Geriatrics/Original ResearchThe effect of mental status screening on the care of elderly emergency department patients☆,☆☆
Introduction
Mental status impairment is highly prevalent among elderly emergency department patients.1, 2, 3, 4 These patients might carry an increased risk for adverse outcome after ED discharge.3 Patients with delirium often have acute underlying illnesses and have been shown to have higher morbidity and mortality rates than their counterparts without delirium.5, 6, 7, 8 Patients with dementia might have difficulty with medication and discharge instruction compliance, which can also result in increased morbidity and mortality. In addition, the presentation of impaired mental status in the elderly might be subtle, making it difficult for the unsuspecting emergency physician to detect.
Prior studies have suggested poor recognition of mental status impairment by emergency physicians.1, 2, 3 However, although these studies prospectively screened for mental status impairment, they addressed recognition by using retrospective methodologies and ED chart reviews. The findings were supported by a lack of specific referrals by emergency physicians to address mental status impairment and by the significant number of patients with delirium who were discharged to home.1 In response to these findings, a recent editorial suggested that if emergency physicians were made aware of mental status impairment, they would take appropriate action in evaluating the complaint and make the appropriate disposition and follow-up arrangements.9 We designed this prospective interventional study with 2 major objectives. The first was to determine the effect of screening examination results for mental status impairment, when presented to the emergency physician, on the care plans of older ED patients. The second was to prospectively assess emergency physician recognition of mental status impairment in this group of ED patients.
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Materials and methods
This was a prospective interventional study involving a convenience sample of older patients presenting to an ED between July 2000 and November 2001. Sampling periods were varied to include day, night, weekday, and weekend shifts, with frequencies based on the usual ED presentation times of older patients. This study was reviewed and approved by the hospital institutional review board.
The study was conducted at an urban teaching hospital with approximately 55,000 ED visits per year and an
Results
Three hundred twenty-seven eligible patients were screened, of whom 56 were subsequently excluded (Table 1).
Participation No. (%) Ineligible 56/327 (17) Prior enrollment 5 Incomplete data 6 Refused 21 Unable to cooperate with survey 15 Non-English speaking 5 Critically ill 4 Completed interview 271/327 (83)
Discussion
Our study, which is one of the first to prospectively assess the recognition of mental status impairment by emergency physicians, reveals that mental status impairment in older persons is both highly prevalent and poorly recognized. The substantial prevalence rate of mental status impairment in this group is in concordance with previous studies.1, 2, 3, 4 Three prior studies1, 4, 12 reported that between 26% and 40% of all ED elders have some form of mental status impairment. Delirium alone has
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2022, American Journal of Emergency MedicineEmergency Department Care Transitions for Patients With Cognitive Impairment: A Scoping Review
2022, Journal of the American Medical Directors AssociationNeurological Emergencies in Geriatric Patients
2022, Emergency Imaging of At-Risk Patients: General Principles
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Dr. Meldon was supported in part by an American Geriatrics Society/Hartford Foundation Jahnigen Career Development Scholars Award.
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Address for reprints: Fredric M. Hustey, MD, Department of Emergency Medicine-E-19, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195; 216-445-4558, fax 216-444-1703; E-mail [email protected] .