Psychiatric Hospitalizations Among Autistic and Non-Autistic Older Adults
Alison Deitsch, Melica Nikahd, J. Madison Hyer, Bethany Wolf, Brian W. Patterson, Lauren Bishop, Brittany N. HandBackground:
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.