Mrs. Sol, a 77 year old woman, arrives in the Ambulatory Area with knee pain after having a fall at home. Mrs. Sol is accompanied by her husband and they are both very focussed on her knee pain, even though she is ambulatory and the x-rays of her knee are normal.
- Watch the video below and answer the questions that follow.
- What do think is missing from this assessment? What would you do differently?
This patient went home, continued to be confused and inattentive, fell down a flight of stairs, and returned with multiple fractures. She died on her 80th day in hospital. An internal review of ED procedures for assessing older patients was carried out.
- What would happen if you took 30 seconds longer with this same patient?
- What do you see the doctor doing well here?
This patient had a complete delirium work-up which detected an acute-on-chronic subdural hematoma (from a recent unwitnessed fall). It was drained. She was discharged home at her baseline function in a week.
The Confusion Assessment Method will be reviewed later in this module. Continue on to learn more.
- Addressing the presenting problem ONLY without thoroughly assessing the underlying cognitive status in older patients is likely to miss important findings.
- It is often difficult for health care providers to sort out the difference between chronic changes (dementia) and acute changes (delirium) especially when symptoms of impaired mental status are common to both. Often close care-givers will also have difficulty distinguishing the two.
- Dementia (an already vulnerable brain) is the principal risk factor for developing delirium.
- It is essential to recognize delirium as the symptom of a life-threatening underlying medical or surgical condition.