Study finds unaddressed mental health needs in older adults of color in assisted living

Residents of Medicaid-funded assisted living have unmet mental health needs, according to a new study by researchers at NYU Meyers published in the Journal of the American Medical Directors Association (JAMDA).

One million older adults in the U.S. live in assisted living facilities, which provide housing, supportive services for activities of daily living, meals, and care coordination for older adults. Mental health issues—such as anxiety, depression, and significant stress—are common among assisted living residents due to a loss of autonomy, medical challenges, and cognitive decline. When these issues are not addressed, residents experience avoidable hospitalization and early placement in nursing homes.

In some states, Medicaid funds are used to pay for assisted living. Compared to older adults in other assisted living facilities, those in Medicaid-funded assisted living are more likely to be younger, people of color, have a history of homelessness, and have decreased financial security.

In this study, the researchers—led by Daniel David, RN, PhD, assistant professor at NYU Meyers—sought to understand the mental health needs and barriers to care among older adults living in Medicaid-funded assisted living. They conducted in-depth interviews with 13 residents of color and further evaluated their mental health needs through questionnaires and health records. 

The researchers found that most participants had mental health needs related to anxiety, depression, and significant stress. However, the residents voiced a lack of trust in the facility and concerns about losing their autonomy if they were to seek out mental health resources. Consequently, residents suffered in isolation or used unconventional resources to address needs which were neither efficient nor effective.

“Collectively, the data provide evidence that mental health needs are present, but residents are uncomfortable with accessing resources due to past experiences that make them suspicious of formal systems of support,” the authors write.

While residents of Medicaid-funded assisted living experience many of the same mental health challenges associated with aging as other assisted living residents, this population lacks trusted resources to overcome barriers to mental health access. The authors conclude that in order to make these services accessible, new interventions are needed such as trained community health workers that provide cultural and experiential wisdom to lower barriers described in the findings.

“These findings are an essential first step to developing interventions and processes that improve quality of life and optimize health care utilization,” write the authors.