and older are higher than any other age group and are more than twice the national rate for all persons (NCHS, 2007).

Mental health conditions are also more prevalent among community-dwelling older adults with ADL and IADL limitations. In 2002 approximately 31 percent of persons with disabilities and 45 percent of severely disabled persons reported depressive symptoms, and 15 percent of older adults with disabilities and 25 percent of severely disabled older adults had cognitive impairments (Johnson and Wiener, 2006). The prevalence of mental health conditions is even higher among nursing home residents. In 2005 nearly half of nursing home residents had dementia, and 20 percent had other psychological diagnoses (Houser et al., 2006).

One reason for these trends may be that mental and physical health are interrelated (New Freedom Commission on Mental Health, 2003). While the direction of causality between the two remains unclear, the correlation between them has been well documented. Persons with dementia and CIND have more serious comorbidity than those without cognitive impairment (Lyketsos et al., 2005). Physically disabled adults report higher rates of mental health conditions. People with depressive symptoms often experience higher rates of physical illness, health care utilization, disability, and an increased need for long-term care services (Federal Interagency Forum on Aging Related Statistics, 2006; Ormel et al., 2002). In addition, depression in later life is associated with poor health habits and diminished adherence to treatment for co-existing medical disorders. Among older adults, the combination of heavy alcohol or substance use with depressive symptoms has been shown to be associated with high risk for suicidal ideation and poor physical well-being (Bartels et al., 2006a,b).

CURRENT UTILIZATION OF HEALTH CARE SERVICES

Older adults have much higher rates of health services utilization than do non-elderly persons. Although they represent about 12 percent of the U.S. population, adults ages 65 and older account for approximately 26 percent of all physician office visits (Hing et al., 2006), 35 percent of all hospital stays (Merrill and Elixhauser, 2005), 34 percent of prescriptions (Families USA, 2000), and 90 percent of nursing home use (Jones, 2002). Utilization data for several acute-care services are displayed in Table 2-3.

On average, older adults visit physicians’ offices twice as often as do people under 65, averaging 7 office visits each year and totaling approximately 248 million visits in 2005 (NCHS, 2007). Older adults are more likely to visit a physician’s office for a chronic problem or for a pre- or post-surgery visit, but they are less likely than younger persons to seek preventive care. In 2004 the most common reasons for older adults to make office visits were all related to chronic conditions: hypertension, malignant



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