Geriatric Psychiatry in the US

SPECIAL REPORT: GERIATRIC PSYCHIATRY

The population of individuals ≥ 65 years is increasing in the United States.¹ According to the 2020 Census, the population of these individuals grew nearly 5 times faster than the total population between 1920 and 2020.² In 2020, there were 55.8 million individuals older than 65 years, constituting 16.8% of the US population. It is projected that there will be 78 million individuals ≥ 65 years in the United States by 2035.¹

Approximately 20% of older adults in the United States have a diagnosable psychiatric disorder.³ Personality disorders, anxiety disorders, mood disorders, and substance use disorders are the most common psychiatric disorders in this population, with a past year prevalence rate of 14.5%, 11.4%, 6.8%, and 3.8%, respectively.⁴ Additionally, the population of individuals with Alzheimer disease is expected to rise from 6.7 million in 2023 to 13.8 million by 2060.⁵

Although psychiatric disorders are common among older adults, many of these individuals do not get the treatment they need.^6,7 It has been noted that non-psychiatrists often prescribe most of the psychotropic medications for older adults, with only 4.8%, 3.5%, 17.3%, and 12.9% of the visits for antidepressants, anxiolytics, antipsychotics, and mood stabilizers being with a psychiatrist.⁶

In addition, older adults are less likely to receive a psychiatric diagnosis (4.8% vs 9.5%; P < .001), have fewer visits with a psychiatrist (0.9% vs 4.0%; P < .001), and receive less psychotherapy (0.6% vs 2.3%; P < .001), but have greater rates of psychotropic medication visits (121.4 per 100 population vs 56.8 per 100 population) compared with younger adults.⁷

A major challenge in providing appropriate care for older adults with psychiatric disorders is the limited number of board-certified geriatric psychiatrists in the United States.⁸ The first geriatric psychiatry certification examination was conducted by the American Board of Psychiatry and Neurology in 1991.⁹ Since then, 3754 time-limited certificates have been issued in geriatric psychiatry. From these, only 1354 certificates remained active at the end of 2022.

Given the dearth of board-certified geriatric psychiatrists, it is important to educate other psychiatric clinicians on best practices for the care of older adults with psychiatric disorders. To begin to answer this call, Psychiatric Times has compiled this Special Report.

There is emerging evidence that interventional procedures such as electroconvulsive therapy can be beneficial in the treatment of behavioral and psychological symptoms of dementia.¹⁰ Additionally, there is evidence that treatments used to manage bipolar disorder in adults are also beneficial in individuals with older-age bipolar disorder.¹¹ There is also growing evidence that integrative therapies are helpful for brain health and aging.¹²

In this Special Report, we will review these 3 topics in greater detail. I hope you will find these articles helpful for the care of older patients with psychiatric disorders.

Dr Tampi is professor and chairman of the Department of Psychiatry at Creighton University School of Medicine and Catholic Health Initiatives Health Behavioral Health Services in Omaha, Nebraska. He is also an adjunct professor of psychiatry at Yale School of Medicine and a Psychiatric Times editorial board member.

References

1. Older people projected to outnumber children for first time in U.S. history. US Census Bureau. March 13, 2018. Accessed November 2, 2023. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

2. U.S. older population grew from 2010 to 2020 at fastest rate since 1880 to 1890. News release. US Census Bureau. May 25, 2023. Accessed November 2, 2023. https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html

3. The state of mental health and aging in America. Centers for Disease Control and Prevention. 2008. Accessed November 2, 2023. https://www.cdc.gov/aging/pdf/mental_health.pdf

4. Reynolds K, Pietrzak RH, El-Gabalawy R, et al. Prevalence of psychiatric disorders in U.S. older adults: findings from a nationally representative survey. World Psychiatry. 2015;14(1):74-81.

5. 2023 Alzheimer’s disease facts and figures. Alzheimer’s Association. 2023. Accessed November 6, 2023. https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf

6. Maust DT, Oslin DW, Marcus SC. Effect of age on the profile of psychotropic users: results from the 2010 National Ambulatory Medical Care Survey. J Am Geriatr Soc. 2014;62(2):358-364.

7. Maust DT, Kales HC, Blow FC. Mental health care delivered to younger and older adults by office-based physicians nationally. J Am Geriatr Soc. 2015;63(7):1364-1372.

8. Wilkins KM, Conroy ML, Yarns BC, et al. The American Association for Geriatric Psychiatry’s trainee programs: participant characteristics and perceived benefits. Am J Geriatr Psychiatry. 2020;28(11):1156-1163.

9. Annual report 2022. American Board of Psychiatry and Neurology. 2022. Accessed November 6, 2023. https://www.abpn.org/wp-content/uploads/2023/04/ABPN_2022_Annual_Report_WEB.pdf

10. Tampi RR, Tampi DJ, Young J, et al. The place for electroconvulsive therapy in the management of behavioral and psychological symptoms of dementia. Neurodegener Dis Manag. 2019;10.2217/nmt-2019-0018.

11. Tampi RR, Joshi P, Bhattacharya G, Gupta S. Evaluation and treatment of older-age bipolar disorder: a narrative review. Drugs Context. 2021;10:2021-1-8.

12. Nguyen SA, Lavretsky H. Emerging complementary and integrative therapies for geriatric mental health. Curr Treat Options Psychiatry. 2020;7(4):447-470