Changes in cognition are relatively common in the older population. Over the age of 75, as many as 1 in 4 people have dementia, and 1 in 10 in the ED has delirium. Depression (with its cognitive changes) is more common in those over 75 than in any other age group. However, these three conditions are often overlooked or incompletely assessed during an older patient’s stay in the ED.
This module explores why the 3Ds – Delirium, Dementia, and Depression – are essential topics in the ED and how their presentations can often be misleading for health care providers. We‘ll introduce some ED-friendly screening tools and strategies for managing the symptoms of delirium and dementia that can be challenging for patients, family members and care-givers.
Upon conclusion of this activity, participants should be able to:
- Describe the 3 D’s of cognitive impairment – delirium, dementia, and depression – and argue for their importance as ED diagnoses.
- Use screening tools for these conditions to assess whether an older person can give an accurate history, participate in determining the plan of care, and understands discharge instructions.
- Document an older person’s mental status and any change from baseline with special attention to determining if delirium has been superimposed on dementia.
- Formulate an age-specific differential diagnosis for an older patient with new cognitive or behavioral impairment and identify potential medical conditions that contribute to delirium.
- Initiate a diagnostic work-up to determine the etiology, and initiate treatment.
- List non-pharmacologic and pharmacologic strategies to manage delirium patients, both agitated and hypoactive.
- Identify changes that can be made in your Emergency Department to decrease the risk of precipitating delirium.
- Assess a patient presenting to the Emergency Department with dementia and make a safe discharge plan.
Attendance at this Mayo Clinic accredited course does not indicate nor guarantee competence or proficiency in the performance of any procedures which may be discussed or taught in this course.
In support of improving patient care, Mayo Clinic College of Medicine and Science and Geriatric Emergency Department Collaborative. Mayo Clinic College of Medicine and Science is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.
Continuing Education Credits
Mayo Clinic College of Medicine and Science designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Mayo Clinic College of Medicine and Science designates this activity for a maximum of 1.00 ANCC contact hours. Nurses should claim only the credit commensurate with the extent of their participation in the activity.