Geriatric Psychiatry in the Emergency Department: Characteristics of Geriatric and Non‐geriatric Admissions

Abstract

A study was made of the Emergency Department records of 49 elderly (65 years old or older) and 49 middle-aged (40-64 years old) patients seen in an urban hospital's psychiatric emergency service. The data were compared for demographic and admission information, psychiatric treatment history, presenting complaints, symptoms, diagnoses, and final disposition status. For the elderly patients, the referral was more likely to be their first contact with psychiatric treatment, and they were more likely to be referred (accompanied) by family or friends than to be self-referred. Among the middle-aged patients, "substance abuse" (e.g., drugs, alcohol) disorders and schizophrenic disorders were more common. The elderly, however, were much more likely to be regarded as having an organic brain syndrome of unspecified cause (34.7 per cent vs 0). Access to treatment was fairly consistent for both groups as measured by the hospital's priority code, total time spent in the emergency department, and final disposition. These results raise important issues concerning the unique psychosocial characteristics and psychiatric treatment needs of elderly patients. This applies particularly to the emergency-department medical clearance of elderly patients with symptoms of organic brain syndrome.

The elderly in the psychiatric emergency service (PES); a descriptive study

“…In contrast to their increasing importance in the ED, anxiety disorders contribute little to the typical PES diagnostic profile [10,21-23]. Preliminary evidence however does suggests that the elderly may possess a PES diagnostic profile different from that of patients < 65, one weighted towards cognitive and/or mood disorders [11,24-28], while that of those < 65 is primarily characterized by chronic psychosis, personality and substance abuse disorders [10,21-23]. In addition, factors other than diagnosis may help differentiate the elderly PES user from those < 65.…”

A Practical Approach to the Assessment and Management of Psychiatric Emergencies

“…For many, a ps ychiatric referral represents their fir st co ntact wit h mental health services. For o thers , th e referral may be the first step toward even tu a l nursing-home pla cement or other institutional care (26). For these rea sons, accurate diagnosis, e ffec t ive management, and ap propriate disposition are critical.…”

“…For these rea sons, accurate diagnosis, e ffec t ive management, and ap propriate disposition are critical. Unfortunately, t hese goals o ft en pro ve el usive due to a lack of awareness among clinicians of th e multifacet ed r elationshi ps between medical a nd psychiatric illnesses in th e eld erly, and a misunderstanding of the psychosocia l aspects of aging (26) . Compared with yo u nger patien ts, the elderly often have no previous psychiatric illness and are more likely to be re fer red by a third party (26) .…”

“…Waxman, et al , reported that as many as 40% of geriatric psychiatric emergency room evaluations result in a diagnosis of organic brain syndrome (OB5) with no specific etiology found (26) . In fact , a large num ber of these patients fai led to receive the medical evaluation nec essary to detect potential organic causes of their psychiatric symptoms (27) .…”

Impaired integrity of the brain parenchyma in non-geriatric patients with major depressive disorder revealed by diffusion tensor imaging

“…Inclusion criteria for 7 the patients were age between 20 and 64 years (Waxman et al, 1982;Korgaonkar et al, 2011), diagnosis of MDD according to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR), and being free of antidepressant medication for at least 6 months. Exclusion criteria were absolute contraindications for MRI, comorbid axis I or II disorders, history of electroconvulsive therapy, history of diseases that might affect white matter integrity (e.g.…”