Chronic health conditions and psychological well-being: Barriers to health care utilization among older adults in California

Background: Poor mental health among the elderly may delay needed medical care for common chronic health conditions compared to chronically ill older adults without mental health problems.

Objectives: To examine the relationship between mental health and delays in care among chronically ill older adults in California.

Methods: Data from the adult 2009 California Health Interview Survey are used to investigate the presence of mental health issues as potential barriers to obtaining needed health care, among 55+ (N=22,345). Multivariate logistic regressions examine presence of serious psychological distress (SPD), self-reported need for mental health services and suicide ideation in adulthood as predictors of medical care or prescription delays in the past year. Gender, age, race, and poverty are included as covariates.

Results: Among older adults with at least one chronic health condition, 50% with SPD, 42% self-reported mental health need, and 43% with suicide ideation sometime in the past delayed care in the past year compared to 15% with a chronic condition but no mental health issue. The odds of delaying care are 5.2 times higher (p<0.001) among older adults with a chronic condition and SPD compared to those with a chronic condition but no SPD. The odds of delaying care significantly increase among older adults with a chronic health condition and self-reported mental health need (3.7, p<0.001) and suicide ideation (3.7, p<0.001).

Conclusions: Findings suggest that poor psychological health may serve as a barrier to health care utilization regardless of needs among the chronically ill in California.