Geriatric psychiatry

Introduction: With the expanding geriatric population in the US and an estimated 71 million people over the age of 65 by 2030, the number of older patients that use the hospital emergency department (ED) for evaluation and treatment will increase accordingly. Patients aged 65 or older, defined as “geriatric,” represent about 13% of the population and currently use an estimated 5–6% of all services in emergency psychiatry. There is high overall prevalence of mental illness in the geriatric population. The most common neuropsychiatric affliction in this group is cognitive impairment. On average 10–15% of the population over 65 report some degree of memory deficit. Over 69% of patients with significant intellectual decline live in skilled nursing facilities or similar institutions. However, many older adults with some degree of cognitive impairment continue to live in the community. As the “baby boomers” mature, and older patients are increasingly remaining in the community with relatives or in assisted living, more geriatric patients are anticipated to present to the ED for management of related psychiatric complaints. A review of the literature suggests that many of the studies examining utilization of psychiatric emergency services in the geriatric population are decades old, though the trend has been for geriatric patients to present to the ED when they are at their most vulnerable, most disruptive behaviorally, the most medically complex, or at the severest point in their illness.