Les patients âgés et « très âgés » aux urgences psychiatriques : une revue systématique de la littérature

The subject of elderly and “oldest old” patients in psychiatric emergency services, especially when compared with the literature on child and adolescent psychiatry and young adults, is still largely unexplored. Yet, with socio-demographic changes in our country and around the world, psychiatric care increasingly involves elderly and “oldest old” patients. Psychiatric emergency services, as a real “portail of entry” to psychiatric care, are and will continue to be on the front line. We therefore decided to carry out a systematic review of the French and international literature on elderly and “oldest old” patients attending psychiatric emergency services. We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard until August 2023. We chose to include all articles reporting cohorts of patients considered “elderly” and/or “oldest old” (without defining an age threshold) attending psychiatric emergency services (whether or not integrated into an Emergency Department), and to exclude other psychiatric emergency facilities (such as outreach services) and studies focusing on a specific reason for consultation or on theoretical aspects of the management of elderly patients in psychiatric emergency services. We selected 14 articles on patients aged 60 and/or 65 and over in psychiatric emergency services published in the international literature and 1 article specifically on patients aged 80 and over in psychiatric emergency services published in French. These articles are mainly North American, and half of them date from before 1990. The number of patients generally ranged from a few dozen to a few hundred and they were generally recruited monocentrically from psychiatric emergency services with very different operating procedures. The results were highly varied and disparate, covering, among other things: the context and modes of consultation, triggering factors, personal and family psychiatric history, distribution of diagnoses, substance use disorders behavioural disorders, suicidal behaviour, whether the consultation is urgent and/or relevant, and hospitalization rates. Some articles also performed bivariate and multivariate analyses, and identified predictive factors of hospitalization. The small number of articles and their great diversity make the generalization of these results to the French population extremely complicated. The problems of age threshold and the term used to designate elderly and “oldest old” patients are probably the greatest limitation to medical research in this population. New studies on this promising subject are needed, particularly outside North America and based on more recent data. Over the coming weeks and months, Centre Psychiatrique d’Orientation et d’Accueil (CPOA, psychiatric emergency services of Sainte-Anne hospital) team plans to publish the results of two cohorts of 300 and 306 patients, the first aged 60 and over, the second aged 80 and over, attending psychiatric emergency services. This work is of interest not only at the population level, to describe the epidemiology of mental disorders and their management, but also at the individual level, to understand patients’ expectations and needs, as well as required medical management.