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Pham-Scottez A, Gallarda T, Calvez M, Silva J, Barruel D, Masson VDL, Lahaye J, Perquier F, Sarazin M, Gourevitch R. Characteristics of older patients in the largest French psychiatric emergency centre. Front Psychiatry 2023; 14:1298497. [PMID: 38161722 PMCID: PMC10756208 DOI: 10.3389/fpsyt.2023.1298497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.
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Affiliation(s)
- Alexandra Pham-Scottez
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Thierry Gallarda
- Centre d’Evaluation des Troubles Psychiques et du Vieillissement (CETPV), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | | | - Jérôme Silva
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - David Barruel
- Département d’Information Médicale (DIM), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Valérie Dauriac-Le Masson
- Département d’Information Médicale (DIM), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Justine Lahaye
- Cellule Epidémiologie, GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
| | - Florence Perquier
- Centre for Addiction and Mental Health, Cundill Centre for Depression and Mental Health, Toronto, ON, Canada
| | - Marie Sarazin
- Department of Neurology of Memory and Language, GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
- Université Paris Cité, Paris, France
- Université Paris-Saclay, BioMaps, Service Hospitalier Frédéric Joliot CEA, CNRS, Inserm, Orsay, France
| | - Raphaël Gourevitch
- Centre Psychiatrique d’Orientation et d’Accueil (CPOA), GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte Anne, Paris, France
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Abstract
Older adults in the United States have lower rates of mental health care utilization than young adults. To understand these lower rates of mental health care, we performed a systematic review, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of barriers that prevent older adults from seeking and accessing treatment. We searched PubMed, PsycINFO, and Clinical Key to identify studies of barriers to mental health treatment in the older adult population (in individuals 50 y of age and older). Thirty-two articles met inclusion criteria (English language and focused on barriers to care in older adults) and exclusion criteria (focus on non-United States populations, focus on younger adults, or no focus on barriers to care). We identified 5 categories of barriers to mental health care in older adults: (1) attitudes and knowledge among older adults; (2) comorbid medical conditions; (3) provider-related factors; (4) other extrinsic barriers (eg, cost, transportation, reliance on caregivers); and (5) unique factors that affect older adults in minority populations. Large studies have primarily identified intrinsic barriers, including negative attitudes toward mental health care and lack of perceived need for treatment, as preventing older adults from seeking mental health care. Minority populations have also been found to face cultural barriers and increased levels of stigma compared with non-Hispanic whites, although several of the identified articles concerning barriers among minority older adults involved qualitative studies with small samples. Larger quantitative studies may help clarify the relative importance of barriers affecting this population. Interventions that have been shown to increase access to mental health services for older adults include community-based care and integrated primary and psychiatric care, but these strategies can be difficult to implement in low-resource settings. More research is needed to determine which interventions and policies are most effective in targeting particular barriers.
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Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med 2020; 75:136-145. [PMID: 31563402 PMCID: PMC7945005 DOI: 10.1016/j.annemergmed.2019.07.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022]
Abstract
Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.
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Affiliation(s)
- Christina Shenvi
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC.
| | - Maura Kennedy
- Massachusetts General Hospital Department of Emergency Medicine and Harvard Medical School, Boston, MA
| | - Charles A Austin
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - Michael P Wilson
- University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, AR
| | - Michael Gerardi
- Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ; Coalition on Psychiatric Emergencies
| | - Sandy Schneider
- American College of Emergency Physicians, Irving, TX; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX; Hofstra Northwell School of Medicine, Hempstead, NY
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Arias SA, Boudreaux ED, Segal DL, Miller I, Camargo CA, Betz ME. Disparities in Treatment of Older Adults with Suicide Risk in the Emergency Department. J Am Geriatr Soc 2017; 65:2272-2277. [PMID: 28752539 DOI: 10.1111/jgs.15011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND/OBJECTIVE We described characteristics and treatment received for older (≥60 years) vs younger (<60 years) adult emergency department (ED) patients with suicide risk. DESIGN Retrospective chart review. SETTING An ED with universal screening for suicide risk. PARTICIPANTS Eligible charts included a random sample of adults (≥18 years) who screened positive for suicidal ideation (SI) in past 2 weeks and/or a suicide attempt (SA) within the past 6 months. Visit dates were from May 2014 to September 2016. RESULTS A total of 800 charts were reviewed, with oversampling of older adults. Of the 200 older adults sampled, fewer older adults compared to younger adults (n = 600) had a chief complaint involving psychiatric behavior (53% vs 70%) or self-harm behavior (26% vs 36%). Although a higher number of older adults (93%) had documentation of current SI compared to younger adults (79%), fewer older adults (17%) reported SA in the past 2 weeks compared to younger adults (23%). Of those with a positive suicide screen who were discharged home, less than half of older adults received a mental health evaluation during their visit (42%, 95% CI 34-52) compared to 66% (95% CI 61-70) of younger adults who met the same criteria. Similarly, fewer older, than younger, adult patients with current SI/SA received referral resources (34%; 95% CI 26-43; vs 60%; 95% CI 55-65). CONCLUSIONS Significantly fewer suicidal older adult patients who were discharged home received a mental health evaluation when compared to similar younger adults. These findings highlight an important area for improvement in the treatment of older adults at risk for suicide.
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Affiliation(s)
- Sarah A Arias
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA
| | - Edwin D Boudreaux
- Departments of Emergency Medicine, Psychiatry, and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel L Segal
- University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | - Ivan Miller
- Department of Psychiatry and Human Behavior, Brown University, Butler Hospital, Providence, RI, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Lu BY, Onoye J, Nguyen A, Takeshita J, Ahmed I. Increased Elderly Utilization of Psychiatric Emergency Resources as a Reflection of the Growing Mental Health Crisis Facing Our Aging Population. Am J Geriatr Psychiatry 2017; 25:680-681. [PMID: 28314605 DOI: 10.1016/j.jagp.2017.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 01/29/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Brett Y Lu
- Department of Psychiatry, University of Hawaii, Honolulu, HI
| | - Jane Onoye
- Department of Psychiatry, University of Hawaii, Honolulu, HI
| | - Anson Nguyen
- Department of Psychiatry, University of Hawaii, Honolulu, HI; Fayetteville VA Medical Center, Department of Psychiatry, East Carolina University, Greenville, NC
| | - Junji Takeshita
- Department of Psychiatry, University of Hawaii, Honolulu, HI
| | - Iqbal Ahmed
- Department of Psychiatry, University of Hawaii, Honolulu, HI; Department of Behavioral Health, Tripler Army Medical Center, Honolulu, HI; Department of Psychiatry, Uniformed Services University of Health Sciences, Bethesda, MD
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Rhodes SM, Patanwala AE, Cremer JK, Marshburn ES, Herman M, Shirazi FM, Harrison-Monroe P, Wendel C, Fain M, Mohler J, Sanders AB. Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health−Related Emergency Department Visits: A Systematic Medical Record Review. J Emerg Med 2016; 50:143-52. [DOI: 10.1016/j.jemermed.2015.06.073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/29/2015] [Accepted: 06/25/2015] [Indexed: 11/29/2022]
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Walsh PG, Currier GW, Shah MN, Friedman B. Older Adults with Mental Disorders: What Factors Distinguish Those Who Present to Emergency Departments for Mental Health Reasons from Those Who Do Not? Am J Geriatr Psychiatry 2015; 23:1162-71. [PMID: 26238232 DOI: 10.1016/j.jagp.2015.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/17/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To identify among older adults with mental disorders factors associated with those who present to emergency departments (EDs) for mental health reasons versus those who do not. METHODS The authors conducted a secondary, cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS), which comprises a representative sample of the U.S. civilian noninstitutionalized population. Of the MEPS participants ages 66 and older on December 31 of the survey years 2000-2005, the analysis sample (2,757) included the 177 persons with at least one mental health ED visit and the 2,580 persons with mental disorders without such a visit. The three categories of the Andersen behavioral model for healthcare services utilization-predisposing, enabling, and need factors-were used as the theoretical framework for the independent variables. RESULTS Logistic regression analysis indicated that four need factors (adjustment disorder [OR: 3.42], psychosis [OR: 2.68], fair perceived physical health status [OR: 2.24], and anxiety disorder [OR: 1.85]) and two predisposing characteristics (widowed and living alone [OR: 1.68] and female [OR: 1.56]) were significantly associated with older adults with mental disorders who present to an ED for mental health reasons. Good perceived mental health status (OR: 0.55) was protective against presenting to an ED. CONCLUSION EDs that serve populations with higher proportions of older persons that are women, widowed and living alone, with adjustment disorder, psychosis, anxiety disorders, or fair perceived physical health should expect to have a greater likelihood of older persons visiting the ED for mental health reasons.
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Affiliation(s)
- Patrick G Walsh
- Department of Psychiatry, University of Rochester, Rochester, NY; Department of Public Health Sciences, University of Rochester, Rochester, NY
| | - Glenn W Currier
- Department of Psychiatry, University of Rochester, Rochester, NY
| | - Manish N Shah
- Department of Public Health Sciences, University of Rochester, Rochester, NY; Department of Emergency Medicine, University of Rochester, Rochester, NY; Department of Medicine, University of Rochester, Rochester, NY
| | - Bruce Friedman
- Department of Psychiatry, University of Rochester, Rochester, NY; Department of Public Health Sciences, University of Rochester, Rochester, NY.
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Are there race/ethnicity differences in disposition of older patients in psychiatric emergency service? Gen Hosp Psychiatry 2013; 35:e3-4. [PMID: 22771106 DOI: 10.1016/j.genhosppsych.2012.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 11/24/2022]
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Sands N, Elsom S, Marangu E, Keppich-Arnold S, Henderson K. Mental health telephone triage: managing psychiatric crisis and emergency. Perspect Psychiatr Care 2013; 49:65-72. [PMID: 23293999 DOI: 10.1111/j.1744-6163.2012.00346.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone. DESIGN AND METHODS An observational design was employed in the study. Wireless headsets were used to observe 197 occasions of MHTT. FINDINGS Clinicians use a range of practical strategies, therapeutic skills, and psychosocial interventions to manage psychiatric crises and emergencies via the telephone. PRACTICE IMPLICATIONS The evidence base for managing psychiatric crisis/emergency in MHTT is minimal. These findings contribute to the MHTT knowledge base and provide evidence-based strategies for high-quality emergency mental health care.
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Affiliation(s)
- Natisha Sands
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
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McBride RG, Hays DG. Counselor Demographics, Ageist Attitudes, and Multicultural Counseling Competence Among Counselors and Counselor Trainees. ADULTSPAN JOURNAL 2012. [DOI: 10.1002/j.2161-0029.2012.00007.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Becker MA, Boaz TL, DeMuth A, Andel R. Predictors of emergency commitment for nursing home residents: the role of resident and facility characteristics. Int J Geriatr Psychiatry 2012; 27:1028-35. [PMID: 23115781 DOI: 10.1002/gps.2817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The ability of nursing homes to manage the mental health needs of their residents is crucial to providing high quality care. An important element is preventing exacerbations of psychiatric conditions that trigger discharge from the nursing home (NH) because of an emergency commitment (EC) for an involuntary psychiatric examination. The objective of this study was to examine the relationship between resident and facility characteristics and the risk of EC for involuntary psychiatric examination among Medicaid-enrolled NH residents in Florida. DESIGN This retrospective cohort study employed 2.5 years (31 December 2002 through 30 June 2005) of Medicaid enrollment and fee-for-service, pharmacy, and involuntary commitment data to examine resident characteristics. NH characteristics were obtained from the Online Survey Certification and Reporting database. SETTING Medicaid-certified NHs in Florida (N= 584). PARTICIPANTS Medicaid-enrolled NH residents (N= 32,604). RESULTS Younger age, male gender, having dementia, having a serious mental illness (SMI), and residing in a for-profit facility were all independently associated with the greater risk of EC. Although most residents with EC were prescribed psychotropic medication, less than half received non-pharmacological behavioral health outpatient services before or after their involuntary psychiatric examination. CONCLUSION Our findings highlight the salience of resident and facility characteristics to prevalence rates of EC for involuntary psychiatric examinations among NH residents and underscore a need for increased education, communication, and future research on the predictive factors as well as the consequences of these adverse events.
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Affiliation(s)
- Marion A Becker
- College of Behavioral and Community Sciences, Louis de la Parte Florida Mental Health Institute, Department of Aging and Mental Health Disparities, University of South Florida, Tampa, FL, USA.
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McDougall GJ, Morgan S, Vaughan PW. Sixteen-month evaluation of depressive symptomatology in older adults. Arch Psychiatr Nurs 2012; 26:e13-21. [PMID: 22449566 PMCID: PMC3314220 DOI: 10.1016/j.apnu.2011.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 11/07/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
We examined the prevalence of depressive symptoms over time in a sample of community-residing older adults at baseline, 2 months, 6 months, and 14 months. The nonprobability sample (N = 222) was 90% female, 87% Caucasian, 15% Hispanic, and 12% African American with an average age of 75 years. If depressive symptoms had been measured at only one time, 19% of the sample would have scored above the cutoff versus 39% scoring above the cutoff when measured at all 4 periods. The findings provide evidence that depressive symptoms in older adults are variable and fluctuate over time. The significance of this research was the longitudinal evaluation of depressive symptoms in community-residing elders.
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Pertile R, Donisi V, Grigoletti L, Angelozzi A, Zamengo G, Zulian G, Amaddeo F. DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience. Soc Psychiatry Psychiatr Epidemiol 2011; 46:651-60. [PMID: 20473480 DOI: 10.1007/s00127-010-0231-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 04/26/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to identify services-related and area-based measures together with socio-demographic factors that could improve diagnosis-related groups in explaining length of stay variability in general hospital psychiatric units in Veneto Region (North East of Italy). METHODS Data were collected from the regional hospital discharge records database. A hierarchical multiple regression model with only diagnosis-related groups as predictors of actual and ln-transformed length of stay was compared with a second model in which patient-, service- and area-level variables were included. Local health district was used as group-level in the hierarchical multiple regression analysis. RESULTS The only diagnosis explains 6.4% of actual length of stay total variance (14.8% for ln-transformation). In the second model length of stay resulted related also to gender, age, severity of hospitalization, patient's local health district, number of psychiatrists, psychologists, hospital attendants/nurses, social workers and educators in the general hospital psychiatric units, number of outpatients in each local health district and percentages of divorced and single people, with almost a 2% point increase on actual length of stay in explained variance (5% point increase for ln-transformation). CONCLUSIONS For the first time the hospital discharge card regional survey of all public acute inpatient psychiatric facilities in Veneto Region were used. The innovative aspect of this study was the attempt to investigate the relationship between length of stay and other indexes, characterizing not only the inpatient facilities, but also the resident population structure in each area. The information about factors that influence length of stay can be useful to inform service planning and resource allocation.
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Affiliation(s)
- Riccardo Pertile
- Section of Psychiatry and Clinical Psychology, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Fan L, Shah MN, Veazie PJ, Friedman B. Factors associated with emergency department use among the rural elderly. J Rural Health 2011; 27:39-49. [PMID: 21204971 DOI: 10.1111/j.1748-0361.2010.00313.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Emergency Department (ED) use among the rural elderly may present a different pattern from the urban elderly, thus requiring different policy initiatives. However, ED use among the rural elderly has seldom been studied and is little understood. PURPOSE To characterize factors associated with having any versus no ED use among the rural elderly. METHODS A cross-sectional and observational study of 1,736 Medicare beneficiaries age 65 and older who live in nonmetropolitan areas. The data are from the 2002 to 2005 Medical Expenditure Panel Survey (MEPS). A logistic regression model was estimated that included measures of predisposing characteristics, enabling factors, need variables, and health behavior as suggested by Anderson's behavioral model of health service utilization. FINDINGS During a 1-year period, 20.8% of the sample had at least 1 ED visit. Being widowed, more educated, enrolled in Medicaid, with fair/poor self-perceived physical health, respiratory diseases, and heart disease were associated with a higher likelihood of having any ED visits. However, residing in the western and southern United States and being enrolled in Medicaid managed care were associated with lower probability of having any ED visits. While Medicaid enrollees who reported excellent, very good, good, or fair physical health were more likely to have at least 1 ED visit than those not on Medicaid, Medicaid enrollees reporting poor physical health may be less likely to have any ED visits. CONCLUSION Policy makers and hospital administrators should consider these factors when managing the need for emergency care, including developing interventions to provide needed care through alternate means.
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Affiliation(s)
- Lin Fan
- Department of Community and Preventive Medicine, University of Rochester, Rochester, New York 14642, USA
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Horton S, Johnson RJ. Improving Access to Health Care for Uninsured Elderly Patients. Public Health Nurs 2010; 27:362-70. [DOI: 10.1111/j.1525-1446.2010.00866.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Larkin GL, Beautrais AL, Spirito A, Kirrane BM, Lippmann MJ, Milzman DP. Mental health and emergency medicine: a research agenda. Acad Emerg Med 2009; 16:1110-9. [PMID: 20053230 DOI: 10.1111/j.1553-2712.2009.00545.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED-initiated interventions for mental health problems. As an increasing fraction of undiagnosed and untreated psychiatric patients passes through the revolving doors of U.S. EDs, the opportunities for improving the art and science of acute mental health care have never been greater. These opportunities span macroepidemiologic surveillance research to intervention studies with individual patients. Feasible screening, intervention, and referral programs for mental health patients presenting to general EDs are needed. Additional research is needed to improve the quality of care, including the attitudes, abilities, interests, and virtues of ED providers. Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real-world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems.
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Affiliation(s)
- Gregory Luke Larkin
- Department of Surgery, Emergency Medicine Division, Yale University School of Medicine, New Haven, CT, USA.
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