Psychogeriatric emergencies

Through training and orientation, clinicians specializing in geriatric medicine are well-equipped to identify the various contributors to life- threatening mental states and associated conditions of older adults. The clinical drill to sort out factors contributing to a change in mental status is well-known and only the less frequently encountered causes and complications of treatment are considered in the previous paragraphs. In situations where a major mental disorder or suicidal or assaultive ideas are suspected, psychiatric consultation will be helpful. When treatment decisions (e.g., acceptance of hospital admission or diagnostic procedures) are difficult to resolve because of distress or conflict in the patient or family, a psychiatric consultation should also be considered. The more challenging task lies in the area of preventable emergencies, those that arise as a result of unsuspected suicidality, elder abuse or an unrecognized anxiety disorder. The pressures of ED practice and the complexity of pathology seen in the clinic work against keeping the physician alert to these possibilities. However, the present economic distress and demographic shifts in American society are unlikely to slow the increase in late life suicide and abuse. The extent to which more aggressive efforts at community outreach might offset the costs of emergency care as well as our seniors' quality of life remain to be demonstrated.