Profiles of psychiatric and substance use disorders among older adults

BACKGROUND: Adults aged 55 or older represent the largest growing demographic category. Yet, little is known about the patterns and features of psychiatric disorders during this developmental period of advanced age.

AIMS: To estimate the 12-month prevalence, co-morbidity, and severity of independent and medically induced DSM-IV psychiatric and substance use disorders, and associated risk factors.

METHODS: Subsample of older adults (age 55+, n=13,420) enrolled in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative, in-person probability sample (age 18+) of the United States (2001-2002). The AUDADIS-IV was used to generate DSM-IV classifications for mood, anxiety, and substance disorders.

RESULTS: Over 12.7% (pop est. 7.5 million) of older adults in the U.S. met the criteria for a mood or anxiety disorder in the past year, with multiple disorders occurring in 25% of these cases. Anxiety(8%)and mood (6%) were the most prevalent. About 20% (pop est. 700,000) of all past year mood disorders was a direct result of medical illness, compared to 4% for anxiety. Past year Alcohol (2%) and prescription drug (1%) disorders were observed. Approximately 25% of all past year disorders had onset age 55 or later.

CONCLUSIONS: The occurrence of mental disorders appears common during later life, is more prevalent in females, characterized by an average onset prior to older adulthood. However, late onset disorders, primarily medically induced, are also widespread. Screening and intervention efforts should consider the unique mental health needs of older adults.