COMMENTARY

Identifying and Treating Delirium in Older Patients in the Emergency Department

Alan R. Jacobs, MD

Disclosures

December 11, 2015

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This is the Medscape Neurology Minute. I'm Dr Alan Jacobs.

Researchers from the Indiana University Center for Aging Research have published a study exploring providers' perceptions regarding identifying and treating older adults with delirium in prehospital and emergency room department environments.

They conducted structured focus groups separately interviewing emergency medical service staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representatives supporting quotations identified.

The results showed that the busy emergency department was the biggest challenge to delirium recognition and treatment. Participants frequently recognized hyperactive features of delirium but not hypoactive features. Participants did not have a clear diagnostic strategy for identifying the condition and used heterogeneous approaches to treating it.

Emergency nurses identified the need for more training around the management of delirium.

Emergency medical service providers identified the need for more support in managing agitated patients when in transport to the hospital, and more guidance from the emergency physicians on what information to collect from the patient's home environment.

Finally, emergency physicians reported the need for baseline mental status data on their patients and access to a simple accurate diagnostic tool for delirium.

The authors conclude that clear steps are needed to improve delirium care in the emergency department, including the development of mechanisms to communicate patients' baseline medical status, the adoption of a systemized approach to recognize delirium, and the institution of a standardized method to treat the condition when identified.

This has been the Medscape Neurology Minute. I'm Dr Alan Jacobs.

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