Are older folks in the US receiving the mental health support they need (or are yours 40s your best decade):

Abstract: Older people (50-60+) seem to receive/utilize less mental health related care relative to young people AND relative to their share of the population. This is particularly noteworthy given the fact that utilization of physical health related healthcare is highly skewed towards older individuals. This suggests potential issues in awareness, access & treatment of mental health in older Americans (unless we think mental health is just a young person problem).

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It is a common adage in healthcare that older people tend to make up a disproportionately high % of the patient population and spending. According to CMS, adults 65 and older accounted for 35% of healthcare spending despite being only 16% of the population.

We see a similar story in an analysis of physical health related insurance claims data by age as shown in the chart above. Patients (defined as individuals making a health insurance claim in a year) ?60 and older made up almost 60% of the patients (despite being only about 20% of US population (ACS 2022)). Not a surprise that as our bodies age, they need more (& usually more expensive care). But what if we looked at a sample of claims related to mental health diagnoses in contrast to physical health related diagnoses as in the chart below.

When it comes to care related to mental health related diagnoses, younger people seem to be the ones seeking & receiving care, with ages 10-39 accounting for over 50% of patients (vs. less than 15% of physical health related patients). And far from being a majority of patients when it comes to mental health patients, older folks 60+ are under-represented relative to the population, accounting for less than 20% of patients (vs. 23% of US population).

Digging deeper in to claims for services delivered and the associated dollar charges for these same mental health related patients tells a similar story. Younger folks (10-39) make up an even greater share of claims and charges than of patients, suggesting that they use more services (~20%-30% more claims per patient) and spend more money (~20% more $ per claim). And as we can see in the chart below, as age increases past 50, each age group progressively makes up a smaller percentage of patients, claims/services and dollars spent.

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So with mental health vs. physical health related diagnoses, we clearly observe an ‘inverted’ picture when it comes to the age of the people utilizing services. ?That healthcare utilization increases for physical conditions as age increases certainly makes sense relative to the wear and tear on our bodies building up. But why does the same utilization seem to DECREASE as age increases when it comes to mental health.

Now ‘mental health’ is a broad brushstroke. Indeed if we were to look at specific age related mental health diagnosis like dementia (~3M claims), we would see a pattern of a greater proportion of older patients as in the chart below, where folks 60+ make up 97% of patients.

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But looking at a more common and less directly age-related diagnosis like Anxiety Disorder (~143 M claims) we once again see a pattern of % of patients (& charges) being lower than population share for ages 50 and up. Moreover, that the % of charges is even lower than % of patients suggests that these same older patients are receiving fewer or cheaper services than younger people with the same diagnosis.

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And a similar picture is seen across all the most common mental health diagnoses including Depression (~180 M claims), ADHD (~52M claims) and PTSD (~25 M claims), where as age increases people seem to be receiving less (& cheaper) mental health care.

So what does this ‘inversion’ of use by age between mental health & physical health mean? Is this proof positive that better mental health comes with age & maturity (& does this mean my father was right about everything?). Or perhaps this means we are actually very good at diagnosing and treating mental health early in life, so by the time people hit their middle-ages they are more likely to be well-adjusted individuals with little need for mental healthcare (does this mean my therapist was right about everything?). Or perhaps the questions we should ask are:

?????? Do we have an ‘awareness’ issue, where older folks are not aware of/acknowledge the need to seek care for mental health issues (& are younger folks too aware of mental health issues)

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?????? Do we have an ‘access’ issue, especially in Medicare (the primary source of medical coverage for older folks in the US), where mental health services are not covered in the same way as physical health services, inhibiting utilizations

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?????? Do we have a ‘diagnosis/treatment’ gap, where physical issues are over-diagnosed for older folks, where the problem is better addressed with mental healthcare (& again vice-versa for younger folks)

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?????? Does mental health require external intervention, i.e. are young people able to seek & access mental health care because they have family support & urging vs less available external support when one is older.

Or simply this is proof that we simply trade mental problems in youth for physical problems in old age and life just goes on regardless of age. A real answer to these questions is beyond this high-level analysis (or my non-medical expertise). But the lower utilization of healthcare among older populations is noteworthy & worthy of further investigation. Since most cliches speak of the cares of life only increasing with age, that older folks receive less mental health related care might speak to a gap in the system due to a variety of reasons that should be investigated and remediated for more healthy societies.

p.s. To any other 40 year olds reading this, depending on your perspective, these statistics might be cause for optimism that your 40s are that sweet spot of mental maturity and continuing physical health OR this is the last decade before you trade mental health worries for physical health disabilities. Either way make good use of this decade and enjoy it at healthfully as you can (whatever age you are)

Disclaimer/Sources:

?????? All numbers based on a aggregated sample of ~500M health insurance claims between 2021 and 2023 sourced from Compile. To extent the sample does not reflect the true universe of health insurance claims, any conclusions from the data are flawed

?????? Physical health diagnoses included Heart Disease, Kidney Disease, Diabetes, Respiratory Issues, Sleep Apnea, Allergies etc. among others. In no means a comprehensive sample or a robust definition.

?????? Mental health diagnoses used an existing categorization in the database and included various conditions including ADHD, PTSD, Depression, Anxiety Disorder, Dementia, Bipolar Disorder, Personality Disorder, Psychosis etc.

?????? Insurance claims data is not an indicator of actual need or the entire population and is biased by being a sample of people who actually have insurance

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Appendix Charts:

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