UTILIZATION PATTERNS OF PSYCHIATRIC EMERGENCY SERVICES BY ELDERLY PATIENTS

Abstract

To the Editor: The number of elderly adults with psychiatric disorders is rising, and older adults are increasingly using psychiatric emergency services (PES).1,2 Their reasons for PES visits include, but are not limited to, suicidality, homicidality, aggression, confusion, depression, and abuse. PES may serve as the gateway for elderly patients to receive mental health services, but data on healthcare accessibility and utilization patterns of PES are lacking. Previous studies have established a role for geropsychiatric emergency services.3–6 Elderly patients are more likely to present with significant comorbid medical and psychiatric disorders.3,7 They are less likely than younger patients to have received previous mental health treatment.4,6 Furthermore, improper prescription of medications and substance usage add complexity to the psychiatric presentations.5 However, these studies share in common that they were conducted in medical and psychiatric emergency departments (PEDs). Other modalities of PES, such as mobile emergency team (MET), 24-hour short-term crisis stabilization unit (CSU), and acute inpatient psychiatric hospitalization (INPT), were excluded. This retrospective study examined the utilization pattern of PES using a database from a California county of 810,000 inhabitants. Psychiatric emergency visits included the four modalities of PES: MET, CSU, PED, and INPT. There were 9,468 PES visits in 2007; elderly patients (aged ≥65) accounted for 268 (2.8%). Descriptive statistics were calculated on demographic and clinical characteristics. Chi-square analysis was used to evaluate differences in PES utilization patterns between elderly and younger patients. The mean age ±standard deviation of the elderly patients making the 268 PES visits was 73.2±6.9; 69.7% were women; 60.7% were white, 18.3% Hispanic, and 21.0% other; 21.9% were married and 78.1% unmarried (widowed, divorced, separated, or single); and 20.4% had previous outpatient mental health visits. Utilization patterns of PES by elderly patients and patients younger than 65 are summarized in Table 1. Elderly patients were more likely to use the MET (chi-square (χ2)=225.23, degrees of freedom (df )=1, P<.001) but less likely to use the CSU (χ2=37.79, df=1, P<.001), the PER (χ2=13.84, df=1, P<.001), and INPT (χ2=16.62, df=1, P<.001) than younger patients. Our findings continue to build on a growing literature that PES are pivotal in geriatric health care. Although elderly people are the highest-risk population in the United States for suicide,8 they account for only 2.8% of the PES visits in this study. It is likely that PES are underused in this population. It has been estimated that 12.3% of elderly patients meet criteria for one or more psychiatric disorders.9 The MET may be the major point of entry into the mental health system for elderly patients. Our data indicate that elderly patients are most likely to use the MET in times of crisis. Its accessibility and availability enhance the quality of care for this vulnerable population. Because PES can provide timely rendering of care, improve access to care, and ensure safety and better assessment,10 specialized geriatric PES should be developed for elderly patients. Little is known about the outcomes of care for elderly patients with psychiatric emergencies. Additional studies would further develop understanding of the delivery of mental health services to elderly patients. Financial Disclosures: None. Author Contributions: I am the sole author of this letter. Sponsors' Role: None.