Characteristics of violent elderly in the emergency department

The objective of the study was to determine (1) the incidence of violent acts committed by elderly patients in an emergency department and (2) the characteristics of these violent elderly patients compared to non‐elderly violent patients. A 5‐year retrospective review was undertaken of all dangerous behaviour incident reports (DBRs) in an urban Veterans Affairs Medical Center. Information abstracted from DBRs included descriptions of verbal or physical aggression, use of a weapon, injury to others and outcome of the incident. Demographic information, psychiatric and medical diagnoses and frequency of medical center use were obtained by medical record review. Twenty‐one violent elderly persons (age 60 years and over) were compared to 190 non‐elderly violent persons (under age 60). Eighty‐one per cent of the aged patients had a psychiatric diagnosis, most commonly alcohol dependence or a psychotic disorder. Old patients had more medical illness than young patients, but both groups were frequent users of medical services (mean 4.4 emergency department visits or hospitalizations for elderly vs 3.7 for non‐elderly in the year before incident). There were no differences between the two age groups in characteristics of the perpetrators, nature of the violent episodes or outcomes. Violent elderly persons in the emergency department are likely to have both medical and psychiatric illness and use medical services frequently. They are not distinctly different from younger violent patients.