Improving Cognitive Evaluation and the Diagnosis of Delirium among Elderly Patients Visiting the Emergency Room
Boris Punchik
Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel and Department of Family Medicine, Sial Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Yan Press *
Yasski Clinic, Comprehensive Geriatric Assessment Unit, Clalit Health Services, Beer-Sheva, Israel and Department of Family Medicine, Sial Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Yakov Grinshpun
Department of Geriatrics, Soroka University Medical Center, Beer-Sheva, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
A. Mark Clarfield
Department of Geriatrics, Soroka University Medical Center, Beer-Sheva, Israel and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel and McGill University, Montreal, Canada.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Delirium is a common problem among elderly patients seen in the emergency department (ED). Under-diagnosis of delirium by the ED team is common and can have serious implications. In a previous study we found poor quality of cognitive assessment and no mention of delirium in the ED of a large teaching hospital in southern Israel in 2003.
Aim: To evaluate cognitive assessment and delirium diagnosis two years after adding of a consultant geriatrician to the ED team.
Methods: We examined the rate of mental status assessment and the prevalence of delirium in the ED among patients older than 65 years via a retrospective chart review.
Results: In a random sample utilizing medical records of 317 older people examined in the ED during 2007-2008, cognitive assessment (full or partial) was performed for 192 of 317 (60.6%) of patients (compared with only 12.5% in 2003), and 12 cases of delirium were specifically diagnosed in the ED (3.8%) compared to none in 2003. The rate of cognitive evaluation for subsequently hospitalized patients was 45% (compared with 59% in 2003).
Conclusions: This study indicates a moderate improvement in the rate of cognitive evaluation and the diagnosis of delirium among elderly patients seen in an ED compared with a similar study which was published 5 years ago.
Keywords: Delirium diagnosis, elderly, emergency department patients, geriatric assessment