Acute Altered Mental Status in Elderly Patients

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


Subtle changes often go unrecognized


Only 30% of patients with delerium are identified


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


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


Many of these patients will present via EMS


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


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


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


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


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


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


Delerium and Dementia are NOT the same


Delerium is not the same as a gradual mental status change


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


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.


Dementia is NOT reversible


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


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


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

they are experiencing lactic acidosis


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%


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

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Acute Altered Mental Status in Elderly Patients