Prevalence of Mental Illness and Its Impact on the Use of Home Care and Nursing Homes: A Population-Based Study of Older Adults in Manitoba

Article excerpt

Objectives: To determine the prevalence of mental illness in older adults and its effect on home care and personal care home (PCH) use.

Methods: Using nonidentifying administrative records (fiscal years 1997-1998 to 2001-2002) from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, we determined the 5-year period prevalence for individuals aged 55 years and over (119 539 men and 145 752 women) for 3 mental illness categories: cumulative mental disorders (those having a diagnosis of depression, anxiety disorder, personality disorder, schizophrenia, and [or] substance abuse), any mental illness, and dementia. We calculated age-specific and age-adjusted rates of home care and PCH use and the prevalence of mental illness in PCH residents.

Results: From the group aged 55 to 59 years to the group aged 90 years or older, the prevalence of mental illness increased with the population's age. The prevalence of any mental illness rose from 32.4% to 45.0% in men and from 42.6% to 51.9% in women, and dementia prevalence rose from 2.0% to 33.6% in men and from 1.3% to 40.3% in women. The age-adjusted annual rates of open home care cases per 1000 population aged 55 and older varied by mental illness grouping (no mental disorder, 57 for men and 91 for women; cumulative mental disorders, 162 for men and 191 for women; dementia, 300 for men and 338 for women). The age-adjusted rates of PCH use per 1000 population aged 75 years and older also varied by mental illness grouping (no mental disorder, 53 for men and 78 for women; cumulative mental disorders, 305 for men and 373 for women; dementia, 542 for men and 669 for women). Among patients admitted to (or resident in) a PCH in 2002-2003, 74.6% (87.1%) had a mental illness, and 46.0% (69.0%) had dementia.

Conclusions: Mental illness affects the use of home care and nursing homes profoundly. Individuals with dementia used home care at 3 times the rate of those having no mental illness diagnosis, and they used PCHs at 8 times the rate.

(Can J Psychiatry 2007;52:581-590)

Clinical Implications

* The high 5-year period prevalence (one-third to one-half) of any mental disorder in older adults indicates the need for appropriate and accessible mental health care resources.

* Dementia is associated with very high use of community services, and the aging population will continue to affect this use.

* Health care providers and lay staff working in community settings (both home care and PCH settings) need to receive training in mental disorders and to offer appropriate services.

Limitations

* This study is based on administrative claims data and not on chart audit or direct diagnosis of the population.

* The comparative rates of use of community services are based on cross-sectional data, which carry the limitation of association ramer than causation.

* The study could only be replicated in jurisdictions having population-based data files similar to those in Manitoba.

Key Words: mental illness, home care, nursing homes, institutional care, dementia, sex differences, health services research, administrative claims data, population-based rates, Manitoba Centre for Health Policy

Abbreviations used in this article

CI confidence interval

CIHR Canadian Institutes of Health Research

FY fiscal year

ICD-9-CM International Classification of Diseases, 9th revision, clinical modification

MCHP Manitoba Centre for Health Policy

MHMIS Mental Health Management Information System

PCH personal care home

RHA Regional Health Authority

Mental illness is a profound problem worldwide, yet population-based information on its prevalence and resource use by those affected is lacking. This research study focuses on community service use patterns of older adults with mental illness-specifically, the use of home care and personal care (nursing) homes. …