Summary
We hope you have added to your knowledge skills and attitudes about Cognitive Impairment in the Older ED Patient. Delirium, dementia, and depression are much more common components of an ED visit by an older person than we often realize. Our ability to recognize, assess, and manage can be increased by heightening our awareness of these conditions and the often atypical or unexpected ways in which they present. We can add some simple questions – like “what has changed?” – to the history, and add some component of standardized screening tools – the CAM, the Mini Cog, a depression screen – to the physical exam.
You may also want to review the modules on Atypical Presentations and Medication Management which have specific relevance to this topic.
Review the Learning Objectives before proceeding to the Knowledge Check.
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.
Discussion: Summary
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Changing my thought process on NPO status in the ED
so true
Incorporate screening tools, better assessments,
i will incorporate. Thanks
Very informative
Respiredone role in delirium
mini cog looks like a great tool , will try to implement into my assessments
the simplified depression screen is good.
also i feel better using haldol more often rather than delaying interventions searching for atypical options in our limited pharmacy
also remembering how prevalent (as yet) undiagnosed dementia is, and trying to do the same thing i do for new HTN dx, ie, setting up a clear follow strategy and plan to start the ball rolling on E&M of that
Utilizar escalas validdas
Aplicar test para screening como el mini cog involucre a familiares o cuidadores y pensar en causas diferenciales de delirium
nice
mini cog as a quick screen for dementia
more consistently consider depression
Will apply the minicog
This module has helped me understand that there maybe atypical presentations for patients that come in. It always helps to dig deeper and go more into depth, especially with the patients history. Helps evaluate the geriatric population better.
Yes I agree
This module has helped me understand that there maybe atypical presentations for patients that come in. It always helps to dig deeper and go more into depth, especially with the patients history.
Mini Cog
more standardized screening
Aprendí que no todo es delirium
Escalas para determinar severidad
Recordé polifarmacia
Nemotécnicas
great overview
I learned to dig into the symptoms and find symptoms from non-verbal cues. I also learnt to have a low threshold for investigations like CT scan. Always consider polypharmacy
mini cog
Mini cog
every patient needs to be evaluated and determine if they have cognitive changes.
mini Cog
mini cog
mini COG!
Screening for delirium, dementia and depression in Emergency department by useful mnemonics shared in this modules
As above
Mini COG for dementia
CAM
participating.
good info
good information
good information
Great use of bedside validated tests of cognition, importance of getting details, i.e. why a patient fell, what family members have noticed, etc. Establishing a timeline for events in
?cognitive deficits, when a change in behavior occurred.
definitely use it more in my clinical practice
use tools for assessment
Will def incorporate
It’s Important to asses a Patient Holistically, should not jump to make a diagnosis, through History, including Presenting complaints, HOPI, Past HX, Social HX ,Medications HX, Risk assessment and looking for all the differential, than thorough examination including a brief Mental state examination , focussed investigations to find the cause of vague symptoms and especially collateral history is very important.
use the tools to screen for delirium, dementia and depression
consider atypical presentations
dont assume, always ask
always include cognitive assessment for patients who are vague and >75yo
criteria for safe discharge
that being in a hurry and not letting yourself go down a rabbit hole of investigation leads to misdiagnosis
I’ve learned that each elderly person can present different health alterations differently, and that cognitive impairment may be the only sign to an infection. Looking and assessing for this right away is important so it isn’t missed during diagnosis.
ways to assess cognition in a brief way
This module was very helpful. It was a great reminder to better assess patient’s change from baseline, and to not assume that all elderly have some level of cognitive impairment…or assuming their impairment is their baseline.
x
Great review of delirium in the ED. Useful tools learnt e.g. MINI COG
adding to my regular assessment of seniors…
1. CAM for delirium
2. Mini Cog… 3 words clock 3 words
3. Depression
Cam
To be more specific/targeted with assessing older patients for dementia vs depression vs delirium. The mini COG test will be helpful in this regard.
I have learnt to have a high suspicion for Dementia, Depression and Delirium in elderly patients presenting in the ED. I have also learnt to use screening tools in the assessment of elderly patients suspected to have Dementia, Delirium and Depression.
good review. the diagnostic tools make the 3D’s easy to identify.
beautiful review. the diagnostic tools make the 3D’s easy to identify.
This has been an awesome review for delirium/dementia/depression in elderly. I think it reminds us that sometimes we need to slow down and take that extra time to get a history in the ‘vague historian’ and remember to use collateral to aid in finding a potential etiology for change in behaviour as it could change management. I think I will try and use the mini-cog in practice and use AIDA to help support suspicion of delirium/dementia in my ED patients. Currently, I have a very low threshold to fill out a geriatric outreach referral for patients I am concerned about but are well enough to go home as I think it is important to have their cognition thoroughly assessed so they can have access to resources and supports if needed.
I learned a lot. Will screen for the 3 D’s.
reviewed minicog
i have learned to better use cognitive assessment tools
I learned how to better incorporate the CAM, the Mini Cog, and a depression screen into my exam.
I really liked the geriatric depression screen and the reminder that geriatric depression may manifest with more somatic complaints. I was not aware that suicides in older adults have a higher incidence of completion.
I agree, the geriatric population most often just want someone to slow down and actually hear them out while they are in the ED.
taking more time for in-depth questioning
Good screening tools
screening for dementia and depression in elderly patients
I was able to gain more knowledge on the difference between dementia, delirium, and depression. I was able to understand the assessment tools that are used to assess dementia and delirium.
more time, patience
to be more aware that multiple physical complaints in the elderly may be a sign of depression
concise and important
will remember to do the screening for causes of delirium
4 features of delirium
good info
mini cog
Minicog
will incorporate mini cog
Quick screening tools. Be more efficient and more likely to screen.
Will incorporate mini-COG into my assessments. Haldol with low-dose for agitation in elderly
Will evaluate formally for dementia, delirium, depression
ok
I think that the screening questions for depression are useful. As well as learning that there could be a acute reasons for delirium
ok
ok
to use the screening tools more often and consider the criteria for discharge
screening tools
nothing
quick screen for dementia
I can include more thorough screening questions to patients. Dig deeper into their symptoms.
a
ok
looking at alternatives to admission
The 3D’s in the elderly is very common but often misdiagnosed due to several factors ranging from doctors overlooking the issues present with the patient to patients being non compliant with there doctor visits. It’s up to family and primary care providers to be fully engaged when issues arise.
useful tools.
i will incorporate the screening tools and be more aware of subtle symptoms
tools for screening
variation in presentation
often can have overlapping dx of delirium, dementia and depression
agreed
I learned about the different use of assessments (CAM vs. Mini-Cog) in assessing delirium and dementia. I found this module helpful in understanding both pharmalogical and non-pharmalogical treatments for delirium and will be implementing moreso non-pharmalogical interventions in my practice. For example, promoting mobility, encouraging food or drinks and assessing bowel/bladder function. Thank you for this!
screening for depression, dementia and delirium for older adults in ED
Mini-Cog is an excellent tool, always be vigilant for delirium, dementia, depression
great info
ok
.
new mnemonics for delirium causes
k
ok
making sure I add this to my assessments for anyone over 75 from now on.
I have learnt to become more mindful of the elderly management in the ED.I am endowed with more knowledge and information about recognizing dementia, delirium and depression in the elderly population.I have learnt how to use useful quick tools in the ED to assess for the above conditions.I have learnt mnemonics to quickly assess the above conditions. I became more cognizant and empathic of the elderly’s perception of an unfamiliar environment and faces in the noisy ,fast paced ED.I am more aware of management and discharge instructions that involves the patient participation.Proper follow up management is important to assist with elderly to achieve at best to their normal baseline functioning.
Doing mini cog more frequently, and depression screening on every 65+ on nurse intake
Geriatrics present with atypical signs and symptoms of diseases, dementia and delirium is often missed and it brought awareness that I never knew was so important when caring for the pt.
importance fo establishing patient’s baseline through collateral, using some form of validating screening for 3 Ds (delirium, dementia, depression)
that we shouldn’t overlook the patient’s complaint or her family member’s concern even if all his investigations are normal.
Discharge criteria for Dementia pt. – RISKS
The mini COGs exam is an additional tool I can have in my wheelhouse now.
The importance of not only looking at my patient but listening to my patient. It has made me think about speaking with family more in the future.
Ive learned the importance of screening and how we easily overlook performing these easy short assessments in the ED. I will use these in the future to better my practice
I will definitely add these screening tools to my evaluations. Will be more aware. Interesting have had two cases in the ED recently of subacute subdurals that have presented similar to the case here and caught them both but was lucky. In retrospect after doing this module it should have been obvious if I had this information.
minicog
I have learned to always approach at the baseline of the patient. Find out how they were before so that I may have a better idea of what’s happening now. The different tools to use in order to have a better focus on a diagnosis. Evaluate vague symptoms alot more carefully in the geriatric patient.
Awareness and tool for testing for dementia, delirium and depression
I have learned to think of delirium as acute brain failure and a sign of another issue not just assume it is the patient’s baseline function. Also a quick screening for dementia and the importance of not just assuming someone else has already addressed it
Tools and assessment strategies
the multiple tools and assessments
Learned the use of the CAM tool for screening. Addition of TSH to delirium screening. Potential need for a delirium workup PPO in my department.
What have you learned in this module that you will add to your practice?
I now know that the most common form of delirium is hypoactive, so I shouldn’t only mainly look for responsive behaviours as an indicator. It is important to evaluate using CAM or MMSE (or shorter tools for ED). I know the definition using AIDA. I should no longer *assume* a baseline diagnosis of dementia. Also the large prevalence of depression in older adults.
E
Definitely would impact my patient management
Mental health diseases are common. Assessment is required for dementia, delirium, and depression if clues are there in history taking.
Good
nice
good
More broadly screening for cognitive impairment in ED
look out for atypical presentations, include cognitive/mental exams in assessments, engage collateral
agreed
screening tools. Better able to differentiate between the 3
i see that depression screening can be done in a timely fashion using these tools.
seeing changes in behaviour
Additional tools to help screen and appropriately treat our geriatric population
It’s definitely given me a new perspective when it comes to managing the elderly patient’s. I really appreciated the mnemonics and the screening tools will definitely come in handy for use in the Emergency department.
The crucial importance of delving into the timeline of changes in behaviour/cognition and enacting easy rapid screening tests to not miss delirium, dementia or depression.
attention to subtle changes in behavior, always include patient in questioning
agreed
The clear examples of delirium and how it can present as well as the screening for dementia are both excellent resouces
Simple tools to assess depression and dementia
the exact questions give us a lot of information
…..
The value of screening for cognitive impairment in the ED setting and its impact on effective patient management and discharge.
It’s definitely given me a new perspective when it comes to managing the elderly patients. Given me cues to look out for and educated me on how to differentiate the three. I also appreciated the mnemonics and the screening tools will definitely come in handy for use in the ED.
Nice
okay
.
I learned that dementia is common in patients over 75 and should. I’ll remember to include something in my assessments that screens for memory impairment.
…
Including “Mini Cog” in my histories as well as Geriatric Depression Screen (especially if diagnoses unclear).
helpful information
great review
.
improving interview with geriatric patient’s and spending more time with them
yes
Good summary
More frequent screening for dementia and depression. More awareness for delirium.
More frequent cognitive impairment screens and mood disorder screens. I think my practice will change for the better by being more aware of the atypical presentations of mood disorders, specifically.
Helpful information and screening tools to use in patient setting
As an RN that the assessment must be thorough and more clear. Must listen and be empathetic. That DC must be safe and clear to the patient. It must be different for the patient with dementia.
.
good review
Good summary
The quick dementia screen. Very helpful. I also didn’t know males were at higher risk of delerium
learned the importance of being aware of the presence of delirium, dementia and depression and how they can greatly impact outcomes of care. How to recognize them and screen for them efficiently in the ED
I will start to use the mini-Cog screen in the ER to identify elderly patients with Dementia and arrange outpatient follow-up and adjust treatment plan accordingly.
Recognition of the mortality associated with delirium esp if missed in ED
Revised cognition tools
As a non-doctor, my main learning is that delirium evidences itself with a change from the normal that is fluctuating.
mini cog
utilize screening test
screening tests are great if they are used
I will use these screening questions for my patients in the ED setting.
Good review
Great summary
important to distinguish between dementia and delirium
Use of screening tools and different causes to check.
Use of relevant screening tools.
What have you learned in this module that you will add to your practice? How do you think your practice will change as a result of your learning in this module?
This module has helped me remember to take a more broad approach to the elderly patient who presents to the ED. A reminder to look past the physical / somatic complaint and consider the possibility of the 3Ds (delirium, dementia, depression) and screen for them.
informational and applicable information
I think that this lesson was extremely helpful. It was a great education experience
learnt alot
will keep in mind the tests that are quick and easy to do
very helpful
identifying a change in baseline and differentiating between Delirium, Dementia and Depression
keeping the causes of the above in mind will help with a thorough investigation
how to treat in ER
how to assess mental status in ER in timely manner
great
ok
Screening tools and the knowledge of the different approaches and incorporating that into a routine exam.
Screening tools
few simple screening tools
What have you learned in this module that you will add to your practice? How do you think your practice will change as a result of your learning in this module?
Using the screening tools will help me to better identify these conditions which will be hugely valuable in formulating treatment plans and better understanding patient needs.
The screening tools are very easy to use. Will definitely use them as well as i like the mnemonics for patient safe discharge! Definitely informative
an easy way to pass the time between asking the words to remember and having them repeat them back
It’s very clear definition between those three now!
Very easy tools to use to dg it- easy and quick
Risk factors has been clearly described and also screening tools well explained how to use them
Delirium tx was clearly and exactly explained in ED settings i.e. haloperidol
Very good realistic videos
incorporating tests into practice
great
I learned 3 quick and effective screening tools to use in the ED for delirium dementia and depression.
good education
very good
More careful consideration of inorganic causes of mental status changes in the elderly as well as increased awareness of the need to take time to really listen to patients and families and pick up on subtle clues about status changes.
lots of good mnemonics to help with testing and recognizing cognitive impairments in the geriatric population
slow
Pay more attention and go slow
Great module. Learned a lot.
To pay more attention to the family and give them time to voice their concerns
So easy to do a quick exam on patients to determine if they have demenia, delirium, or depression
3 D’s of cognitive impairment
ok
assessment is key to improving patient outcomes
helpful
acronyms
Standardizing the CAM, the Mini Cog, a depression screen into my assessments.
January 8, 2020
Screening for delirium, dementia and depression. Understand the broad differential diagnosis of delirium in older adults
mini cog, feeding pts, irritating tethers
Screening for delirium, dementia and depression. Understand the broad differential diagnosis of delirium in older adults
Was an intersting summary of huge topic, easy to rember and practical in ED settings
Great Module, good ideas for assessments.
all will be helpful in my practice
I plan to institute the clock drawing test as a means to document cognitive impairment.
Confusion assessment scale and definitions and causes of delirium and dementia
The whole module brings light to the 3 Ds and how easy it is to assess as long as we do it. Take the extra few minutes. I will change my practice to include the mini mental health and mini cog
Aprendí a conocer de las 3D y los elementos para diagnóstico, por lo que los incorporaré a mí práctica diaria ante la sospecha en pacientes de emergencia
Think more often about the 3 D and start trying to use ED screening tools. In the best case scenario try to implement their use among all coworkers…
a more systematic approach to the 3 D’s which we usually don’t pay much attention to in our daily practice as we don’t realize the significant impact.
Specifically add orientation/cognition to my physical exam with elderly patients in the ED even if their chief complaint seems pretty straight forward (UTI with no obvious LOC change).
Assessment with clock drawing and asking to recall three words and repeat them is an accurate way to diagnose dementia. In addition, identifying depression is significant for frequent flyers and vague complaints in the elderly.
I’ve learnt the 3 D’s of cognitive impairment and will be able to incorporate the screening tools in the physical exams.
Implementing more standardized testing (COG) to evaluate for dementia.
agree
get a more in depth history and make sure to ask family/friends or caregivers about their observations.
use of screening tools. Will incorporate into physical exam
Subtle cues, involving the family, assessing for home safety
paying attention to subtle clues and hints from family. performing screening tools and mental state tests. remembering to look out for 3Ds in older adults.
start doing mini-COG and depression screens in elderly routinely
agreed! screening is very important
Agreed, soccommon amongst elderly and pts with polypharmacy, infections, and inadequate nutrition
agreed!
great review
thanks!
Great review!
very eyeopening and used BPG
This module has helped me understand the importance of change in baseline in cognitive function in the geriatric population. Very useful mnemonics too.
Very educational module, thank you!
Very useful.
module very useful
difference between delirium and dementia, causes, how to assess and accurate diagnosis
I have learned the importance of screening for delirium, often an undiagnosed symptom of infections, polypharmacy, and metabolic changes. I also learned the MMSE and the Mini-Cog Assessment.
the difference between dementia and dilerium
Differentiation between delirium and dementia. I also learned how to score the Mini cog exam.
I have learned to ask for sudden recent changes and include family members in case the client is comfortable with it and seems confused. also I have learned how to use screening tools to differentiate depression, dementia, and delirium.
A great educational model to make new considerations with these presentations.
What have you learned in this module that you will add to your practice? How do you think your practice will change as a result of your learning in this module?
I like mnemonics to remember details and groups of items. I appreciated the DIMES, “I watch Death”, DELIRIUM, RISKS, and SIGECAPS as assessment tools and plan to help teach this to others in our ED as we develop our skills to be more geriatric focused. I also appreciated the videos and opportunity to comment and receive the feedback to the answers.
In geriatric patients I’m going to be looking more often for the acute change in mental status. In addition I didn’t realize that being excessively annoyed by a monitor beeping could be an indicator of change in mental status.
really reinforced how often somatic complaints in the elderly can be 3D related
CAM and several mnemonics that are applicable in practice. specific assessment questions when screening
I have learned of the various tools such as CAM, MIN COG and SIGECAPS to includes in the assessment process of elderly clients, as they are less likely to complain of delirium, dementia and depression.
many acronyms for causes of delirium.
how to assess for delirium, dementia, and depression
i’ve learning many menumonics and very quick screening tools that i cu=ould use to provide better care for the clients we care for as HCPs
-Applying the mini-Cog assessment through video practice to assess for delirium.
-PPOS for delirium diagnosis.
The importance of probing further into the pt’s concerns, asking open-ended questions, especially “what’s changed?”. Using the CAM for delirium, mini-cog test for dementia (so quick and useful!), and depression screening is so important yet often overlooked because HCP’s miss cues.
yes
the
Screening tools &mnemonics are all great in distinguishing the 3 D’s of cognitive impairment!
Three different cognitive impairment in order to distinguish them (depression, delirium and dementia)
Good assessment tools
Definitely bringing the CAM, 3 depression Qs and Mini COG into my practice- easy to perform and can help provide some initial information that can lead to a more focused assessment!
Do a mental screen for geriatric age group in Ed. Always assess for any change in baseline.
learn to be aware of s/sx the 3 Ds of cognitive impairment, atypical presentations, and the use of screening tools and mnemonics to help with d/dx.
ability to do a focused assessment of the three D’s and come out of it with some helpful information….time well spent
Spend more time with patient who cannot give specifics to illness, do more MME’s, and ask more questions r/t depression.
use of CAM, screening for dementia
very informative and helpful in regards to the 3 d’s and screening tools
AIDA acronym is useful, minicog testing is also useful
great information in distinguishing 3 D’s
very helpful for screening process
This module was a real eye-opener to the seriousness of elderly depression, dementia and delirium in the ED. Delirium and depression can potentially be associated with high mortality and should be routinely screened once suspected.
this module was very helpful and offered quick and easy approaches to make sure things like delirium, depression, or dementia are not missed in the ED setting.
Very helpful. Often overlook the depression and will start adding the screen to my ?s, not just the nurses. also, the mini-cog is quite helpful and I will use this more. Likely many of the difficult history patients have one or more of the 3D’s.
working in ED, these tools will be very helpful not to miss out the 3 D’s. The mnemonics were also helpful
none
The Mini-Cog is a great alternative to the MMSE in the ED.
AIDA and Mini—cog are truly handy
Lots of handy mnemonics
Aida, minicog
minicog is goos
Aida,minicog
good module
I will be sure to screen for delirium in elderly patients in ED
I will use the minicog more frequently and the tool for screening for depression in the ER. A very helpful module. I found the videos very helpful.
the simplicity of the screening,should include it routinely in geriatric ER assessments
To pay more attention to older person’s mental status and any change from their baseline.
Thank you on opening my eyes to the importance of having more patience with the elderly.
always look for the cause of delirium.Screen for depression in elderly as it may present as dementia and be missed
given the simplicity of the screening, more likely to include it routinely in geriatric ER assessments
screening tools
Incorporating screening tools into the EHR to remind practitioners to evaluate for these conditions.
help me better understand the difference between the 3 ds
Depression is common in geriatrics but presents differently than in the younger population. There is a higher success rate of first time suicide attempts in this group. Collateral history and timelines of patient changes are essential to determining what the cognitive changes might be due to. Listen to the patient’s answers (and how they answer) as well as what the family’s concerns are. Rule out medical/physical reasons first, but don’t stop there.
screening tools
A lot of evaluation tools simple enough to use I like it. Been working 12 years in the ER and I think don’t miss many delirium or dementia or depression cases but having objective tools to use makes it a bit easier in the grey areas where I have doubts.
agree
i learned a lot especially in regards to assessment skills within the geriatric population
helpful
helpful
This was a great module
I learned to be more thorough in my assessments with older populations coming into clinical settings due to the lack of delirium diagnoses. Also how to assess and identify dementia and delirium more efficiently
quick screening tools and causes for delirium
assessment skills
The Minicog and delerium screening will be very useful
not to ignore depression
Prevalence of somatic symptoms as presentation for depression in older adults.
Picking up on clues that suggest confusion, asking more open questions, further assessing etc.
Reflective practice and patience is highly important. Don’t make assumptions and do not conclude based on what is already known. Taking the time to understand and investigate a patient condition, asking open ended questions to lead to more explanation is important. Listen to family member concerns, and to not create a ill-personable experience. There is an issue, but look at intersecting factors that my influence it. The quick tests are easy to conduct and simple, and i feel that we should make use of it whenever it seems fit.
I will ow take a little extra time when evaluating the elderly. and not over look small signs
Check own assumption
helpful1
1
helpful
the acronyms
Learning of the assessment screening tools for the 3 D’s: AIDA for delirum, Mini-cog with the 3 words and clock drawing, and depression questions.
I learned of the screening tools for these conditions, 3 Ds, that are effective in ED.
Check own assumption.Very good screening tool
Don’t assume that if a pt isn’t already diagnosed with dementia, that they do not have it.
Just becoming more knowledgeable about the topic of Delirium, Depression and Dementia will greatly improve my perspective in that type of population
very interesting and informative module
Screening methods for delirium, dementia, and depression and when to suspect them. I will use some of the screening tools suggested.
screening for the 3 d’s and symptoms for each.
how to screen for dementia and delirium
Screen for dementia and memory clinic referral if anormal as if cardiac problem
I have learned a lot about the delirium and how it can easily be missed. I can understand the importance of having a baseline assessment of pt. beforehand. I have come to understand that delirium can be related to many different diagnosis and can be life threatening if underlying cause is nor treated.
What I have learned in this module that I will add to my practice is the screening method for delirium (AIDA) and the knowledge I have attained with understanding the causes of it. My assessment with older adults will be strengthened and enhanced with the knowledge and assessment skills I have learnt in this module.
I have learned useful quick assessment tools such as the CAM that I can easily integrate into my practice
some component of standardized screening tools – the CAM, the Mini Cog, a depression screen – to the physical exam.
not sure about this
this is strange
great review
beneficial
Screen
Great course, good information
More attention to ask questions and assess dementia, depression and delirium.
great course with screening tips
CAM and mini-COG
Use active listening more
HELPFUL
Useful memory tools for assessment
Using more active listening
I will incorporate more active listening and awareness of geriatric depression
mini-cog
Reminded me of the frequency of these diagnoses and the workup for each one of them.
I have never come across the ED Depression Screening 3 questions before. That’s definitely something that can be implemented when I practice.
I already have increased the time I spend counselling and speaking to relatives and caregivers of patients with existing dementia. Sometimes the biggest challenge is understanding whether the reason they have brought them into hospital is an acute change or that they are unable to care for the patient even if the problem might be a reversible cause.
I try to emphasize that at times home care may be best for these patients in terms of avoiding delirium and acute confusional states and a decline by virtue of lengthy stays in the ED.
remember not everyone has dementia or cognitive impairment, treat them as I would want to be treated..listen, listen, listen to the patient and family…they know better! don’t rush to diagnose.
Greater appreciation to screen all elderly patients for dementia, and stop assuming it has been it was a previously diagnosed dementia.
Mini COG use and CAM as assessment tools – very useful for a quick screen and assessment
great tools and reminder to take time and get it right
good mnemonic example
gocnition assessment method as well as the mini assessment for demtia. the fact that the presentation of depression is different in the elderly.
Management of delirium
Management of delirium, mini-COG assessment, maintain a high level of suspicion in all elderly people
what drugs to use..haloperidol
screening tools
RISKS
CAM and mini COG are easy to use and very useful tools
Mini-cog
Tool for depression
– Mini Cog screen
– collateral history to find out the difference from his base line
– considering the non physical symptoms in account
-Considering the mini cog screen in patients over 75
-taking caregiver’s more seriously when they say “something is not right” “this is not my mom/dad”. -Not assuming that individuals with dementia are chronically at the state in which they present
TO differentiate between delirium dementia and depression
great review with key points
highlighting the importance of screening for delirium, especially in pts with known dementia. Not assuming that cognitive impairment is due to their dementia
Quick screening tools for use in the ED.
Use of validated screening tools to use in the ED.
Use of CAM
Collateral history, CAM ICU, mini cog.
I will definitely start using the mini cog more frequently and make sure delerium is higher on my radar.
screening tools
The addition of the mini-cog and increased questioning about mood
important screening tools
assessment of the elderly, important considerations such as screening
Useful bedside screening tests.
Always assess change to the baseline, being more suspicious when patients have multiple complains.
I really love Acute brain failure…
Clear illustrations of how somatic complaints in the elderly can be a manifestation of underlying depression: importance of screening for mood disorders when symptoms don’t fit exam findings/tests.
Assessment tools: Mini-cog
assesments tools
CAM, mini-cog, assessment for dementia
screening tools
Very good information presented some of which surprised me. Very good quick assessment tools which would be an asset to me as a paramedic and an ER nurse. Well organized
I will be able to use some of the screening and assessment tools listed for Delirium and Dementia to help gauge how accurate of a historian the patient is, or if their presenting symptoms of Delirium is really caused by something else.
Remember the phrase, “Today’s poor historian can be tomorrow’s ICU patient”.
I will add the 3 word, clock face, time MSE and I will also add more questions on what the patient likes to do for enjoyment. I think this will help me better help my patients.
I will at the 3 word, clock face, time MSE and I will also add more questions on what the patient likes to do for enjoyment. I think this will help me better help my patients.
great to learn the quick screening tools which I can implement in ED without slowing me down too much
It does not take a significant amount of time to effectively evaluate elderly patients for potentially serious cognitive impairment.
Delirium – Acute brain condition
Dementia – Chronic brain condition
Relation of depression and dementia
Suspect delirium in acute confusion or reduce conscious level or change in behaviour in elderly.
Dementia screening in elderly is an important and effective tool
To be aggressive with elderly and screen for dementia and depression
Often over-looked as not deemed and ‘acute’ medical issue
excellent course with great tips on how to screen for
dementia, delerium in busy ED or acute care.
I think the biggest things I learnt are
1. The difference between the 3Ds
2. tools to Ax for these int he ED
I think incorporating a short mobilization and providing water during my assessments can make some improvements to the care in the ED. Through mobilizing I can practically see the physical challenges and safety issues when considering sending somebody home. Not only does this provide me with invaluable information, but it provides an opportunity to decrease delirium.
Biggest thing I will take away is the use of the mini assessmetn tools for delirium, dementia and to consider depression as an alternative.
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A little extra time up front to better understand the patients recent mental status and changes cn pay off down the road.
I am more cognizant of when patients’ cognitive status has changed from baseline and when patients’ family members state “they don’t seem like themselves”. Great tools and mneumonics to remember for practice.
mini-cog
use of more validated scales
good review
More informed regarding cognitive impairment screening/special needs of this population. Ability to apply this directly into my practice.
I learned about the acronym AIDA and how to use it to quickly determine if a person is experiencing delirium. Also, learned about the different classes of drugs and side effects that could cause delirium.
The importance of gaining sufficient collateral from patient and or the relative. establishing what is the patients baseline to establish where they are now.
not ignoring the obvious – as this can lead to missing out on a more serious physical diagnosis.
the ease of assessing for delirium and dementia in the ED with appropriate tools.
I think the mini-Cog is a really useful tool that I should use more. I’ve recently discovered how many elderly people with dementia are still driving, and specifically checking for this plus flagging it to family/the GP is something I’ve started to do.
Sensitization to the subtle presentations and significant overlap between delirium, dementia and depression and ED- relevant screening tools which could be used to increase diagnostic accuracy and can direct appropriate interventions which would not otherwise have been utilized.
it is really is a good review
develop a strategy for yourself that will trigger you to identify those who may be at high risk – the ones that need the extra minutes of assessment.
awesome!
Very interesting. I will be more cautious with vague presentations.
To incorporate screening for delirium, dementia and depression in the ED is very important.
good mnemonics
Useful mnemonics
aware or the 3 D trying not to skip important evaluation that could lead to miss possible better tratment for the patient
Will be able to objectively evaluate cognitive changes & screen specifically for delirium, dementia & depression. Will improve pt outcomes & be able to give more information to family, caregivers etc
very helpful
like review of tools like CAM and COG – will incorporate those into my practice
The minicog gives me a simple way to justify my concern to consultants.
I really like the mini-cog screen i think that will be very useful.
The different screening tests were very useful
helpful review
I really liked the simplicity of the mini-cog over the lengthy MMSE which is what I normally do. I think I will start to incorporate this into my practice.
Importance to differentiate the 3 as distinct issues; useful mneumonics and simple tests to expedite the ER assessment process and keep the visit on point.
Use of simple screening tools aids in discovery of psychiatric or psychological functional impariment
regular screening
Will add the screening to my assessments
The 3 D’s, screening for these. AIDA, mini-cog, sigecaps. Causes of delerium, obtaining collateral information.
Going beyond the surface.
I found the mincing and the CAM approach particularly useful. I will use this in the future.
Assessment tools/acronyms particularily useful in practice.
I now know to have a high index of suspicion for cognitive impairment in older patients.From now on I would be sure to incorporate the simple screening tools for the 3 D’s in my practice where relevant.
Good review
Screening tools simple and validated. More apt to introduce and fine tune approach. Need by in for other health care members and family of a person with cognitive decline. Often patient and family expectations are not in line with the anticipated outcomes
Mini-COG – I will certainly introduce this into my practice.
usefull screening tool,good module
I realized how prevalent conditions like delirium, dementia, and depression are in the elderly population and quick screening tools to employ to identify these issues. I also a more comprehensive mnemonic for etiologies of delirium and the appropriate workup.
I have a better understanding of cognitive impairment after doing this module. Found it absolutely useful. I also will use the min-cog tool in my workplace.
A good overview, thanks.
I now have a better understanding of the three “Ds” in the elderly.
I will use the new tools I have learned.
good review
Will use tools for assessment of Depression, delirium and Dementia
I will use the brief screening tools – especially the Mini Cog as part of my elderly care exam.
useful assessement scores
great review
educational module, will need to do it again
ask more questions, consider cognitive impairment, utilizes tools available
Be more attentive when assessing vague patients.
Thank you
Great tools, will help in doing things better
USEFUL KNOWLEDGE GAINED
I will ask more specific questions to diagnose between dementia and delirium.
Given the tools to evaluate for dementia. More objective approach to person with dementia and or delerium
history is key
Interesting to learn some of the information about depression and the risks. Very useful.
will better assess for delirium and dementia
looking at the whole picture and not just the symptoms presented. finding potential underlying causes and knowing the three D’s should be more thought of
good learning/assessment tools
Any knowledge whether directly related to our specific practice is valuable. This knowledge provides great insight to dealing with elderly relatives
importance of active listening and thorough patient history
You’ve opened my eyes to delirium and dementia! The assessment scores are a great tool.
How did the politician win the election?
He promised to balance the budget, rein in the banks and put a unicorn in every backyard!
Unicorns are my favorite. Best comment ever
easy to use
Will have an impact on 911 calls; unlikely to have a real effect on interfacility critical care transfers.
Giving extra time and assessment to patient provides a more accurate diagnosis and tx plan.
Useful screening tools. Quick= more likely to be used regularly.
I will definitely implement some of these screeing tools in my ED practice, including the depression screen (Fabacher) and the mini-cog.
Using the Mini-Cog, the DIMES mnemonic and the three question depression screen.
will screen more often
I’ll probably have a more structured documentation of my screening for the 3Ds in my record
Utilizing the CAM & Mini Cog assessment are quick effective tools that can be used to confirm or delete important dx.
More cognizant of depressionomn as presentation in vague elderly in ED.
The mini Cog test, CAM, approach the patient in an organized way, the DIMES mnemonic, medications causing the delirium. How to pay attention to depression screening.
Establishing a baseline LOA is important. New screening tools.
Great pneumonic, great assessments for Depression/Dementia
complete assessments, use screening tools, ask family members
mini cog, important to not dismiss and do functional hx/collateral infor imporatnt
Plan to use the CAM, mini-Cog, and brief depression screening test more often.
learned some good assessment tools and will try to use the screening tools for delirium, dementia and depression, when time allows, in the pre-hospital setting
The depression screen.
Make more use of screening tools for delirium, dementia and depression and be more aware of the atypical presentations of elderly patients. Better appreciation of the need for adequate social support especially those patients being considered for discharge.
complete medical history, don’t forget de cognition and behavior status
interview henceforth be directed and complete to interview an elderly also conduct evaluation tests
I have an older vision of the specific interrogation to do
applying the test in the form copleta means that we can make a more Diagnosis of COP Presis real pathology of the patient
This was a relatively a very concise and useful instruction on cognitive disorders in the elderly. the screening tools are easier to remember and use.
Clear and concise overview on 3D with efficient screening tools that will certainly be helpful for day to day practice on primary care settings/ER. Thanks for this excellent course!
I will keep 3D in my mind when working in ED
I now appreciate the importance of diagnosing and ruling out out the presence of the 3 Ds as important aspects in the management of elderly patients presenting with another clinical diagnosis eg. Pneumonia, UTI, fall with bone injuries. The outcome of the management Will be jeopardised by inadequate assessment for presence and scope of the 3 Ds in the elderly patient.
I now have screening tests to determine if the pt. is Depressed or has Dementia
Very much like the brief screening tools, will certainly use them
Comprehensive assessment of cognitive impairment
3 main D’s and screening tools for them
The 3 question screen for depression. Much less cumbersome than the GDS and easier for patients to answer too. I already use the mini-cog, but always good to have a reminder!
Good summary
Minicog
minicog will be useful
MiniCOg, screening for dementia in ER, refresher of delirium
management of agitation in the elderly. Screening for dementia in the ED. CAM.
This is helpful.
good module. helpful screening tools
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that the 3D’s are more prevalent in ER points to the necessity to establish behavioural baselines and acute changes
good to review.
Excellent module. I like the screening tools and the PPO in the resource section. I plan to use the screens and push for implementation of these and the PPO in our Department.
Early screening will help facilitating the plans as well as communication with the patients family and primary caregivers to ensure proper followup.
The quick dementia screen. Very helpful. I also didn’t know males were at higher risk of delerium.
Excellent module. I learnt that I am overcalling dementia and probably missing depressed elderly. I will know assess many more elderly for dementia and depression in the ED.
Learning how to quickly assess for depression in the ED
Depression screens in the elderly and causes of dementia work up
I have learned that I have been sorely lacking in assessing for the 3Ds in the ED. Thinking of the 3Ds like any other dx (e.g. acute brain failure for delirium) is a useful tool. Short screening tools are also useful.
greater use of mini-COG
mini-COG
i will definately use the the mini cog more often. I do try to informally ask my patients family when they are there, how the patient is different from baseline, but when it’s busy sometimes you just don’t make the effort with phone calls etc. this module really reinforces the idea of doing it every time when you see that elderly person there alone (who wouldn’t pass the mini cog)
agree with above,the screening tools will be very helpful in the future
I will be more focused on detecting cognitive impairment
Taking more time to solicit information from family and other caregivers.
Very helpful module, I will start using the Mini-Cog in my practice.
it was the most valuable learning module I have ever had. It changed my view about assessing an elderly with vagueness in history
The 3 question quick depression screen is ideal for the ER.
Will put this new knowledge to practice!
minicog
Minicog
Thank you for reminding us of the 3d’s often very hard to differentiate in the ED setting. I also like the 3 question depression screen, as I was not aware of it!
adding standardized screening tools – the CAM, the Mini Cog, a depression screen – to the physical exam.
to evaluate every elderly patient with SIS score or Mini Cog … before making management / disposition decissions
Will evaluate formally for dementia, delirium, depression
Minicog
CAM method for delerium and minicog for dementia are useful quick screens
I liked the mini-cog and the depression questions but we have to change the attitude of the emergency staff towards the elderly who present with just another nursing home patient with”dementia” and “why did you send him!.
I have to agree with you old fart, changing attitudes and improving communication between ER staff and LTC staff would be a great first step in improving and offering quality care for our elderly.
The minicog seems useful. I was tempted to do a clock drawing test with my 75 year old mother recently! I’m often amazed at how poorly this is executed in otherwise socially well preserved elderly.
I will make greater use of the Mini-Cog as time constraints sometimes leads to the MMSE being skipped.
I like the three question screening for depression. I’m going to start using it. I like the wording of the questions. I always found even asking the questions for the GDS made me depressed. This is much better.
I will incorporate the screening tests into my practice and teaching
It was very educational module,will help us in evaluating our geriatric pt.adequately.
that each geriatric patient needs at least a high degree of awareness of atypical disease presentation, that dementia is more prevalent and that delirium may not always be agitated familiarity with the elderly and their issues improves accuracy of diagnosis