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Comparison of Adult and Geriatric Psychiatric Practice Patterns

Findings From the American Psychiatric Association's Practice Research Network

Received December 14, 2000; revised March 27, 2001; accepted May 16, 2001. From the Department of Psychiatry, Michigan State University, East Lansing, Michigan (CCC,MAM), The University of Pennsylvania School of Social Work, Philadelphia, PA ((SCM), The Rand Corporation, Washington, DC ((TLT,HAP), and the Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania (HAP). Address correspondence to Dr. Colenda, College of Human Medicine, Michigan State University, East Lansing, MI 48824. e-mail: Colenda{at}msu.edu

OBJECTIVE: The authors explored diagnostic and treatment patterns for patients under and over age 65 seen by a nationally representative sample of psychiatrists participating in the American Psychiatric Association's Practice Research Network. METHODS: Detailed patient information, including demographic and financial characteristics, diagnoses, service utilization, and treatment, was collected by 383 psychiatrists on 1,026 patients to assess the impact of patient age on pharmacotherapy and psychotherapy service use as well as treatment outcomes. RESULTS: Approximately 15% of the patient sample was over age 65. Compared with patients ages 19–64, a lower percentage of geriatric patients had Axis I comorbidity, but a higher percentage had Axis III comorbidity. Geriatric patients were more often treated in hospital settings, and older patients were less likely to have their visits adversely affected by financial pressures of the healthcare system. Over 60% of patients in both age-groups received antidepressants, but there was a disproportionately increased use of antipsychotics and antianxiety/benzodiazepine medications among geriatric patients. Being age 65+ was a strong predictor for "improved" clinician rating on general assessment scores, but failed to be a predictor of receiving psychotherapy or pharmacotherapy. CONCLUSION: There were important differences between subject groups. Overall, American psychiatrists treat a complex group of geriatric patients suffering from major mental disorders complicated by medical comorbidity. Additional studies would further enhance our understanding of the delivery of mental health services to elderly patients and improve training of psychiatrists who help care for our aging population.

Key Words: Practice Techniques • Geriatric Psychiatry

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