U-M study indicates frail elders vulnerable to mental health problems

ANN ARBOR, Mich.—Meals and personal care services are often brought to frail elders living at home, but a University of Michigan researcher says mental health care should be delivered, too.

In a study published in the August issue of The Gerontologist, researcher Lydia Li examined the mental health status of elders who remain in their homes in Michigan.

The sample composed of nearly 19,000 older adults (age 65 or older) who were admitted to two community-based, long-term care programs in Michigan—Medicaid Waiver and Care Management—between 1998 and 2003. These programs help individuals who are at risk of nursing home placement to remain in the community by providing them with supportive services, such as meal delivery, homemaking and personal emergency response systems.

All applicants to the programs are assessed by case managers, who are social workers or nurses, to determine their needs and to develop a care plan, said Li, an associate professor in the U-M School of Social Work and the study’s lead author.

Using the assessment data obtained from the sample, the researchers found that about 40 percent of the sample had a mental disorder, with depression (32 percent) being the most prevalent, followed by anxiety (18.8 percent). Psychotropic medications were used by nearly 40 percent of the respondents, with antidepressants (26.9 percent) and anti-anxiety (17.4 percent) as the most commonly used. About 25 percent of the sample exhibited depressive symptoms that warranted further investigation, and 1.4 percent reported having self-injury thoughts or attempts.

“This study makes an important contribution by revealing frail elders’ vulnerability to mental health problems,” Li said. “It seems imperative that mental health care be a component of community-based, long-term care programs, which may also be cost effective.”

Li collaborated on the study with Yeates Conwell, a researcher at the University of Rochester Medical Center.

When factoring various sociodemographic and clinical characteristics, the researchers found that greater pain, more diseases, and higher levels of physical and cognitive impairments increase the likelihood of having mental health problems.

“These findings suggest that, if resources are limited and mental health services have to target those individuals who are most in need, then the most vulnerable segment of the frail elderly population should be given a top priority,” the authors noted.

Being female, white and a “young” elder also increase the likelihood of having mental health problems, she said.

“While it is consistent with previous research that women are more susceptible to psychological distress than men, frail elders who are younger may have a more difficult time to accept their frailty than those who are older,” Li said. “However, the findings related to race should be interpreted cautiously. It is possible that the measures used in the study do not adequately assess the mental health of Black elders.”