Challenges of Delirium Detection in Older Adults in the Emergency Department
An estimated one to two million older adults with delirium visit hospital emergency departments in the United States annually. Yet about two-thirds of the cases of this sudden and potentially lethal change in mental status are unrecognized by emergency department clinicians who are under time pressure and almost always managing multiple patients at once. Half a year later, those with undetected delirium who were discharged from the emergency department have significantly higher mortality rates than those whose delirium was recognized.
Researchers from the Indiana University Center for Aging Research and the Regenstrief Institute have conducted what is believed to be the first study to interview providers to identify the barriers and possible catalysts to delirium detection in emergency care situations.
A release from the university quotes Michael LaMantia, M.D., MPH, an Indiana University Center for Aging Research scientist, Regenstrief Institute investigator and assistant professor of medicine at IU School of Medicine, as saying, “Delirium is a serious condition that is too often missed in the ambulance and emergency department and we need to improve its detection. Patients sent home from the emergency department with undetected delirium have six-month mortality rates almost three times greater than their counterparts in whom delirium is detected. Unrecognized delirium presents a major health challenge to older adults and an increased burden on caregivers and the health care system.”
The researchers, led by Dr. LaMantia, report that the hectic emergency department environment, typically focusing on accident victims and acutely ill individuals rather than older adults with multiple chronic illnesses who are experiencing a sudden need for emergency care, is the largest challenge to delirium recognition and treatment. They also found that emergency department medical staffers were more likely to think of delirium in older adults when patients exhibit agitation, rather than in those who are more withdrawn.
“Emergency Medical Service, Nursing, and Physician Providers’ Perspectives on Delirium Identification and Management” was published online ahead of print in July 2015 in Dementia: The International Journal of Social Research and Practice, a peer-reviewed journal.
In focus groups convened by the researchers, emergency physicians, emergency department nurses, and emergency medical service personnel indicated that delirium recognition is hampered by not having a sense of the baseline cognitive state of the patient, particularly among those with pre-existing cognitive impairment such as Alzheimer’s disease.