Don't make assumptions about older psych patients

You might overlook medical conditions

If a 65-year-old patient came to you with acute visual hallucinations but no behavioral health care history, what would you suspect?

"I assessed the patient subjectively and found several bruises on both upper and lower extremities," recalls Maria C. Boyes, BSN, RN, a psychiatric liaison nurse at Northwest Community Hospital in Arlington Heights, IL. "When asked where she got these bruises, the patient told me she fell the night before, tripping on a rug while letting her dog in."

The ED physician was informed, and a CT scan of the brain was performed. This showed cerebral inflammation with a possible bleed. "This was the cause of her visual hallucinations," says Boyes. "The patient was admitted to the critical care unit and was there for weeks."

If the patient had mistakenly been admitted to the psychiatric unit, she could have ended up in a coma or possibly died, says Boyes.

Don't assume

If you fail to obtain adequate information about the patient's medical history and medications, you might wrongly assume the patient is a psychiatric patient based on the initial presenting symptoms in the ED, warns Boyes.

"Most elder psychiatric patients seen in the ED present with severe depression with suicidal ideations, and behavioral problems with agitation and psychosis," she says. "These patients need somebody — a family member or a health provider — who knows them and who can communicate their needs to ED staff."

A proper mental health diagnosis should be carefully given after thorough medical, physical, and psychiatric assessments, says Boyes. "Some factors that can be overlooked are their medical diagnosis, their medications and health history," says Boyes. "That is why our ED physician orders medical testing, including a CT scan of the brain, to rule out medical issues causing their psychiatric symptoms."


For more information on elder ED psychiatric patients, contact:

  • Maria C. Boyes, RN, Psychiatric Liaison Nurse, Northwest Community Hospital, Arlington Heights, IL. Phone: (847) 618-4040. E-mail: