ELDERLY PATIENTS WITH ALTERED MENTAL STATUS - 09/09/11

Doi : 10.1016/S0733-8627(05)70029-8

Kelly P. O'Keefe, MD, FACEP ^a, Tracy G. Sanson, MD, FACEP ^b

^a Medical Services Flight and Emergency Services, 6th Medical Group, MacDill Air Force Base, Tampa, Florida(KPO)

^b Emergency Department, Spring Hill Regional Hospital (TGS), Spring Hill, Florida

Résumé

The body immures the mind within a fortress; presently on all sides the fortress is besieged and in the end, inevitably, the mind has to surrender.

The body immures the mind within a fortress; presently on all sides the fortress is besieged and in the end, inevitably, the mind has to surrender.

MARCELL PROUST, REMEMBRANCE OF THINGS PAST Once a man, twice a child

As the graying of our society continues and the baby boomer generation nears retirement age, the number of times emergency physicians will be called on to differentiate the causes of mental status changes in the elderly patient will likewise increase. Astoundingly, the percentage of the population aged 65 years and older is increasing at a rate more than twice that of the total population.^{15 Furner S.E., Brody J.A., Jankowski L.M. Epidemiology and aging Geriatric Medicine New York: Springer (1996).
37-43

Cliquez ici pour aller à la section Références} Unfortunately, the difficulty with which the correct diagnosis is made and proper therapy is initiated will remain unchanged. Dementia, delirium, sepsis, hypoxia, and hypoglycemia are but a few of the possibilities facing the physician, who will be relied on to act quickly and correctly in the face of altered mental status. Iatrogenic causes, mainly prescription medication, must be considered, and a thorough knowledge of drug effects and changes in metabolism occurring in the elderly is necessary. Organic causes and inorganic disease states require consideration. The myriad diagnostic possibilities mandate that the emergency physician (EP) be familiar with the proper course of investigative avenues and treatment options, or the problem may be missed and result in improper treatment. Regardless of the chief complaint, with the high prevalence of dementia and the potential reversibility of its symptoms, it is recommended (and feasible) that the emergency department (ED) screen all elderly patients for cognitive impairment.^{17 Gerson L.W., Counsell S.R., Fontanarosa P.B. , et al. Case finding for cognitive impairment in elderly emergency department patients Ann Emerg Med 1994 ; 23 : 813-817 [cross-ref]

Cliquez ici pour aller à la section Références, 34 Maddens M.E. Should elderly emergency department patients be screened for dementia? Ann Emerg Med 1994 ; 23 : 873-874 [cross-ref]

Cliquez ici pour aller à la section Références}