Access to Psychiatric Care for Late Life Hoarding Patients

Introduction

The purpose of this investigation is to examine the availability of psychiatric care for rural-dwelling older adults with hoarding disorder. Across the United States there is a dearth of psychiatrists. This issue is amplified in rural areas where there is less access to medical care overall. Comparing the situation in Northeast Mississippi to other areas across the United States will allow us to determine the severity of the issue specifically for older adults in this area.

Methods

Forty-five adults, the majority of which were aged 50 and over, were recruited for a treatment study for hoarding disorder. The zip codes of participants’ addresses were used to determine available psychiatric care in their area or distance to such care. Thirty-five participants completed a semi-structured interview at the baseline assessment to determine presence of psychiatric co-morbidities. In determining availability to psychiatric care, the number of licensed psychiatrists in the participant zip codes was determined. We used one hour driving distance as our a priori acceptable range for older adults to travel to seek treatment, and licensed psychiatrists in that range were counted as well. The access to psychiatrists was then compared to other rural and urban areas in the United States.

Results

On average, participants met criteria for at least one psychiatric co-morbid condition (range 0-5). 31% of participants met criteria for two or more psychiatric co-morbid conditions. The most common co-morbid diagnoses were major depressive disorder (n = 14; 40%), generalized anxiety disorder (n = 5; 14%), and history of a manic episode (n = 6; 17%). 0% percent of participants had access to a psychiatrist for in person outpatient care in their zip code, or within 1 hour of their zip code.

Conclusions

Older rural adults with hoarding disorder in Northeast Mississippi must overcome significant barriers to receive access to psychiatric care. Like many rural areas, the lack of psychiatrists in Northeast Mississippi means the burden of care falls on those without the necessary means to treat hoarding disorder, and co-morbid psychiatric conditions. This includes the families and friends of older adults with hoarding disorder, and other professional caregivers in the area. With a lack of psychiatrists, these people will see an increase in the amount of people they care for as well. This increased burden on them can lead to decreased quality of care for older adults and a decreased quality of living for caregivers.