Optum Behavioral Health. Medicare Advantage Debra M. Katz, M.D.

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1 Optum Behavioral Health Medicare Advantage Debra M. Katz, M.D.

2 One in five seniors met criteria for a mental disorder 1 50 % higher costs Symptoms of seniors with depression have roughly 50% higher healthcare costs than non-depressed seniors. 2 The elderly are more likely to suffer depression The National Institute for Mental Health estimates that as many as five million elderly people experience mild to moderate depression, and if left untreated it can lead to major depression 3 Depressed elderly are at high risk for suicide Although senior citizens comprise only 12% of the U.S. population, they accounted for 16% of all suicides according to the National Institute of Mental Health 3 1. Karel, M. J., Gatz, M., Smyer, M. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist. Vol. 67 ( ). 2. Unutzer, J., Depressive symptoms and the cost of health services in HMO patients aged 65 years and older, JAMA 277;20 (1997). 3. National Institute of Mental Health, Older Adults: Depression and Suicide Facts (Fact Sheet), NIH Publication No. 4593, Revised April 2007.

3 The prevalence of depression in later life is estimated to be highest among seniors with chronic medical conditions 80% of seniors suffer from at least one chronic condition 1 24% Depression is undiagnosed on average, among patients with chronic medical conditions 2 Mental health problems are two to three times more common in patients with chronic medical illnesses 2 Chronic Medical Condition Depression Increased use of medical services 3 83% 2.5X 3X More primary care visits (5.3 vs. 2.9) 4 More emergency room visits for Medicare beneficiaries with chronic medical conditions and depression 3 More inpatient medical hospitalization for Medicare beneficiaries with a comorbid depression 3 1. National Council on Aging, 2. Melek S, Norris D. Chronic Conditions and Comorbid Psychological Disorders. Seattle: Milliman, Himelhoch S, Weller WE, Wu AW, Anderson GF, Cooper LA. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Medical Care,42(6), Luber MP, Hollenberg JP, Williams-Russo P, DiDomenico TN, Meyers BS, Alexopoulos GS, Charlson ME. Diagnosis, treatment, comorbidity and resource utilization of depressed patients in a general medical practice. Int J Psychiatry Med. 2000;30(1):1 13.

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6 1. Fiske A, Wetherell JL,. Gatz M.. Depression in older adults. Annu. Rev. Clin. Psychol. 2009;5: Dennis M, Coffey J, Kadri A. Depression in older people in the general hospital: a systematic review of screening instruments. Age Ageing 2012; 41: Pasquini M, Biondi M. Depression in cancer patients: a critical review. Clinical Practice and Epidemiology in Mental Health Feb 8;3:2. 4. S. Paolucci, Epidemiology and treatment of post-stroke depression. Neuropsychiatric Disease and Treatment, vol. 4, no. 1, pp , Guck TP, Kavan MG, Elsasser GN, Barone EJ. Assessment and treatment of depression following myocardial infarction. Am Fam Physician. 2001;64(4): Levin CA, Wei W, Akincigil A, et al: Prevalence and treatment of diagnosed depression among elderly nursing home residents in Ohio. J Am Med Dir Assoc 8(9): , 2007.

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9 Age, gender and previous episodes of depression are not predictive

10 Source: Koenig H. and Blazer D. Epidemiology of Geriatric Affective Disorders, Clinics in Geriatric Medicine, 8: , 1992.

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18 Clinical definition A chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning An acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech Onset Chronic, slowly progressive Acute, sudden Course Progressive, stable Quick, fluctuating Duration Months to years Less than one month Alertness Alert, attentive Lethargic or hyper-vigilant Psychosis Delusions Hallucinations, auditory, visual, tactile

19 Source: Tamara G, Fong MD. Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease, Ann Intern Med June 19; 156(12): 848 W296.

20 Age Prevalence Source: Chapman, D. P., Williams, S. M., Strine, T. W., Anda, R. F. & Moore, M. J. Dementia and its implications for public health. Prev. Chronic. Dis. 2006: 3, A34.

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27 Source: Kirmizioglu Y, Dogan O, Kugu N, Akyuz G. Prevalence of anxiety disorders among elderly people. International Journal of Geriatric Psychiatry, 2009: 24(9):

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