Older Adults With Psychological Distress Had Increased Use of Acute Care

Eligibility for Medicare in adults aged 65 years and older was associated with an increased use of acute care and a decreased use of mental health outpatient services in those who had psychological distress, according to a study published in JAMA Health Forum.¹ These findings display a weak point in the ways of addressing mental health in this population.

Psychological distress is experienced by millions of US adults, with mental health disorders increasing overall.² Adults aged 65 years and older are eligible for Medicare, which has helped keep health care accessible for this population. However, it is unknown what gaps exist in Medicare for the care of mental health due to the changes in the approach to mental health that have occurred over time, with Medicare not covering some essential mental health treatments like psychiatric rehabilitation and peer support services. This study aimed to assess how eligibility for Medicare affected the use of acute care services and mental health care.

This study used a cross-sectional design to accomplish its analysis. The Medical Expenditure Panel Survey was used to collect data on US residents who were not institutionalized who participated in the survey. All participants in the survey had interviews performed over 2 years, and data were collected, which included demographic data, use of health care services, socioeconomic data, dates of visits, and diagnoses. Participants were adults with psychological distress as identified using the 2-item Patient Health Questionnaire and the 6-item Kessler Psychological Distress Scale, with higher scores indicating psychological distress.

Older adults with psychological distress and Medicare eligibility were more likely to use acute care services | Image credit: Chanintorn.v - stock.adobe.com

The main outcomes were mental health care use, outpatient mental health visits with a psychiatrist, general health care use, and acute care use.

There were 3970 participants included in this study who had a mean (SD) age of 64.0 (3.6) years and lived in the US. There were more women included in the study, with 59.7% of the population being women. Medicare coverage increased in adults with psychological distress, increasing from 33.0% to 96.1%, whereas Medicaid coverage did not change significantly for older adults, decreasing from 26.6% to 22.0%. Private coverage also decreased from 41.3% to 2.7%.

Decreases in outpatient mental health visits were associated with Medicare eligibility at 65 years of age, with visits decreasing from 31.2% to 23.5%. Psychotropic medication fills also decreased from 49.7% to 45.2%. Visits with psychiatrists did not significantly change, with a decrease from 15.4% to 8.9%. Overall outpatient visits also did not significantly change, going from 34.8% to 36.9%. Inpatient admissions (19.0% to 26.1%) and emergency department visits (28.6% to 30.9%) both saw significant increases with the eligibility of Medicare. Conditions not related to mental health were the primary drivers of these increases.

There were some limitations to this study. The analysis assumed that an evolution of the outcomes would occur with age, but outcomes could also be influenced by other life events. Institutionalized, unhoused, and incarcerated individuals were not accounted for in this survey. Psychological distress was self-reported, which could introduce bias. The effect of the type of Medicare that an individual had was not accounted for due to the design of the study. The underlying mechanisms of these associations require future research, and changes in policy could have influenced these results.

A decrease in outpatient mental health visits and an increase in inpatient admissions and emergency department visits were associated with Medicare eligibility in adults aged 65 years and older. “These findings highlight the need for policies that address gaps in mental health care in the Medicare program, although further research is needed to determine whether policy responses should differ between traditional Medicare and Medicare Advantage,” the authors concluded.

References

1. Park S, Koh KA, Liu M, Wadhera RK. Medicare eligibility and health care use among adults with psychological distress. JAMA Health Forum. 2025;6(5):e251089. doi:10.1001/jamahealthforum.2025.1089

2. Mental health issues increased significantly in young adults over last decade. News release. American Psychological Association. 2019. Accessed May 29, 2025. https://www.apa.org/news/press/releases/2019/03/mental-health-adults