health Hospitalizations Among Autistic Older Adults
Why is this important?
Autistic older adults can experience more mental health conditions than non-Autistic older adults, so it’s important to understand how Autistic older adults use mental health services. Autistic older adults may have a harder time getting mental healthcare than non-Autistic older adults. They can be hospitalized for mental health reasons when symptoms worsen. We focused on understanding mental health hospitalizations among Autistic older adults in the United States because understanding how Autistic older adults in the US use mental health services can improve health service delivery.
Study Purpose
The research team compared mental health hospitalizations in Autistic older adults to non-Autistic older adults. The team also looked at how mental health hospitalizations differed if Autistic older adults did or did not have an intellectual disability.
Study Information
Method
The research team used data from Medicare, a publicly funded health insurance for Americans aged 65+ and Americans of all ages with some disabilities. The sample included 6,518 Autistic older adults and 12,945 population controls matched by characteristics like age, sex, and race. The team compared these two groups in terms of mental health hospitalizations, length of hospital stay, and likelihood of having another mental health hospitalization (re-hospitalizations). Finally, the team looked at how these findings changed the comparison if Autistic older adults did or did not have an intellectual disability.
Results
While Autistic and non-Autistic older adults in the study had a similar likelihood of having a mental health hospitalization, Autistic older adults stayed in the hospital 23% longer than non-Autistic older adults when they were admitted for mental health hospitalizations. Autistic older adults also had higher odds of being re-hospitalized within 90 and 180 days.
When compared to non-Autistic older adults, Autistic older adults without intellectual disability had higher odds of having a mental health hospitalization and a longer stay than non-Autistic older adults, while Autistic older adults with intellectual disability had lower odds of having a mental health hospitalization.
Conclusions
Autistic and non-autistic older adults had similar likelihood of having a mental health hospitalization, but when admitted, Autistic older adults stayed in the hospital longer and were more likely to have another mental health hospitalization (re-hospitalization) within 90 and 180 days.
The findings suggest that Autistic older adults in the US, especially those without an intellectual disability, may need more support for their mental health conditions in the community.
Autistic Heterogeneity and Intellectual Disability
The Autistic population is very heterogeneous, meaning there are a lot of differences in symptoms, communication abilities, and overall experiences of life. Some Autistic people have intellectual disability, which means they have limitations in functioning and behavior. These differences can influence use of medical and mental health services. It’s important to understand that no two Autistic people are the same; the findings from this research study can help service providers and policymakers to improve service delivery.
Study Limitations
Since the team used Medicare data, study findings are specific to the US healthcare system. Additionally, current Autistic older adults may have different experiences with mental health hospitalizations than future Autistic older adults, since the adults in the study were born and became adults before Autism was formally recognized as a diagnosis in 1980. Also, Medicare data does not include information about social support, like help from family or caregivers, which can affect the use of mental health services.
Factors to Consider
Social Determinants of Health (SDoH)
Social determinants of health are non-medical, environmental conditions that can heavily influence health, daily functioning, and quality of life. According to the US Department of Health and Human Services, SDoH relate to where people are born, live, work, play, and age; they include things like education access, health care quality, neighborhood structures, and social context.
Home and Community-Based Services (HCBS)
In the US, Autistic individuals with intellectual disability qualify for Home and Community-Based services (HCBS), which provide government-funded support to improve health and welfare. In many states, HCBS doesn’t apply to Autistic people without intellectual disability, and waitlists to receive services can be lengthy, but consistent access to HCBS throughout adulthood may be important to manage mental health conditions.
Mental Health Treatment For Autistic Adults
Autistic people can have higher mental health needs than non-Autistic people, so it’s important for Autistic people and their support system to find mental healthcare that meets specific needs. Working with service providers who understand autism and are trained to recognize autistic needs can be very helpful.
Searching provider lists like the Psychology Today for autism service providers can be a good starting point for finding mental health treatment appropriate to unique needs:
https://www.psychologytoday.com/us
Next Steps for Research
The findings from this research study indicate that Autistic older adults without intellectual disability may need individually tailored mental health care services to meet their unique needs. Future research should further examine community-based mental healthcare service use and social determinants of health to understand the big picture related to psychiatric and mental health hospitalizations for Autistic older adults, especially because this is a growing population.
Study Title, Authors & Affiliation
“Psychiatric Hospitalizations Among Autistic and Non-Autistic Medicare Beneficiaries”
Deitsch, A., Nikahd, M., Hyer, J.M., Wolf, B., Patterson, B., Bishop, L., & Hand, B.N.
The Ohio State University; Medical University of South Carolina; University of Wisconsin – Madison