Changes in cognition are relatively common in the older population. Over the age of 75, as many as 1 in 4 people have dementia, and 1 in 10 in the ED has delirium. Depression (with its cognitive changes) is more common in those over 75 than in any other age group. However these three conditions are often overlooked or incompletely assessed during an older patient’s stay in the ED.
This module explores why the 3Ds – Delirium, Dementia, and Depression – are essential topics in the ED and how their presentations can often be misleading for health care providers. We‘ll introduce some ED-friendly screening tools and strategies for managing the symptoms of delirium and dementia that can be challenging for patients, family members and care-givers.
At the end of this module you should be able to::
- Describe the 3 D’s of cognitive impairment – delirium, dementia, and depression – and argue for their importance as ED diagnoses.
- Use screening tools for these conditions to assess whether an older person is able to give an accurate history, participate in determining the plan of care, and understands discharge instructions.
- Document an older person’s mental status and any change from baseline with special attention to determining if delirium has been superimposed on dementia.
- Formulate an age-specific differential diagnosis for an older patient with new cognitive or behavioral impairment, and initiate a diagnostic work-up to determine the etiology, and initiate treatment.
- List strategies to manage agitated patients such as addressing untreated pain, hypoxia, hypoglycemia and use of irritating tethers and environmental factors, disorientation.