Assessing cognition in elderly patients presenting to the emergency department

Hare, Malcolm; Wynaden, Dianne; McGowan, Sunita; Speed, Gaye

doi:10.1016/j.ienj.2008.01.005

« Previous Next »International Emergency Nursing
Volume 16, Issue 2 , Pages 73-79, April 2008

Assessing cognition in elderly patients presenting to the emergency department

Malcolm Hare, RN, BSc (Nursing) (Hons) (Acting Nurse Manager Informatics Support, Research Associate)
- Nursing Research, Evaluation and Informatics, Fremantle Hospital and Health Service, Alma Street, GPO Box 480, Fremantle, WA 6959, Australia
- School of Nursing and Midwifery, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
- Corresponding author. Tel.: +61 8 9431 3325.
Dianne Wynaden, RN, RMHN, PhD (Associate Professor (Mental Health))
- School of Nursing and Midwifery, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
Sunita McGowan (Director Nursing Research and Evaluation, Adjunct Research Fellow)
- Nursing Research, Evaluation and Informatics, Fremantle Hospital and Health Service, Alma Street, GPO Box 480, Fremantle, WA 6959, Australia
- School of Nursing and Midwifery, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia
Gaye Speed, RN, B. AppSc (Nursing) PGradDip Hadm (Nurse Consultant, Clinical Improvement, Adjunct Senior Researcher)
- Nursing Research, Evaluation and Informatics, Fremantle Hospital and Health Service, Alma Street, GPO Box 480, Fremantle, WA 6959, Australia
- School of Nursing and Midwifery, Curtin University of Technology, GPO Box U1987, Perth, WA 6845, Australia

Received 25 October 2007; received in revised form 17 January 2008; accepted 21 January 2008.

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.

Keywords: Cognition, Confusion, Delirium, Emergency department, Elderly