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.
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.