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Managing Delirium Among Elderly Patients in the ED

Managing Delirium Among Elderly Patients in the ED

National estimates demonstrate that elderly patients are increasingly presenting for care at EDs throughout the United States each year, and by current projections, this trend is expected to increase significantly as Americans are living longer than ever. Between 10% and 30% of the elderly who are evaluated in the ED will present with delirium, but the prevalence may be higher. “The causes of delirium in elderly patients presenting to EDs are multifactorial,” explains Medley O’Keefe Gatewood, MD (Table 1). “While it’s difficult to discern exactly what’s going on clinically, delirium is oftentimes the only sign of underlying serious and potentially life-threatening illnesses. Much like myocardial infarction and sepsis, delirium is a high-stakes entity.” Research has suggested that emergency physicians are inconsistent in recognizing mental status impairment and the signs and symptoms indicative of a delirium diagnosis in the elderly. Recent analyses have shown that emergency physicians correctly diagnose delirium in only about 24% to 35% of elderly patients, and many of these individuals are discharged with little consideration of delirium as an indicator of more serious medical conditions. Diagnosing Delirium Among the Elderly “Failing to detect delirium among the elderly in the ED and then discharging them can increase mortality within the first few months of discharge and up to a year,” says Dr. Gatewood, who coauthored an article in the May 2012 Western Journal of Emergency Medicine on the topic. “Even when delirium is diagnosed, some patients are still inappropriately discharged. Considering the high prevalence of impaired mental status and the increasing number of elderly patients who have delirium and are still discharged, emergency physicians must make greater...
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