Geropsychiatric emergency services: utilization and outcome predictors

Characteristics of older patients in the largest French psychiatric emergency centre

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.

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

BACKGROUND

The impact of an aging population on the psychiatric emergency service (PES) has not been fully ascertained. Cognitive dysfunctions aside, many DSM-IV disorders may have a lower prevalence in the elderly, who appear to be underrepresented in the PES. We therefore attempted to more precisely assess their patterns of PES use and their clinical and demographic characteristics.

METHODS

Close to 30,000 visits to a general hospital PES (Montreal, Quebec, Canada) were acquired between 1990 and 2004 and pooled with over 17,000 visits acquired using the same methodology at three other services in Quebec between 2002 and 2004.

RESULTS

The median age of PES patients increased over time. However, the proportion of yearly visits attributable to the elderly (compared to those under 65) showed no consistent increase during the observation period. The pattern of return visits (two to three, four to ten, eleven or more) did not differ from that of patients under 65, although the latter made a greater number of total return visits per patient. The elderly were more often women (62%), widowed (28%), came to the PES accompanied (42%) and reported « illness » as an important stressor (29%). About 39% were referred for depression or anxiety. They were less violent (10%) upon their arrival. Affective disorders predominated in the diagnostic profile, they were less co-morbid and more likely admitted than patients under 65.

CONCLUSION

Although no proportional increase in PES use over time was found the elderly do possess distinct characteristics potentially useful in PES resource planning so as to better serve this increasingly important segment of the general population.

Quality of care for depressed elders in post-acute care: variations in needs met through services

This paper addresses quality of post-acute care for older adults going home after hospitalization for depression. Quality was conceptualized and assessed in terms of services received for four domains of need: psychiatric, medical, functional, and psychosocial. At discharge, needs for care was assessed using medical records, standardized instruments, and patient interviews; quality of care was assessed by whether or not needs were met by services through the first 6 weeks of post-acute care. Quality of care varied across type of need: psychiatric needs were most likely, and psychosocial needs were least likely, to be met. Urban elders received better psychiatric care than did rural elders. Elders in worse physical health received better medical and psychosocial care, but poorer psychiatric care. Elders with psychoses and living with others had better care for functional dependencies. The competing demands perspective suggests that medical illness may take priority over psychiatric care.