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

Maïna Laforce, MD ; Valérie Boucher, MSc ; Ann-Pier Gagnon ; Pier-Alexandre Tardif, MSc ; Axel Benhamed, MD, MSc ; Pierre-Gilles Blanchard, MD, MBA, PhD ; Marcel Emond, MD, MSc ; François Poirier, MD ; Eric Mercier, MD, MSc

J Clin Psychiatry 2025;86(2):24m15516

Abstract

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.

J Clin Psychiatry 2025;86(2):24m15516

Author affiliations are listed at the end of this article.

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References (21)

Statistics Canada. Mental health care needs. 2018. Accessed July 17, 2023. https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00011-eng.htm
Information CIfH. Canadian seniors and mental health. 2017. Accessed February 3, 2023. https://www.cihi.ca/en/canadian-seniors-and-mental-health
Dufour I, Dubuc N, Chouinard MC, et al. Profiles of frequent geriatric users of emergency departments: a latent class analysis. J Am Geriatr Soc. 2021;69(3):753–761.
Dufour I, Chiu Y, Courteau J, et al. Frequent emergency department use by older adults with ambulatory care sensitive conditions: a population-based cohort study. Geriatr Gerontol Int. 2020;20(4):317–323. PubMed CrossRef
Schroeder SM, Peterson ML. Identifying variability in patient characteristics and prevalence of emergency department utilization for mental health diagnoses in rural and urban communities. J Rural Health. 2018;34(4):369–376.
Betz ME, Schwartz R, Boudreaux ED. Unexpected suicidality in an older individual in an emergency department. J Am Geriatr Soc. 2013;61(6):1044–1045. PubMed CrossRef
Brathwaite D, Waller AE, Gaynes B, et al. Age and sex trends among mental health-related emergency department visits in North Carolina. Healthc Anal. 2022;2:100056.
Arias SA, Boudreaux ED, Segal DL, et al. Disparities in treatment of older adults with suicide risk in the emergency department. J Am Geriatr Soc. 2017;65(10):2272–2277.
Fleury MJ, Fortin M, Rochette L, et al. Assessing quality indicators related to mental health emergency room utilization. BMC Emerg. 2019;19(1):8. PubMed CrossRef
Boulet S, Gagnon A-P, Nadeau A, et al. Characteristics of older adults attending the emergency department for suicidal thoughts or voluntary intoxication: a multicenter retrospective cohort study. Cureus. 2022;14(10):e30428.
Public Health Agency of Canada. Canadian Hospitals Injury Reporting and Prevention Program. 2022. Accessed September 12, 2023. https://www.canada.ca/en/public-health/services/injury-prevention/canadianhospitals-injury-reporting-prevention-program.html
Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(suppl 1):S31–s34.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association; 2013.
Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–706.
Chou MY, Hsu YH, Wang YC, et al. The adverse effects of physical restraint use among older adult patients admitted to the internal medicine wards: a hospital-based retrospective cohort study. J Nutr Health Aging. 2020;24(2):160–165.
Ang SY, Bakar Aloweni FA, Perera K, et al. Physical restraints among the elderly in the acute care setting: prevalence, complications and its association with patients’ characteristics. Proc Singapore Healthc. 2015;24(3):137–143.
Cully JA, Molinari VA, Snow AL, et al. Utilization of emergency center services by older adults with a psychiatric diagnosis. Aging Ment Health. 2005;9(2):172–176. PubMed CrossRef
Conejero I, Olié E, Courtet P, et al. Suicide in older adults: current perspectives. Clin Interv Aging. 2018;13:691–699.
Bonte-Baert A, Angerville B, Assal S, et al. [Clinical profile of elderly patients referred to liaison psychiatry for substance use disorders in an Academic Emergency Department]. Geriatr Psychol Neuropsychiatr Vieil. 2021;19(4):440–446.
Tanguay K, Nadeau A, Brousseau AA, et al. Nonmedical problems among older adults visiting the emergency department for low acuity conditions: a prospective multicentre cohort study. Heliyon. 2024;10(15):e35352.
Saunders NR, Toulany A, Deb B, et al. Acute mental health service use following onset of the COVID-19 pandemic in Ontario, Canada: a trend analysis. CMAJ Open. 2021;9(4):E988–E997.