Acute Altered Mental Status in Elderly Patients Taken 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