title: Costs of community-based public mental health services for older adults: variations related to age and diagnosis.
abstract: BACKGROUND
  Several studies have examined service use among older adults although, to our knowledge, none has examined costs from a systems perspective. This study examined use and costs of mental health services among older adults in San Diego County in order to determine how expenditures and modes of service varied by age cohort and psychiatric diagnosis.
  
  
  METHODS
  Utilization data from San Diego County Adult and Older Adult Mental Health Services (AOAMHS) were used to identify older adults (age > or = 60) receiving services in the community during fiscal year 2003-2004. Cost data were derived from detailed examination of cost reports, and Medicaid fee schedules. Trends in demographic and clinical characteristics by six age cohorts were described. Multivariate models were used to estimate the relationships between costs, age, and clinical diagnosis while controlling for other demographic and clinical characteristics. Components of costs were also examined.
  
  
  RESULTS
  Total expenditures declined from age cohorts 60-64 through ages 85 and over. Expenditures were similar, and greatest, for clients with schizophrenia and bipolar disorder, while outlays were lower for those with major depression, other psychotic disorder, other depression, anxiety, substance use disorder, and cognitive disorders. Clients diagnosed with cognitive disorder had high use of emergency services and little connection to outpatient services.
  
  
  CONCLUSIONS
  Expenditures were related to age and clinical diagnosis. Future efforts should investigate older adults' pathways to care, and should determine whether older adults presenting in emergency services would benefit from a specialized case management program providing linkages to community based resources.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, CA 92093, USA. tgilmer@ucsd.edu
authors.forename: Todd
authors.initials: T
authors.lastname: Gilmer
authors.forename: Victoria D
authors.initials: VD
authors.lastname: Ojeda
authors.forename: David
authors.initials: D
authors.lastname: Folsom
authors.forename: Dahlia
authors.initials: D
authors.lastname: Fuentes
authors.forename: Viviana
authors.initials: V
authors.lastname: Criado
authors.forename: Piedad
authors.initials: P
authors.lastname: Garcia
authors.forename: Dilip V
authors.initials: DV
authors.lastname: Jeste
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003156:Community Mental Health Services / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D008875:Middle Aged