08. Long Stays and Revolving Doors: A Comparison of Psychiatric Hospitalizations Among Autistic and Non-Autistic Medicare Beneficiaries

Background: Autistic older adults experience higher rates of nearly all psychiatric conditions compared to non-autistic peers, yet psychiatric hospitalizations in this group remain underexamined. Most research on psychiatric service use among autistic individuals focuses on pediatric populations, leaving critical gaps in understanding how aging and autism interact to shape psychiatric service needs.
Objectives: We examined whether autistic older adults differ from population controls (PCs) on odds of psychiatric hospitalization, length of stay (LOS), and odds of psychiatric readmission. Secondarily, we assessed whether co-occurring intellectual disability (ID) modifies these associations.
Methods: We conducted a retrospective cohort study using national Medicare claims data, a federal health insurance program for adults aged ≥65 years. The analytic sample included 7,801 autistic older adults and 7,801 propensity score matched PCs. Multivariable logistic regression models estimated the odds of psychiatric hospitalization, adjusting for demographic and clinical characteristics. Among those with a psychiatric hospitalization, a negative binomial regression model assessed differences in LOS, and logistic regression models estimated the odds of 30-,90- and 180-day readmissions. All models were replicated after stratifying autistic beneficiaries by ID status.
Results: Autistic older adults did not differ from PCs in odds of psychiatric hospitalization. However, they had significantly longer LOS (IRR=1.23, 95% CI: 1.12–1.36) and higher odds of 90-day (OR=1.50, 95% CI: 1.12–2.00) and 180-day (OR=1.35, 95% CI: 1.03–1.76) readmission. Stratified analyses showed autistic older adults with ID had lower hospitalization odds than PCs, while those without ID had higher odds and longer stays.
Conclusions: Autistic older adults, particularly those without ID, face elevated risks for prolonged and recurrent psychiatric hospitalizations, highlighting unmet needs in inpatient care and post-discharge support.

Autism

psychiatric conditions

healthcare service utilization 

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