Clinical profile of older adults presenting to psychiatric emergency services: A retrospective study from South India

Abstract

Background: Older adults constitute an important subgroup among those presenting to psychiatric emergency services. Psychiatric emergencies in older adults are particularly understudied in India. Objective: The objective was to study the clinical profile of older adults presenting to psychiatric emergency services. Method: All case records of older adults (60 years and above) presenting to Emergency psychiatry and Acute care (EPAC) in a tertiary care Neuropsychiatric institute from July 2018 to December 2018 were reviewed. The details pertaining to sociodemography, clinical profile, medical comorbidity and clinical management were reviewed and analyzed. Results: 230 older adults were seen in EPAC during the study period. This constituted 6.7% of the 4200 patients of all age groups seen in EPAC during this period. The mean age of the study group was 68.77 years (standard deviation-7.23) with 61.30% males and 38.69% females. The frequency of individuals with at least one co-morbid medical illness was 62.6%. The common diagnosis was mood disorders (30.87%), followed by dementia (16.52%) and delirium (10.43%. Agitation/aggression (46.52%), confusion (31.74%), and risk of self-harm (13.47%) were the most frequent reasons for presentation to EPAC. Neuropsychiatric disorders (31.30%) and mood disorders (30.87%) constituted the most common diagnosis in the group. Among those who required parenteral sedation, lorazepam (18.7%) was the most preferred agent followed by haloperidol (16.1%). Discussion and Conclusion: Older adults in our study predominantly had depression, behavioral and psychological symptoms of dementia and delirium although the proportion of delirium is smaller when compared to western studies. The most common reason for older adults' visit to emergency was agitation/aggression which is in agreement to other similar studies. Nearly half were managed without emergency sedation. However, smaller proportion of patients received sedation with haloperidol and lorazepam. The study was done in a primary psychiatry setup where general medical emergency is not available. This could be the probable reason for lower prevalence of delirium in our study compared to previous studies which is a limitation.