Be ADEPT: An approach to the older patient with confusion or agitation
With Dr. Sandra Schneider
Older adults often present to the ED for or with confusion or agitation. It is important to have a framework for assessing these patients, diagnosing the presence of delirium or dementia, looking for underlying causes, preventing worsening, treating the underlying condition, and sometimes treating the symptoms. The ADEPT tool is the newest one in a toolbox of resources being released by ACEP to provide quick access to basic clinical guides while on shift. This episode is introduced by former ACEP president, Sandy Schneider, and covers the details of the ADEPT tool.
The ADEPT tool is the product of a collaborative effort on the part of a group of physicians with expertise in EM, geriatrics, psychiatric medications, with input from other outside specialists.
Two important take-home points of ADEPT
- Always look for an underlying cause or causes in patients with delirium.
- In treating agitated patients, it is important to avoid causing harm. Many medications in doses that are used in younger agitated patients can cause prolonged sedation or even paradoxically worse agitation in older patients.
Funding for the creation of the ADEPT tool was in part provided through a grant from the Allergan Foundation, and it was created with support from ACEP, the Coalition on Psychiatric emergencies, and the Emergency Medicine Foundation. Dr. Shenvi received funding through ACEP as part of the team creating the ADEPT tool.
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Dr. Christina Shenvi is an associate professor of Emergency Medicine at the University of North Carolina. She is fellowship-trained in Geriatric Emergency Medicine and is the founder of GEMCast. She is the director of the UNC Office of Academic Excellence, president of the Association of Professional Women in Medical Sciences, co-directs the ACEP/CORD Teaching Fellowship, is on the Annals of EM editorial board, is on the Geriatric ED Accreditation board of governors, and she teaches and writes about time management at timeforyourlife.org.