Older Adults Visiting Emergency Departments for Mental Health Issues: A CHIRPP Database Study

Objectives: To describe the characteristics, clinical trajectories, and disposition of older adults consulting in the emergency department (ED) for mental health issues. The secondary objective was to explore the impact of age, sex, and living environment on those patients' clinical care and disposition.

Methods: This registry study included data from 5 Canadian EDs. Patients were included if they were aged ≥65 years and consulting in the ED between March 1, 2020, and March 31, 2021, for mental health issues. Relative risks (RRs) were obtained using a modified Poisson regression model, and 95% confidence intervals (CIs) were estimated with a robust variance estimator.

Results: 1,673 patients were included. The mean ±SD age was 75.2±8.1 years; 58.8% were female, and 87.4% had a prior history of mental health issues. Suicidal ideations (40.8%) and neurocognitive disorders (31.8%) were the most frequent diagnostic impressions. 52.0% were assessed by a psychiatrist, and 49.9% were discharged from the ED. Males were at higher risk of neurocognitive (RR: 1.16 [95% CI, 1.01-1.32]) and substance use disorders (RR: 1.54 [95% CI, 1.19-1.99]). Patients aged ≥85 were more likely to be physically/chemically restrained and less likely to be assessed by psychiatry and hospitalized (RR: 1.69 [95% CI, 1.14-2.50], RR: 0.62 [95% CI, 0.52-0.74], RR: 0.73 [95% CI, 0.57-0.95]).

Conclusion: This study highlights that most older ED patients consulting for mental health issues had a prior history of such issues. A psychiatrist assessed most patients, but those aged ≥85 were less likely to be assessed or hospitalized, yet more likely to be restrained. These results should be considered when designing targeted investigations to meet the complex needs of this population.