Potential ‘Tsunami’ of Mental Health Issues Among Older People Identified

An examination of psychiatric referrals to an emergency department during Covid-19 has raised concerns about mental health issues in older people, aged 65 and older, with some doctors warning that difficulties providing services during this period, coupled with the lack of presentations, could lead to a future tsunami of issues.

In an article published in this month’s \’Irish Medical Journal\’, corresponding authors David O’Donovan, Michelle O’Donohoe, and Leonard Douglas of St Vincent’s University Hospital, Dublin, looked at Covid-19 and the impact on referrals to psychiatry in those aged 65 years and older.

The authors state that the 65 and over cohort was the only group which saw a reduction in psychiatric presentations, and referrals to the hospital’s emergency department in April 2020, compared with the year before.

Only 6.7% of referrals were among those aged 65 years or over in 2020 – compared with 11% in 2019) – with more referred for anxiety, suicidality, and overdose, and with no BPSD (behavioural and psychological symptoms of dementia) referrals recorded.

The authors stated that the changes in method of presentation to the ED (more brought by ambulance and Gardai), could suggest reduced contacts, or that these presentations were more acute.

They said, “there was also a slight drop in those who required psychiatric admission, and those referred to a CMHT for follow up, which raises questions about where the appropriate care was provided for this cohort.\”

They continue by observing that if patients with psychiatric concerns are not presenting to services in the usual manner, there is a concern that they are ‘suffering in silence’ and this could also add to the future burden on services.

They added, “there also evidence of a greater proportion in this cohort, presenting to the ED intoxicated and with alcohol issues, which could add to a future strain on health services.\”

The authors acknowledged the limitations of a one-year comparison by concluding that future research in this area, will hope to explore presentations after the pandemic subsides to investigate if there is the expected ‘tsunami’ of cases, at this stage.

Previous years before the pandemic also will be explored, to study the pattern of presentations over a longer period.