title: Older Adults with Mental Disorders: What Factors Distinguish Those Who Present to Emergency Departments for Mental Health Reasons from Those Who Do Not?
abstract: OBJECTIVE
  To identify among older adults with mental disorders factors associated with those who present to emergency departments (EDs) for mental health reasons versus those who do not.
  
  
  METHODS
  The authors conducted a secondary, cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS), which comprises a representative sample of the U.S. civilian noninstitutionalized population. Of the MEPS participants ages 66 and older on December 31 of the survey years 2000-2005, the analysis sample (2,757) included the 177 persons with at least one mental health ED visit and the 2,580 persons with mental disorders without such a visit. The three categories of the Andersen behavioral model for healthcare services utilization-predisposing, enabling, and need factors-were used as the theoretical framework for the independent variables.
  
  
  RESULTS
  Logistic regression analysis indicated that four need factors (adjustment disorder [OR: 3.42], psychosis [OR: 2.68], fair perceived physical health status [OR: 2.24], and anxiety disorder [OR: 1.85]) and two predisposing characteristics (widowed and living alone [OR: 1.68] and female [OR: 1.56]) were significantly associated with older adults with mental disorders who present to an ED for mental health reasons. Good perceived mental health status (OR: 0.55) was protective against presenting to an ED.
  
  
  CONCLUSIONS
  EDs that serve populations with higher proportions of older persons that are women, widowed and living alone, with adjustment disorder, psychosis, anxiety disorders, or fair perceived physical health should expect to have a greater likelihood of older persons visiting the ED for mental health reasons.
authors.affiliation: Department of Psychiatry, University of Rochester, Rochester, NY; Department of Public Health Sciences, University of Rochester, Rochester, NY.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Walsh
authors.affiliation: Department of Psychiatry, University of Rochester, Rochester, NY.
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Currier
authors.affiliation: Department of Public Health Sciences, University of Rochester, Rochester, NY; Department of Emergency Medicine, University of Rochester, Rochester, NY; Department of Medicine, University of Rochester, Rochester, NY.
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.affiliation: Department of Psychiatry, University of Rochester, Rochester, NY; Department of Public Health Sciences, University of Rochester, Rochester, NY. Electronic address: Bruce_Friedman@urmc.rochester.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Friedman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
keywords: Emergency department; adjustment disorders; anxiety disorders; psychosis