What to do if you detect a person may have dementia?
An awareness that your patient has dementia will have an effect on each step of the ED process:
- Your ability to gather information (a cognitively intact 90 year-old will likely be able to give his own account of his medical history whereas for a 70 year-old with mild dementia you may need to involve other family or caregivers); perhaps the reason you are getting a “vague history” is because the person cannot REMEMBER their symptoms.
- Your ability to pursue diagnostic testing – the person with cognitive impairment may not be able to understand the risks and benefits of some investigations for which consent is required – eg. scans with contrast, LP, surgical procedures.
- Your ability to engage the patient in a treatment plan – the person with cognitive impairment may become frustrated with waiting and decide to leave – but may not have capacity to “leave against medical advice”; or may not be able to follow through on purchasing or taking prescribed medications or remember the instructions for wound care or head injury management .
- Your ability to establish a safe discharge plan – can the person even make their own way home? Are they at risk for “RISKS”?
Imminent danger – falls or fire-setting ;
Suicidal ideation ;
Kinship and relationships (elder abuse/adequate social support) ;
Safe driving Substance misuse, Self neglect,
Also if you are the first person to suspect or make a diagnosis of dementia, it will be helpful to that patient to pass the information along to his family doctor or even arrange referral to a Memory Clinic for further investigation. (If you detected that a person had deteriorating coronary artery disease, you’d refer him to an outpatient cardiologist, wouldn’t you?)