View source for Altered mental status (geriatrics)

==Background==
*Elderly patients present differently with common issues
*Unique aspects of elderly altered mental status
*See [[altered mental status]] for complete differential list
*[[Dementia]] should be diagnosis of exclusion

==Infectious==
[[Encephalitis]]
*Mental status changes - personality/behavior changes
*Unlikely to have [[fever]]s, meningismus
*High risk: same for meningitis, live near water 

[[Meningitis]]
*Usually other etiology for altered mental status, but if negative workup do LP
*Consider [[Ampicillin]] for [[listeria]]
*Consider [[acyclovir]] for [[HSV]]
*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]]

[[Pneumonia]]
*False negative [[CXR]] ~15-20%
*High morbidity  

[[UTI]]
*Very common etiology for altered mental status in elderly
*Straight cath [[UA]]
*Resistant organisms likely, look up old urine culture + sensitivity  
*High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer 

[[Cholecystitis]]
*May not have [[RUQ pain]] or GI symptoms
*Ask about history of gallstones/[[RUQ Ultrasound|US RUQ]]

Skin/Soft Tissue
*Completely undress to examine
*Often [[decubitus ulcers]] present
**Old photos helpful
*Consider fistula, [[osteomyelitis]], [[necrotizing fasciitis]]

==Metabolic/Toxic/Polypharmacy==

Withdrawal/Overdose
*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use
*[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]]

Polypharmacy
*[[NSAIDS]] - may be taking multiple 
**Long term [[ASA]]
*[[Steroids]]
*[[Sedatives]]/Psychoactives
*[[Anticholinergics]] - many OTC
**[[Meperidine]], [[cimetidine]], [[ranitidine]], [[TCAs]], antiparkinson, [[antipsychotics]], [[diphenhydramine]]
**Dietary - teas, supplements


Other
*[[Cardiac Ischemia]] - no chest pain needed
*[[Seizure]] v Post ictal
*[[Urinary retention]] - [[uremia]]
*[[Fecal impaction]]
*Occult [[mesenteric ischemia]]
*[[Electrolyte abnormalities]] (e.g. Ca/Mg/Phos)

==See Also==
*[[Altered Mental Status]]
*[[Geriatrics (Main)]]
*https://www.aliem.com/2013/08/a-time-based-approach-to-elderly-patients-with-altered-mental-status/

==References==
<references/>
ACEP Academic Affairs Committee Geriatric Video lecture series
SAEM Academy of Geriatric Emergency Medicine

[[Category:Neurology]]
[[Category:Misc/General]]
[[Category:Symptoms]]