A Systematic Review of Barriers Faced by Older Adults in Seeking and Accessing Mental Health Care

Abstract

Older adults in the United States have lower rates of mental health care utilization than young adults. To understand these lower rates of mental health care, we performed a systematic review, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of barriers that prevent older adults from seeking and accessing treatment. We searched PubMed, PsycINFO, and Clinical Key to identify studies of barriers to mental health treatment in the older adult population (in individuals 50 y of age and older). Thirty-two articles met inclusion criteria (English language and focused on barriers to care in older adults) and exclusion criteria (focus on non-United States populations, focus on younger adults, or no focus on barriers to care). We identified 5 categories of barriers to mental health care in older adults: (1) attitudes and knowledge among older adults; (2) comorbid medical conditions; (3) provider-related factors; (4) other extrinsic barriers (eg, cost, transportation, reliance on caregivers); and (5) unique factors that affect older adults in minority populations. Large studies have primarily identified intrinsic barriers, including negative attitudes toward mental health care and lack of perceived need for treatment, as preventing older adults from seeking mental health care. Minority populations have also been found to face cultural barriers and increased levels of stigma compared with non-Hispanic whites, although several of the identified articles concerning barriers among minority older adults involved qualitative studies with small samples. Larger quantitative studies may help clarify the relative importance of barriers affecting this population. Interventions that have been shown to increase access to mental health services for older adults include community-based care and integrated primary and psychiatric care, but these strategies can be difficult to implement in low-resource settings. More research is needed to determine which interventions and policies are most effective in targeting particular barriers.

Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults

“…While for most of the participants this was their first experience in an online setting, and although they were not experienced with online art-based interventions, the findings show that the intervention enabled a creative process via Zoom where the participants were able to process their life experiences in a safe and creative therapeutic environment. Thus, CAT interventions can be made accessible and available to a broader population of older adults, including those who are homebound or have limited access to therapy due to mobility difficulties [ 39 ].…”

“…Tele-psychotherapy is a form of therapy that is conducted through a digital device, such as a smartphone, tablet or computer, by means of a videoconferencing application (such as Zoom, Skype, Meet) or via the telephone. Tele-psychotherapy can overcome some of the barriers that prevent older adults and the general public from turning to psychotherapy, such as physical limitations, lack of transportation, financial difficulties, and social stigma [ 37 , 38 , 39 ]. This is extremely important in the case of older adults whose mobility difficulties can lead to social isolation, which is associated with a decline in mental health [ 40 , 41 ].…”

Perceived Need for Treatment and Non-utilization of Outpatient Psychotherapy in Old Age: Two Cohorts of a Nationwide Survey

“…Yet, determinants of the mental health treatment gap among older adults remain unclear, especially for German older adults. A recently published systematic review on barriers preventing older adults from seeking and accessing mental health care in the United States [13] found intrinsic hurdles, such as negative attitudes toward mental health care and lack of perceived need for treatment as main barriers.…”

Disparities in Utilization of Psychiatry Services Among Home Care Clients: The Tale of Two Canadian Jurisdictions

“…Second, there are substantial and unique barriers faced by these older adults to diagnose and treat their illnesses. These intrinsic (i.e., attitudes of care providers, personal/cultural stigma and confounding medical comorbidities) and extrinsic (i.e., cost, transportation and reliance on caregivers) barriers are summarized in a recent systematic review by Lavingia et al (8). Older adults living with mental health illness are often subjected to a double burden preventing referral to psychiatry services.…”

“…While more comorbidities and loss of social connections are related to higher rates of depression, anxiety and other mental health problems, these same problems are often underreported by patients and under diagnosed by clinicians (4,9). Referral to psychiatry services is impeded by the stigma surrounding mental health, the belief that mental illness is a normal part of the aging process and the complexity of distinguishing symptoms of mental illness from multifaceted medical conditions (8).…”