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

Abstract

BackgroundThe 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.MethodsClose 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.ResultsThe 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.ConclusionAlthough 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.

Dual diagnosis in older drinkers during the COVID-19 pandemic

“…This may reflect poor reliability in diagnostic coding of drug use disorder compared with more detailed evaluation from rating scales that explore individual drug use. Such a finding was also noted in a retrospective case note study of people aged 65 and over attending a mental health emergency service in the USA (Chaput et al, 2011). Although 23% of people had substance use disorder or dual diagnosis, the authors reported a "relative absence of substance use" using coded diagnoses.…”

A agressividade no serviço de emergência psiquiátrica: um problema frequente

“…Foi estudada a prevalência excluindo pacientes repetidos, e o primeiro encontrou que 16% iniciaram a agressividade no serviço, enquanto o segundo relatou que 18% haviam sido levados ao hospital por comportamento violento [3,4]. Em estudos que relataram a prevalência entre as consultas, esta variou de 7,3% a 19,9% [5,6,7,8]. Já quando consideradas as admissões nos SEPs, a frequência de agressividade apresentou grande variabilidade, de 3,48% e 38,8% [9,10,11,12,13].…”

“…No outro oposto da faixa etária, encontraram uma prevalência bem menor que a das crianças: um décimo dos idosos acima de 65 anos eram agressivos em emergências psiquiátricas. Sendo que, para esses mesmos autores, em adultos menores de 65 anos esse índice poderia até dobrar, sendo, então, essa faixa etária, um fator de risco para agressividade [7].…”

“…Os estudos de prevalência de agressividade no ambiente hospitalar focam nos serviços de emergência médica e em unidades de internação psiquiátrica [3][4][5][6][7][8][9][10][11][12][13]. Dessa forma, questiona-se a frequência da agressividade especificamente em SEPs, os quais apresentam maior potencial de agressividade.…”

Characteristics of Older Adults Hospitalized in Acute Psychiatric Units in Ontario: A Population-Based Study

“…3 Psychiatric disorders are common among older adults, and management of mental health problems in this group has become a significant public health priority. [4][5][6][7][8][9][10][11][12][13] APUs provide inpatient services for people with complex needs that cannot be met in other health care settings. Although most people in APUs are younger adults, 14,15 older adults also receive inpatient care in APUs, and this group may present challenges for clinicians.…”