Psychiatric disorders often go underdiagnosed, particularly among older adults. Because of the difficulties in screening older adults for psychiatric disorders, whether through visits to primary care physicians or otherwise, it has been suggested that emergency department visits be used to assess mental health needs among older adults. Older adults use emergency departments at a relatively high rate, and some hypothesize that individuals are more likely to accurately and thoroughly report psychiatric symptoms in this setting. A study at the University of Rochester suggests that current instruments being used to diagnose mood disorders and cognitive impairment may need to be adjusted for emergency department mental health screenings to be used diagnostically.
Research staff enrolled consenting English-speaking adults 60 years and older who visited the University’s Medical Center emergency department. Commonly used scales to measure depression, cognitive impairment, confusion, and anxiety were administered at the visit and then again in telephone follow-up appointments over the following two weeks. Contrary to their initial hypothesis, the researchers found that the vast majority of subjects who had tested positive for depression and cognitive impairment at the emergency department tested negative in the follow-up screenings. The authors cite limitations to their study and provide context about the variability of depression and other psychiatric disorders. For instance, a disproportionate number of individuals who tested positive for the disorders did not participate in the follow-up.
Many of the “limitations,” however, by themselves suggest the need for further study of the use of current psychiatric measures in emergency settings. For instance, the authors point out that the emergency visit was likely to raise the level of symptoms, confounding the initial screening scores and suggesting that the clinical meaning of diagnostic scores may need to be reinterpreted in the emergency department setting. Most scales used for mental health screenings have been developed for community and primary care settings. It appears that before clinicians and researchers can use emergency visits to address the underdiagnosis of psychiatric disorders in older adults, these scales might need to be adjusted for emergency department use.
Source: Shah MN, Richardson TM, Jones CMC, Swanson PA, Schneider SM, Katz P and Conwell Y (2011). “Depression and Cognitive Impairment in Older Adults Emergency Department Patients: Changes over 2 Weeks.” Journal of the American Geriatrics Society Jan 28, 2011 doi: 10.1111/j.1532-5415.2010.03268.x. [Epub ahead of print]