Malcolm Hare1, Dianne Wynaden, Sunita McGowan, Gaye Speed. 1. Nursing Research, Evaluation and Informatics, Fremantle Hospital and Health Service, Alma Street, GPO Box 480, Fremantle, WA 6959, Australia. Malcolm.Hare@health.wa.gov.au
Abstract
INTRODUCTION AND BACKGROUND: Delirium occurs frequently among elderly patients in the Emergency Department (ED), and accurate assessment is difficult without knowledge of the patient's usual cognitive functioning. This audit was designed to determine whether routine cognitive screening of elderly patients in ED could lead to early identification of delirium. METHODOLOGY: An audit using the abbreviate mental test (AMT) and Confusion Assessment Method (CAM) tools assessed 28 elderly ED patients for the presence of delirium. RESULTS: Fourteen (50%) of the 28 patients had no cognitive deficit on admission. Eleven (39.3%) displayed a cognitive deficit other than delirium and three (10.7%) had delirium, but only one had been diagnosed prior to the audit. DISCUSSION: The prevalence rate of delirium in elderly ED patients was similar to those reported in the literature. The audit demonstrated the importance of cognitive assessment, as cognitive changes can be an early and sensitive indicator of physiological dysfunction. However, the AMT had limitations which inhibited its use in ED. A four question version known as the AMT4 may be more suitable. RECOMMENDATIONS: ED nurses should routinely establish baseline cognitive functioning and assess for delirium. The AMT4 may be more suitable because of its brevity, but requires further research.
INTRODUCTION AND BACKGROUND:Delirium occurs frequently among elderly patients in the Emergency Department (ED), and accurate assessment is difficult without knowledge of the patient's usual cognitive functioning. This audit was designed to determine whether routine cognitive screening of elderly patients in ED could lead to early identification of delirium. METHODOLOGY: An audit using the abbreviate mental test (AMT) and Confusion Assessment Method (CAM) tools assessed 28 elderly ED patients for the presence of delirium. RESULTS: Fourteen (50%) of the 28 patients had no cognitive deficit on admission. Eleven (39.3%) displayed a cognitive deficit other than delirium and three (10.7%) had delirium, but only one had been diagnosed prior to the audit. DISCUSSION: The prevalence rate of delirium in elderly ED patients was similar to those reported in the literature. The audit demonstrated the importance of cognitive assessment, as cognitive changes can be an early and sensitive indicator of physiological dysfunction. However, the AMT had limitations which inhibited its use in ED. A four question version known as the AMT4 may be more suitable. RECOMMENDATIONS: ED nurses should routinely establish baseline cognitive functioning and assess for delirium. The AMT4 may be more suitable because of its brevity, but requires further research.
Authors: Christopher R Carpenter; Nada Hammouda; Elizabeth A Linton; Michelle Doering; Ugochi K Ohuabunwa; Kelly J Ko; William W Hung; Manish N Shah; Lee A Lindquist; Kevin Biese; Daniel Wei; Libby Hoy; Lori Nerbonne; Ula Hwang; Scott M Dresden Journal: Acad Emerg Med Date: 2020-12-12 Impact factor: 5.221
Authors: Jacinta A Lucke; Jelle de Gelder; Laura C Blomaard; Christian Heringhaus; Jelmer Alsma; Stephanie C E Klein Nagelvoort Schuit; Anniek Brink; Sander Anten; Gerard J Blauw; Bas de Groot; Simon P Mooijaart Journal: PLoS One Date: 2019-06-20 Impact factor: 3.240