Psychiatric Hospitalizations Among Autistic and Non-Autistic Older Adults

Abstract

Background:

Autistic older adults are more likely to have psychiatric conditions and unmet health care needs, likely driven by marginalization and social inequities. Yet there is a paucity of information about psychiatric service utilization, like psychiatric hospitalizations for mental health crises, in this population. We compared Autistic older adults’ psychiatric hospitalizations, length of stay (LOS), and psychiatric readmissions with those of population controls (PCs) in the United States.

Methods:

We analyzed psychiatric hospitalization claims from Medicare, a public insurance for Americans aged 65+. Our sample included 6518 Autistic older adults and 12,945 matched PCs. We used multivariable logistic regression to compare groups on the odds of hospitalization and 30, 90, and 180-day psychiatric readmission. We used negative binomial regression to compare LOS. We repeated analyses, stratifying by co-occurring intellectual disability among Autistic older adults.

Results:

Autistic older adults and PCs did not significantly differ on the odds of psychiatric hospitalization (odds ratio [OR] = 0.91, 95% [confidence interval] CI = 0.79–1.05) prior to stratifying by intellectual disability. However, Autistic older adults experienced longer LOS (incidence rate ratio [IRR] = 1.23, 95% CI = 1.12–1.36) and higher odds of 90-day (OR = 1.50, 95% CI = 1.12–2.00) and 180-day (OR = 1.35, 95% CI = 1.03–1.76) psychiatric readmission. Among Autistic older adults with intellectual disability, odds of psychiatric hospitalization were significantly lower than PCs (OR = 0.47, 95% CI = 0.37–0.59). Conversely, Autistic older adults without intellectual disability had significantly higher odds of psychiatric hospitalization (OR = 1.66, 95% CI = 1.34–2.04) and longer LOS (IRR = 1.48, 95% CI = 1.30–1.68) than PCs.

Conclusion:

Medicare-enrolled Autistic older adults experienced longer psychiatric hospitalizations and higher odds of readmission. Autistic older adults without intellectual disability experienced greater odds of psychiatric hospitalizations. Findings may reflect opportunities to improve inpatient and community-based mental health services to support Autistic older adults’ mental health. Future research should characterize psychiatric service utilization across settings and explore the influence of social factors on service utilization among Autistic older adults in the United States.

Community Brief

Why is this an important issue?

Autistic older adults have a harder time getting mental health care than non-Autistic older adults. They can be hospitalized for mental health reasons when symptoms worsen. We focused on understanding these hospitalizations among Autistic older adults in the United States (U.S.) to better support their mental health.

What was the purpose of this study?

We compared mental health hospitalizations in Autistic older adults with non-Autistic older adults in the U.S. We also looked at how mental health hospitalizations differed if Autistic older adults did or did not have an intellectual disability.

What did the researchers do?

We used data from Medicare, a publicly funded insurance for Americans aged 65 years and older. We studied mental health hospitalizations among Autistic older adults. We matched Autistic older adults to non-Autistic older adults by characteristics like age, sex, and race. Then, in this matched group, we compared Autistic and non-Autistic older adults’ mental health hospitalizations, length of hospitalization, and rehospitalizations. Finally, we looked at how these findings differed for Autistic older adults with or without intellectual disability.

What were the results and conclusions of the study?

We found that Autistic and non-Autistic older adults in our study had similar likelihood of having a mental health hospitalization when we did not consider intellectual disability. But when we looked at just Autistic older adults without intellectual disability, we found they were more likely to have a mental health hospitalization and longer stay than non-Autistic older adults. Autistic older adults with intellectual disability were less likely to have a mental health hospitalization than non-Autistic older adults. When admitted, Autistic older adults were also more likely to have another mental health hospitalization (re-hospitalization) within 90 and 180 days.

What is new or controversial about these findings?

To our knowledge, this is the first study of mental health hospitalizations among Autistic older adults in the U.S. Our results are based on a large group of Autistic older adults from across the U.S.

What are potential weaknesses in the study?

Our findings are specific to the U.S. Mental health hospitalizations among current Autistic older adults may differ from future Autistic older adults. Also, Medicare data do not include information about social support, (e.g., help from family or friends), which can affect mental health hospitalizations. We did not ask Autistic older adults about whether they found mental health hospitalizations beneficial, but this is an important future step.

How will these findings help Autistic adults now or in the future?

Mental health hospitalization may be an important, life-saving care option for those experiencing mental health crisis that cannot be managed in outpatient care. Understanding how Autistic older adults in the U.S. use mental health services can help improve health service delivery. Knowledge from this study can help health care providers and policymakers develop and implement mental health interventions and services for Autistic older adults. For example, mental health hospitalizations and community-based mental health services might be able to be improved to better support Autistic older adults’ mental health.