Acute Altered Mental Status in Elderly PatientsTaken from EMSWORLD.com February 2013

Acute Altered Mental Status in Elderly Patients

Can be challenging to determine the cause

Acute Altered Mental Status in Elderly Patients

Subtle changes often go unrecognized

Acute Altered Mental Status in Elderly Patients

Only 30% of patients with delerium are identified

Acute Altered Mental Status in Elderly Patients

Elderly are those 65 and older and make up 10% of the population

Acute Altered Mental Status in Elderly Patients

Altered mental status is present in 10% of all elderly patients who present to the emergency department

Acute Altered Mental Status in Elderly Patients

Many of these patients will present via EMS

Acute Altered Mental Status in Elderly Patients

One in nine of these patients ultimately die during their hospital stay

Acute Altered Mental Status in Elderly Patients

Delerium represents a serious underlying condition and is marked by an acute change in cognition

Acute Altered Mental Status in Elderly Patients

Delerium is defined as a disturbance of consciousness and change in cognition that develops over a short period of time

Acute Altered Mental Status in Elderly Patients

Delerium is not natural and not associated with diseases such as dementia and Alzheimer's

Acute Altered Mental Status in Elderly Patients

Delerium is a hyper or hypoactive alteration in brain function and affects behavior, memory, actions, and attitudes.

Acute Altered Mental Status in Elderly Patients

Delerium may be the only symptom of a serious underlying medical condition

Acute Altered Mental Status in Elderly Patients

Delerium and Dementia are NOT the same

Acute Altered Mental Status in Elderly Patients

Delerium is not the same as a gradual mental status change

Acute Altered Mental Status in Elderly Patients

Things to look for in Delerium An acute onset of the condition Patient’s inattention Disorientated thinking Altered level of consciousness

Acute Altered Mental Status in Elderly Patients

Dementia is generally thought of as a single disease caused by decreased brain size and function that becomes a permanent cognitive impairment worse than would be expected for the patient’s age.

Acute Altered Mental Status in Elderly Patients

Dementia is NOT reversible

Acute Altered Mental Status in Elderly Patients

Sepsis is a common cause of mental status change The entire body has an increased oxygen demand that can

lead to hypoxia Toxins are released into the blood stream that can impair

normal brain function Metabolic acidosis occurs which interrupts normal brain

function

Acute Altered Mental Status in Elderly Patients

Infection sources are not always obvious UTI’s are one of the most common causes of delerium in

patients over 50 Anytime an elderly patient appears toxic and has a history

of diabetes or immunocompromised, consider a UTI

Acute Altered Mental Status in Elderly Patients

Avoid Ringers Lactate It contains lactate which may make the situation worse if

they are experiencing lactic acidosis

Acute Altered Mental Status in Elderly Patients

It is important to communicate sepsis suspicion to the physician For each hour that passes with no intervention, the patient’s

mortality rate increases by 7.6%

Acute Altered Mental Status in Elderly Patients

Remember: Delerium may signal a life-threatening underlying medical

condition Delerium is not associated with dementia and is not a

normal part of the aging process Delerium is often subtle and easy to miss Use family and friends to help understand the patient’s

behavior