Logan Reid
Older adults are at risk of developing mental health conditions such as depression and anxiety disorders. They are also more likely to experience adverse events such as bereavement, reduced income, or a reduced sense of purpose due to retirement. Social isolation and loneliness affect about a quarter of older people and are key risk factors for mental health conditions. Abuse of older people, including physical, verbal, psychological, sexual, or financial abuse, as well as neglect, is also prevalent, with one in six older adults experiencing abuse. These factors can lead to depression and anxiety, and many older adults with mental health issues require hospitalization. This paragraph introduces the topic of older adults' mental health and hospitalization, providing context for the discussion on the number of older adults hospitalized for behavioral issues.
| Characteristics | Values |
|---|---|
| Reason for hospitalization | Nonfatal injuries, including falls, motor vehicle crashes, drug poisoning, and suicide |
| Risk factors | Age, poor balance, visual impairment, medication use, frailty, opioid use, depression, and self-harm |
| Sex | Women had higher rates of fall-related injury hospitalizations, but mortality rates were higher for men |
| Behavioral health needs | Psychiatric consultation, pharmacological treatments, management of agitation, diagnostic clarity, and follow-up care |
| Psychotic symptoms | Delusions, hallucinations, disorganized speech and behavior, delirium, and dementia |
| Challenges for emergency departments | Limited mental health resources, longer lengths of stay, and the need for specialized training |
| Discharge planning | Addressing barriers to access, transportation, insurance, and mental health stigma |
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What You'll Learn
Falls and accidents
Falls are a serious problem among older adults, leading to increased morbidity and mortality, premature nursing home admissions, and reduced functionality. Falls are one of the most common reasons for emergency department visits by older adults, with about 3 million visits occurring annually in the United States. Additionally, falls result in approximately 1 million hospitalizations among older adults each year.
Falls can have severe consequences, including fractures, traumatic brain injuries, subdural hematomas, and pain. In 2019, falls caused 83% of hip fracture deaths and 88% of emergency department visits and hospitalizations for hip fractures. Annually, nearly 319,000 older adults are hospitalized for hip fractures. Falls are also the leading cause of traumatic brain injuries, which can have long-lasting impacts on an individual's health and quality of life.
The risk of falling increases with age, and older adults with certain conditions are more susceptible to falls. For example, older adults with mild cognitive impairment, dementia, or age-related loss of muscle mass (sarcopenia) are at a higher risk of falling. Additionally, medications, vision problems, unsafe footwear, and safety hazards in the home or community environment can contribute to the risk of falling.
To prevent falls, older adults can take several measures. These include exercising, managing medications, having regular vision check-ups, and making homes safer by removing hazards that may cause trips or slips. Home safety interventions, vitamin D supplementation, and individually tailored interventions have been shown to reduce the rate of falls. Additionally, fall prevention clinics and community step-down programs can play a crucial role in reducing fall-related injuries.
Falls can have a significant impact on the mental health and well-being of older adults. The fear of falling can lead to social isolation, anxiety, and depression. It may cause older adults to avoid activities such as walking, shopping, or social gatherings. Therefore, early intervention and prevention strategies are essential to address the physical, mental, and emotional impacts of falls on older adults.
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Motor vehicle crashes
Older drivers are more likely to be involved in certain types of collisions, such as angle crashes, overtaking or merging crashes, and especially intersection crashes. In 2022, 59% of the deaths in crashes involving passenger vehicle drivers aged 70 and older were the older drivers themselves, with 12% being their passengers. The rate of fatal crash involvements among passenger vehicle drivers aged 70 and older per 100,000 people decreased by 47% between 1975 and 2023. However, in 2023, the number of motor vehicle deaths involving drivers and other road users aged 65 and older increased slightly to 9,587, from 9,545 in 2022. This is a 40% increase over the last decade.
There are several reasons why older adults are more susceptible to injuries and medical complications from motor vehicle crashes. Age-related changes in vision, physical functioning, and the ability to reason and remember, as well as diseases and medications, can affect some older adults' driving abilities. For example, older drivers may have slower reaction times and reduced flexibility, strength, and range of motion, which can make it more difficult to avoid or recover from a crash.
However, it is important to note that older adults are more likely to exhibit safer driving behaviours than other age groups. They are also more likely to wear seat belts, which is one of the most effective ways to save lives and reduce injuries in crashes. Additionally, older drivers tend to drive older vehicles that may not have modern safety features such as side airbags with head and torso protection, which have been estimated to reduce fatalities in nearside impacts by 45% for front-seat occupants aged 70 and older.
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Drug poisoning
Adverse drug reactions (ADRs) are common in older adults, with falls, orthostatic hypotension, delirium, renal failure, gastrointestinal bleeding, and intracranial bleeding being among the most common clinical manifestations. ADR risk increases with age-related changes in pharmacokinetics and pharmacodynamics, increasing the burden of comorbidity, polypharmacy, inappropriate prescribing, and suboptimal monitoring of drugs. ADRs are a preventable cause of harm to patients and an unnecessary waste of healthcare resources. Several ADR risk tools exist, but none has sufficient predictive value for clinical practice. Good clinical practice for detecting and predicting ADRs in vulnerable patients includes detailed documentation and regular reviews of prescribed and over-the-counter medications through standardized medication reconciliation.
Inadequate communication with patients or between healthcare professionals (particularly during healthcare transitions) is a major cause of adverse drug effects in older adults. Many medication-related problems could be prevented if greater attention were given to medication reconciliation when patients are admitted or discharged from the hospital or at other care transition points. Another source of adverse drug effects is the lack of ongoing evaluation of drug effectiveness and the continued need for specific medications. A medication given to treat one disease can exacerbate another disease regardless of patient age, but such interactions are of special concern in older adults. Distinguishing often subtle adverse drug effects from the effects of disease is difficult and may lead to a prescribing cascade.
The European Commission has estimated that approximately 5% of all hospital admissions are due to ADRs and 5% of hospitalized patients will experience an ADR during their hospital stay. In 2008, 197,000 deaths per year in Europe were attributed to ADRs. A more recent exploratory review assessed 32 studies from different settings and 12 different countries, finding that the overall ADR rate was 3.6% at hospital admission and 10.1% during the hospital stay. The overall proportion of fatal ADRs was approximately 0.5%.
In the United States, among all visits to the emergency department in 2004 and 2005, more than 700,000 patients were admitted due to adverse drug events, and 3,487 were hospitalized. Older patients (≥65 years) accounted for 25.3% of emergency department visits attributed to adverse drug-related events (ADEs) and 48.9% of events requiring hospitalization. Hospitalization rates due to adverse drug effects are 4 to 7 times higher in older patients than in younger patients, and these hospitalizations in older patients are most commonly due to anticoagulants, antibiotics, diabetes agents, opioid analgesics, and antipsychotics.
Self-poisoning accounts for a substantial proportion of acute medical hospital presentations but has been poorly characterized in older adults. A retrospective observational study of patients admitted via the emergency department due to drug overdose between 2004 and 2007 found that there were 8,059 admissions, including 4,632 women (57.5%). This included a subgroup of 361 patients (4.5%) who were >60 years of age. Another study found that 196 (91.6%) patients deliberately overdosed with pharmaceutical agents, while 107 out of 214 patients (50%) deliberately ingested multiple medications, and 16 of these patients took more than five different medications. Hypnotic sedatives, cardiovascular drugs, and antidepressants were the most common medications implicated.
Concurrent alcohol and medication poisoning hospitalizations in older adults are increasing, with greater increases in rural areas and among adults aged 65 and older. Benzodiazepines were the most frequently involved drugs in poisonings (36.5%). These findings indicate the need for public health prevention and clinical intervention to better educate and manage alcohol-consuming older adults on safe medication and alcohol practices.
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Suicide
Older adults are at a heightened risk of suicide, with around a quarter of deaths by suicide occurring in people aged 60 or over. They are also more likely to experience adverse events such as bereavement, a drop in income, or a reduced sense of purpose with retirement, all of which can negatively impact mental health. Social isolation and loneliness, which affect about a quarter of older people, are also key risk factors for mental health conditions in later life. Furthermore, older adults may experience chronic pain, frailty, or dementia, which can contribute to a decline in mental health and an increased risk of suicide.
Older adults hospitalized for suicidal ideation, suicide attempts, or deliberate self-harm are at a critically high risk of suicide shortly following hospital discharge. This risk is especially pronounced for geriatric patients, and there are wide variations in the rates of follow-up outpatient mental healthcare within 7 days of discharge, with only about one-third of older adults receiving timely follow-up care. This period of transition from hospital to home is critical, and the lack of consistent follow-up care is concerning given the high-risk nature of this group.
The complex etiology of suicide makes it challenging to predict the likelihood of suicide in older adults. However, it is known that the risk factors for suicide in this population include social isolation, loneliness, abuse, financial insecurity, and physical and functional decline. Additionally, certain antidepressants, such as mirtazapine, fluvoxamine, and venlafaxine, have been linked to increased suicidal behaviors in older adults.
To address the issue of suicide in older adults, it is crucial to promote healthy ageing and create supportive environments. This includes implementing measures to reduce financial insecurity and income inequality, ensuring safe and accessible housing and transportation, and providing social programs for vulnerable groups, such as those living alone or in remote areas. Additionally, addressing ageism and promoting social connections can help reduce feelings of isolation and improve mental health in later life.
While suicide is a complex and challenging issue, there are preventative measures that can be taken to support older adults and reduce their risk of suicide. By addressing risk factors and promoting healthy ageing, we can work towards mitigating the expected increase in suicide rates in this vulnerable population.
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Psychiatric hospitalization
Older adults are at risk of developing mental health conditions such as depression and anxiety disorders. They are also more likely to experience several conditions at once, including reduced mobility, chronic pain, frailty, and dementia. Social isolation and loneliness affect about a quarter of older people and are key risk factors for mental health issues. Abuse of older people, including physical, verbal, psychological, sexual, or financial abuse, as well as neglect, is also prevalent, with one in six older adults experiencing abuse, often at the hands of their own caregivers. These issues can have serious consequences for the mental health of older adults, leading to depression and anxiety.
In the past, state psychiatric hospitals provided services to many elderly individuals with dementia and other brain disorders. For example, in 1970, patients aged 65 and older made up 29.3% of residents in state and county psychiatric hospitals in the United States, with 24% diagnosed with organic brain syndrome. However, more recently, in 2014, only 8.8% of patients in state and county psychiatric hospitals were 65 and older. This decrease may be due to the implementation of Medicaid and Medicare programs in the late 1960s, which provide coverage for older adults, allowing many to receive care in their homes or in nursing homes or other residential settings specializing in Alzheimer's and dementia care.
Older adults with mental health issues can be treated in a variety of settings. These include specialized public and private psychiatric hospitals, psychiatric inpatient units, and licensed residential treatment units within general hospitals. Additionally, non-residential treatment centers offer intensive 24-hour treatment services without being licensed as inpatient services.
To support the mental health needs of older adults, the World Health Organization (WHO) has developed various strategies, programs, and tools. For instance, the Decade of Healthy Ageing (2021-2030) is a global collaboration led by the WHO to enhance the lives of older individuals, their families, and their communities. Furthermore, the Comprehensive Mental Health Action Plan 2013-2030, endorsed by WHO Member States, aims to improve mental health care for all populations, including older adults.
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Frequently asked questions
Although injuries from opioid overdoses are less common than injuries from falls or motor vehicle crashes, the exact number of hospitalizations due to opioid overdoses is not available.
Older adults with behavioral health emergencies are often hospitalized due to limited mental health resources in emergency departments. In cases where a medical cause for the behavioral symptoms is identified, hospitalization may be necessary.
The behavioral health needs of older adults in emergency departments include connections to behavioral health services and primary care. Early involvement of behavioral health services can help provide guidance for managing symptoms.
Older men have higher rates of hospitalization due to motor vehicle crashes and fall injuries.
Older adults are at risk of developing mental health conditions such as depression and anxiety disorders. Social isolation and loneliness affect about a quarter of older people and are key risk factors for mental health conditions.
