Psychiatric morbidity among elderly presenting to emergency medical department: A study from tertiary hospital in North India

Abstract

Background: Geriatric population is on a steady rise since the past decade especially in densely populated countries like India. Elderly form a significant proportion of patients presenting to the medical emergency department and they warrant more attention in terms of mental health conditions as they are more predisposed to conditions such as delirium and cognitive impairment. Aim of this Study: This study aimed to evaluate the prevalence of psychiatric morbidity including substance use disorders among elderly (age ≥60 years) presenting to emergency medical outpatient services. Methodology: A total of 300 patients aged 60 years and above attending the medical emergency department of tertiary care hospital were approached, out of which, 232 participated. All the patients were assessed by Confusion Assessment Method, Modified Mini Screen and Alcohol, Smoking, and Substance Involvement Screening Test. Those found positive on any of the screening instrument were further evaluated on International Classification of Diseases-10 criteria, by a semi-structured interview to confirm the psychiatric diagnosis. Results: At least, one psychiatric diagnosis, i.e., either axis-I psychiatric disorder or substance dependence disorder was seen in 62% of cases. Nearly, half of the patients (47.4%) fulfilled at least one axis-I psychiatric diagnosis other than the substance dependence disorder at the time of assessment, with delirium being the most common, seen in about one-third (34.1%) of the participants. Other psychiatric diagnoses in the study sample included dementia (9.5%), depressive disorders (8.2%), adjustment disorder (3%), and anxiety (not otherwise specified) disorder in 3.4% of participants. About one-third (31%) of the participants had tobacco dependence, currently, using and one-fifth (19.8%) of patients had alcohol dependence syndrome currently using. Higher prevalence of delirium and dementia was noted among patients who were aged ≥70 years. Conclusion: The present study shows that elderly patients presenting to medical emergency department have a high prevalence of psychiatry morbidity. Accordingly, there is a need to reorganize psychiatric services and training to improve the identification and management of mental disorders among elderly patients presenting to emergency.