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Psychiatric Emergency Services for the U.S. Elderly: 2008 and Beyond

From the Departments of Psychiatry (PGW, GC, JML, BF), Emergency Medicine (MNS), and Community and Preventive Medicine (MNS, BF), University of Rochester, NY.

In 2011 the oldest baby boomers will turn age 65. Although healthcare researchers have started to examine the future preparedness of the healthcare system for the elderly, psychiatric emergency services (PES) have been widely overlooked. Research is needed to address PES need and demand by older patients, assess the consequences of this need or demand, and establish recommendations to guide PES planning and practice. The authors examined journal articles, review articles, textbooks, and electronic databases related to these topics. The authors outline the current PES environment in terms of facilities, characteristics, and visits, and discuss current geriatric patient PES use. Factors expected to impact future use are examined, including sociodemographic characteristics, psychiatric illness prevalence, cohort effects, medical comorbidity, mental healthcare resources and utilization, and stigma. Consequences of these on future psychiatric care and well-being of the elderly are then explored, specifically, greater acute services need, more suicide, strained delivery systems, increased hospitalization, and greater costs. The following are proposed to address likely future PES shortcomings: enhance service delivery, increase training, standardize and improve PES, prioritize finances, and promote research. The degree to which the geriatric mental healthcare "crisis" develops will be inversely related to the current system’s response to predictable future needs.

Key Words: Aged • psychiatric • emergency department