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More seniors with mental health issues ending up in the ER

A study presented last month at the annual American Psychiatric Association conference points to a pending crisis in geriatric psychiatry and potential healthcare cost increases as older adults end up in emergency rooms for mental health-related issues.

"Increased Elderly Utilization of Psychiatric Emergency Services in Honolulu: A Reflection of the Mental Health Crisis Facing Our Nation's Aging Population" looked at the records of 17,004 patients who used the emergency room and were identified as using psychiatric emergency services at the Queen's Medical Center in Honolulu between 2007 and 2010.

The study found that the number of geriatric patients (age 65 and older) with mental health issues – which include dementia, depression and Alzheimer's disease – increased nearly 21 percent from 2007 to 2010. That increase seen is one example of a nationwide geriatric mental health crisis.

The crisis is due to a confluence of problems, said Brett Lu, MD, PhD, one of the authors of the study. It's mainly due to a shortage of mental health resources and the large number of Baby Boomers becoming seniors.

"There is about one geriatric psychiatrist for every 10,000 senior citizens right now, and this shortage will worsen to one for every 20,000 by 2030, especially if no significant efforts are made to encourage physician trainees to consider a career in geriatric psychiatry and to improve the current poor Medicare reimbursement," said Lu.

"While comprising about 12 percent of the U.S. population, older Americans only account for 6 (percent) to 9 percent of outpatient mental health services, and this disparity is likely to worsen with our aging population," he noted.

A lack of awareness and education about the mental illnesses faced by the elderly, such as dementia, means elderly patients with mental illness often end up in the ER.

"Emergency care is always more expensive," said Iqbal "Ike" Ahmed, MD, clinical professor of psychiatry and geriatric medicine at the University of Hawaii. "You're employing the most expensive possible care to these folks. And generally the care for the elderly tends to be more expensive for a couple of different reasons. One, in addition to the fact that it's an emergency, elderly have more co-morbid medical problems. It's never purely a psychiatric issue. ... You're dealing with people with multiple medical problems. ... So they often end up in more hospitalization, nursing home care, ER care. These are probably the most expensive types of care you can provide."

Ideally, prevention, early intervention, policy change and education are needed to help mitigate the crisis, Ahmed said.

[See also: States, feds slash mental health funding.]

Public education is crucial so that caregivers can recognize the difference between normal aging and dementia and find care before a crisis develops. But, Ahmed said, "there's no point educating the public if you cannot provide the services. So I think we need to address the service delivery piece of it."

"People are interested in looking at new models of care as well because geriatric psychiatrists can't be the only ones taking care of these needs," he said. There aren't enough geriatric psychiatrists to go around, he said, so the healthcare system needs to begin addressing mental health issues of the elderly at the level of the primary care physician.

"People are looking at working on collaborative care models, integrated care models, medical home, things of that sort, where they actually might be able to provide mental health services at the level of people coming to the clinic – the primary care – to see their doctor," he said. "And that's where we see the need to do it."

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