Associations of Mental Health and Substance Use Disorders With Presenting Problems and Outcomes in Older Adults’ Emergency Department Visits

Abstract

Objectives: The increasing prevalence of mental health and/or substance use disorders in older adults is a significant public health issue affecting their health, health care use, and health care outcomes. These disorders are especially prevalent in emergency department (ED) visits. This study examined the effect of mental health and substance use disorders on older adults' ED presenting problems and outcomes.Methods: Data were from the publicly available 2012 Nationwide Emergency Department Sample data set (unweighted n = 5,344,743 visits by the 65+ years age group). We used binary logistic regression analysis to test relationships between mental health and substance use disorders and suicide attempts, falls, and other injuries and multinomial logistic regression analysis to test relationships between the disorders and ED outcomes of death, hospital admission, transfer to institutional care, home health care, leaving against medical advice (AMA), or other or unknown destinations, as opposed to routine care.Results: Of ED visits by older adults, 5.1% involved anxiety disorders, 7.1% involved mood disorders, 10.45% involved delirium/dementia, 1.4% involved alcohol use disorders, and 0.6% involved drug use disorders; 0.2% were suicide-related, 12.0% involved falls, and 10.2% involved other injuries. Mental health and substance use disorders had large-to-medium effects on suicide attempts. Both dementia and delirium and alcohol use disorders had a small effect on falls. Drug use disorders had a small effect on other injuries. Anxiety disorder had a small effect on the risk of death in the ED or in the hospital, relative to routine care. Suicide attempts and drug use disorders had a medium effect on hospital admission. Suicide attempts had a large effect, delirium and dementia and other mental disorders had medium effects, and mood disorder had a small effect on the risk of transfer to another facility. Delirium and dementia, suicide attempts, and drug use disorders had small effects on the risk of discharge with home health care. Alcohol use disorders and drug use disorders had a small effect on the risk of leaving AMA. Finally, suicide attempts had a medium effect on the risk of other outcomes and unknown destinations.Conclusions: Late-life mental health and substance use disorders are significant risk factors for both intentional self-harm and unintentional injuries that bring older adults to the ED and contribute to ED dispositions and outcomes that involve more intensive and longer-term health care services.

Mortality in people with mental disorders in the Czech Republic: a nationwide, register-based cohort study

“…24,25 Finally, schizophrenia and common mental health disorders such as depression and substance abuse are the main proximal risk factors for suicide, which is the second leading cause of death in young adults (<30 years) globally. 3,26 The high mortality due to intentional self-harm in our study corresponds with other research showing heightened rates of suicide, unintentional injuries, 27 and likelihood of being a victim of homicide among people with mental disorders, which might partially explain the differences in mortality from external causes of death. 28 Our data provide a strong evidence base for the substantial life expectancy gap in people with mental disorders in the central and eastern Europe region.…”

Deliberate self‐harm in older adults: A national analysis of US emergency department visits and follow‐up care

“…27,28 This suggests that EDs may be reacting to the greater acute risk of suicide in older adults with self-harm compared with younger adults or that self-harm in older adults necessitates hospitalization more often because of physical frailty. 45 In the present study, hospital admission was significantly related to known suicide risk factors following self-harm including a depressive disorder and recent inpatient psychiatric care 46,47 but unrelated to others, such as bipolar disorder, 48 substance use, 23,49 or use of highly lethal methods. 10,50 African American self-harm patients were less likely to be hospitalized, a finding observed in other analyses using the US National Trauma Data Bank for self-harm visits.…”

Utilisation of emergency departments of behavioural disorders and supply of workforce in Nebraska

“…Few studies have examined the distribution of BH professionals or BH-related ED utilisation in largely rural states. One prior study examined only urban counties in North Carolina,21 while Choi et al studied the impact of specific BH illnesses on non-suicidal self-injury and suicide attempts among ED patients aged 50 years and older 16. Other studies have focussed on specific subpopulations, such as adolescents and older adults 22…”

“…Other studies have analysed the impact of BH disorders on the ED outcome of discharge against medical advice among specific classes of patients. For example, one study examined impact of discharge against medical advice among HIV patients,5 while another focussed on older adults 16. O’Toole and group studied the impact of leaving against medical advice in an outpatient substance abuse treatment unit 17.…”