The trends and characteristics of older people presenting with mental health or drug and alcohol conditions to four emergency departments

Prof. Margaret Fry1,2, Mr Steven Kay2, Dr Rosalind Elliott1,2

1University Of Technology Sydney, Broadway, Australia, 2Northern Sydney Local Health District, St Leonards, Australia

Introduction: The incidence of older people with mental health and/or drug and alcohol conditions is on the rise.  It has been estimated that older people with mental health and/or drug and alcohol conditions will double by 2020.  Emergency Departments (ED) need to be alert to the needs of this cohort. Therefore, the aim of this study was to explore trends and characteristics of older people with mental health and/or drug and alcohol conditions presenting to ED.

Methods: A 12 month retrospective medical record audit was conducted of presentations by older people (aged 65 years and over) with mental health and/or drug and alcohol conditions. The study was conducted in four Sydney EDs; one university tertiary referral hospital and three district Hospitals.

Results: There were 40,093 presentations during the study period; 2.3% (n=900) were related to mental health or drug and alcohol related conditions. The majority were female (n=471, 52.3%) with a mean age of 79 years and more than half arrived by ambulance. Diagnoses related to cognitive impairment (n=234, 26%), affective disorders (n=233, 26.0%), chronic mental health conditions (n=91, 10.1%) and aggression (n=86, 9.6%). Alcohol related (n=120, 13.3%) conditions or medication overdose (n=81, 9.0%) were more common than suicide related presentations (n=55, 6.1%). There was no documentation of completed suicide. Sixty-three per cent were admitted as an inpatient, with a seen by time of 36 minutes (mean) and a length of stay of 6 hours 21 minutes (mean).

Conclusion: Given our ageing population, early recognition and appropriate assessment will assist in better outcomes and management, reduce disease burden and improve overall quality of life for older people of this patient group.


Professor Fry is Director of Research and Practice Development for Northern Sydney Local Health District and holds a Professorial Chair position with the University of Technology Sydney. Professor Fry has a strong emergency care background, has held CNC positions and is an authorised Nurse Practitioner (NSW). Professor Fry has extensive senior nursing experience and a proven research track with 118 peer reviewed publications and over $2.2million in grant, research tenders and or scholarship funding. Her program of research has led to significant state and national practice change. She was awarded Australasian emergency nurse of the year in 2005 and St George Hospital nurse of the year in 2001 and was a finalist in 2014 Nursing Excellence Awards for ‘Innovation in Research”. Professor Fry has also been awarded NSW Heath Care awards for innovative research making a difference for practice.