Race and inpatient psychiatric diagnoses among elderly veterans

Objective: Limited data exist on differential rates of psychiatric diagnose s between ethnocultural groups in the elderly population. The purpose of th is study was to examine more closely the issue of race and rates of psychia tric diagnoses among elderly inpatients. Methods: The national sample inclu ded 23,758 veterans age 60 or over admitted in 1994 to acute inpatient unit s in Department of Veterans Affairs (VA) hospitals. Psychiatric diagnosis d etermined inclusion in one of six diagnostic groups: cognitive, mood, psych otic, substance use, anxiety; and other disorders. The study also assessed rates of psychiatric diagnoses among patients admitted to psychiatric units only and by age group and treatment setting, such as the size of the hospi tal and whether it had an academic affiliation. Results: Compared with elde rly Hispanic and Caucasian patients, a significantly higher proportion of e lderly African-American patients were diagnosed as having cognitive disorde rs and substance use disorders, and a significantly lower proportion were d iagnosed as having mood and anxiety disorders. Hispanic and African-America n patients had significantly higher rates of psychotic diagnoses than Cauca sian patients. For all diagnoses except cognitive disorders, these differen tial rates were also found among patients admitted to psychiatric units onl y. Age and treatment setting appeared to moderate some of the differences i n diagnostic rates, except for mood disorders. In every analysis performed, the rate of mood disorder diagnoses among elderly African-American patient s was less than half the rate among elderly Caucasian patients. Conclusions : The findings suggest that elderly African-American veterans admitted to V A inpatient units have strikingly lower rates of mood disorder diagnoses. F uture studies should examine the contribution of both patient and provider factors to these differences.