The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition

Sherry Tang,Priyanka Patel,George T Grossberg,Jagdish Khubchandani

doi:10.1155/2014/413572

Sherry Tang, Priyanka Patel + Show 2 more

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https://doi.org/10.1155/2014/413572

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Abstract

Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009–December 2010). Results. Of the total subjects (n = 95) included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatient unit compared to patients with other psychiatric complaints (2.4% versus 16.7%). Conclusion. Even though delirium is the most common reason for ER visits among psychogeriatric patients, very few delirium patients got a psychiatric consultation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes.

Highlights

According to the recent United States (US) census bureau report, the older population (65+ years of age) is projected to increase to 88.5 million by 2050, which is more than double the population of elderly people (40.2 million) in 2010 [1]
As it relates to the mode of arrival, almost a third of the psychogeriatric patient visits were from a nursing facility (34.1%) and arrival from home unaccompanied by family via emergency medical service (EMS) (32.6%)
In elderly patients presenting with a primary psychiatric diagnosis, delirium is the chief complaint in a majority of visits to the emergency room (ER) and its cause is multifactorial

Summary

Introduction

According to the recent United States (US) census bureau report, the older population (65+ years of age) is projected to increase to 88.5 million by 2050, which is more than double the population of elderly people (40.2 million) in 2010 [1]. Emergency rooms (ER) have been increasingly visited by older adults who present with complex medical conditions and who are more likely to have longer stays, requiring extensive testing, and treatment regimens [2]. Psychogeriatric patients may have a variety of clinical presentations, including delirium, behavioral changes, mood disorders, and others. While several studies have been conducted that focus on the recognition and presentation of psychogeriatric patients in the ER [4,5,6], only a few studies discuss patient management and disposition after the initial ER visit, which are discussed below. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes

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