Prevalence of physical and mental health conditions in Medicare-enrolled, autistic older adults

Abstract

While there is emerging evidence on the prevalence of physical and mental health conditions among autistic adults, less is known about this population’s needs during older adulthood (aged 65+). We conducted a cross-sectional retrospective cohort study of 2016–2017 Medicare data to compare the prevalence of physical and mental health conditions in a national sample of autistic older adults (N = 4685) to a matched population comparison (N = 46,850) cohort. Autistic older adults had significantly greater odds of nearly all physical health conditions including epilepsy (odds ratio = 18.9; 95% confidence interval = 17.2–20.7), Parkinson’s disease (odds ratio = 6.1; 95% confidence interval = 5.3–7.0), and gastrointestinal conditions (odds ratio = 5.2; 95% confidence interval = 4.9–5.5). Most mental health conditions were more common among autistic older adults, including schizophrenia and psychotic disorders (odds ratio = 25.3; 95% confidence interval = 22.4–28.7), attention deficit disorders (odds ratio = 24.4; 95% confidence interval = 16.2–31.0), personality disorders (odds ratio = 24.1; 95% confidence interval = 17.8–32.5), and suicidality or self-inflicted injury (odds ratio = 11.1; 95% confidence interval = 8.9–13.8). Health conditions commonly associated with advanced age in the general population (e.g. osteoporosis, cognitive disorders, heart disease, cancer, cerebrovascular disease, osteoarthritis) were also significantly more common among autistic older adults. By highlighting the significant physical and mental health needs for which autistic older adults require care, our findings can inform healthcare systems, healthcare providers, and public health initiatives seeking to promote well-being in this growing population.

The Mental and Physical Health Profiles of Older Adults Who Endorse Elevated Autistic Traits

“…Therefore, our results suggest that older adults with elevated autistic traits may be more susceptible to poorer mental, but not physical, health in later life. In the current study, elevated rates of almost all psychiatric diagnoses were observed in older adults with high vs low autistic traits; a pattern consistent with the literature on mental health in autistic adults (Croen et al, 2015;Hand et al, 2019;Lever & Geurts, 2016) and those with high autistic traits (Kanne, Christ, & Reiersen, 2009;S. Lundström et al, 2011).…”

“…Lundström et al, 2011). For depression and anxiety diagnoses, a three to four-fold increase was found, comparable to the rates previously described in autistic adults across the adult life course (Croen et al, 2015;Hand et al, 2019), and in the few previous studies of older adults with high autistic traits (Geurts et al, 2016;Stewart et al, 2018). From self-rated current/recent symptoms, too, rates of anxiety and depression were elevated in the high autistic traits group; more than 20% passed clinical cut-off for depression and more than 10% for anxiety.…”

“…Several clinical and population-based studies have documented that autistic children and adults experience increased rates of almost all mental health difficulties when compared to neurotypical individuals (Bishop-Fitzpatrick & Rubenstein, 2019;Croen et al, 2015;Hand, Angell, Harris, & Carpenter, 2019;Lever & Geurts, 2016;Lugo-Marín et al, 2019;Rydzewska et al, 2019;Simonoff et al, 2008). An association has also been reported between elevated (but subclinical) autistic traits and mental health problems.…”

“…Autistic adults show elevated rates of not only psychiatric problems, but also physical health problems compared to non-autistic adults (for review see Cashin, Buckley, Trollor, & Lennox, 2018). Based on analysis of medical insurance records of young and mid-life autistic adults (Croen et al, 2015) and older autistic adults (Hand et al, 2019), increased rates of autoimmune, cardiovascular, gastrointestinal, neurological, and metabolic disorders have been reported when compared to age and gender matched non-autistic adults. Furthermore, an epidemiological study using 2011 census data from Scotland, found that 21% of males and 31% of females (aged 25 years or older) with an autism diagnosis had a physical disability, compared to 9% of the non-autistic population (OR 6.2) (Rydzewska et al, 2018).…”

“…Despite this, few studies have explored the physical and mental health profile of autistic populations in older adulthood (Happé & Charlton, 2011;Howlin & Taylor, 2015;Mukaetova-Ladinska, Perry, Baron, & Povey, 2012;Stuart-Hamilton et al, 2010). The few studies exploring health in older autistic adults suggest that rates of physical (but not mental) conditions and general health difficulties increase in older age (Croen et al, 2015;Hand et al, 2019;Rydzewska et al, 2019). The Scottish epidemiological study (Rydzewska et al, 2019(Rydzewska et al, , 2018 found double the rate of physical disability in autistic males and females aged 65 years or older (42% and 48% respectively), compared to those in the 25-35 years age bracket (14% and 25%).…”