Geriatrics

Psychiatric emergencies in the geriatric population are expected to increase in the next decade and pose a unique challenge for clinicians in the emergency department or emergency consult setting. This cohort generally presents with numerous medical comorbidities and polypharmacy, and clinicians must be aware of age-related changes in physiology and pharmacokinetics. Geriatric psychiatric emergencies may also be precipitated by psychosocial factors such as retirement, grief, or elder abuse. Evaluation should initially focus on safety and typically requires utilization of collateral sources of history. Underlying medical etiologies of delirium should be ruled out, in addition to dementia screening and evaluation of depression or decompensated psychiatric illness. Medications should be used judiciously if indicated, and particular attention should be given to drug interactions and risk of toxicity. The COVID-19 pandemic has complicated the evaluation and management of psychiatric emergencies because there must now be clear procedures for screening, isolating, and treating COVID-19-positive patients. Age remains one of the most robust risk factors for both morbidity and mortality due to COVID-19. The growing use of telepsychiatry has improved access to emergency psychiatric services, geriatric patients included, but can be challenging.