# Delirium, Agitation, and the Role of POCUS in Older Adults in the ED About This Podcast Our population is aging, and with that comes an increase in the number of older adults in emergency departments. Delirium affects up to 1/3 older adults who present to the ED and is a medical emergency that is often overlooked by ED clinicians. In this episode of GEMCast host Dr. Christina Shenvi discusses the importance of recognising delirium, documenting it, and intervening where possible in the ED with Dr. Kayla Furlong and Dr. Gillian Sheppard.  Dr. Furlong and Dr. Sheppard are both emergency medicine physicians in St. John’s, Newfoundland & Labrador, who are experts in point of care ultrasound (POCUS). Dr. Furlong is a Clinical Assistant Professor in the Faculty of Medicine at Memorial University and is the Chair of the CAEP Geriatric EM Committee. Dr. Sheppard is an Associate Professor and Chair of the Discipline of Emergency Medicine at Memorial University. She is also a Diplomate of the Royal College of Physicians of Canada with an Area of Focused Competence in POCUS and is the education lead for the Canadian Association of Emergency Physicians Emergency Ultrasound Committee. They have taken a special interest in whether the use of POCUS increases the ED clinicians’ ability to determine the aetiology of a geriatric patient’s delirium or agitation, and in doing so have developed the ABLE approach. They discuss why and how POCUS can be a useful tool and provide helpful tips for ED clinicians for how to implement POCUS. Play the Episode Tune in to learn more about how to approach older adults in the ED considering delirium, agitation, and the challenges they present.  https://youtu.be/pVNHOBD7zQY Subscribe on YouTube Subscribe on iTunes Key Points Delirium is an acute change in mental status often caused by an underlying process leaving a patient confused, drowsy, disoriented and sometimes with changes to their speech or mobility. There are 3 types of delirium: hypoactive, hyperactive and mixed. The most common, and under-recognized, type of delirium is hypoactive. Delirium is a syndrome with a cause – while it often seen as a non-specific complaint it can be a sign a sign of a serious acute illness. It increases short- and long-term mortality, length of stay in hospital, long term functional and cognitive decline.  Agitation, characterised by motor and inner restlessness coupled with verbal/physical aggressiveness, can overlap with delirium. In the absence of delirium, agitation can also be a clinical sign that a patient’s needs, such as hunger or pain, are not being met.  The difficulties associated with addressing delirium and agitation are compounded by a variety of factors: older adults tend to be multimorbid, have polypharmacy, physiological changes associated with ageing and ED clinicians ought to consider multimorbidity, polypharmacy and geriatric syndromes. Older adults can present atypically, with vague and non-specific complaints making it challenging to identify an underlying disease process. It is essential to ask about function, considering frailty and changes from baseline function, and collateral history. POCUS is inexpensive, fast and non-invasive imaging technique making it a favourable investigative tool for older adults in the ED. Similar to the DIMES (Drugs, Infections, Metabolic derangements, Environmental, Structural) acronym to help clinicians consider causes of delirium or agitation, the ABLE approach helps physicians use POCUS to help delirious or agitated patients in the ED.  ABLE helps clinicians address non-specific complaints and provides a system that can be easily implemented at the bedside.  Abdomen: Quickly rule out abdominal aortic aneurysm, determine volume status, and examine the urinary system.  Blocks: Ultrasound guided nerve blocks reduce the need for analgesics. Listen to the GEMCast episode Precision Relief: Nerve Blocks for Pain in Older Patients to learn more.  Lung: Useful for breathless patients, especially those who are too weak to go to X-ray.  Extras: Any other procedures such as ultrasound guided intravenous access and diagnostic POCUS.  Open Access Maced J Med Sci | May 19, 2021 Point of Care Ultrasound in Geriatric Patients at the Emergency Department A retrospective observational study of geriatric patients looking at the usefulness of POCUS for diagnosing disease. View Article Age and Ageing | July 25, 2024 Usefulness of point of care ultrasound in older adults: a multicentre study across different geriatric care settings in Spain and the United Kingdom A retrospective observational study focused on the use of multi-organ POCUS in geriatric patients. View Article ALIEM | October 1, 2013 10 Tips for Approaching Abdominal Pain in the Elderly Visit Website Next, listen to Getting Hotter: Heat Emergencies in Older Adults with Dr. Geoff Comp. Play Episode View All Delirium Resources >