Altered mental status (geriatrics): Difference between revisions
No edit summary
 
(20 intermediate revisions by 5 users not shown)
Line 1: Line 1:
==Background==
==Background==
*Elderly patients present differently with common issues
*Elderly patients present differently with common issues
*Unique aspects of elderly AMS
*Unique aspects of elderly altered mental status
*See AMS for complete differntial list
*See [[altered mental status]] for complete differential list
*Dementia should be diagnosis of exclusion
*[[Dementia]] should be diagnosis of exclusion


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


'''Meningitis'''
'''[[Meningitis]]'''
*usually other etilogy for AMS, but if negative workup do LP
*Usually other etiology for altered mental status, but if negative workup do LP
*consider ampicillin for listeria
*Consider [[Ampicillin]] for [[listeria]]
*consider acyclovir for HSV
*Consider [[acyclovir]] for [[HSV]]
*high risk: HIV, DM, Malignancy, s/p ctx, prior NSG, alcoholism, recent sinusitis
*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]]


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


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


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


'''Skin/Soft Tissue'''
'''Skin/Soft Tissue'''
*completly undress to examine
*Completely undress to examine
*often decubs present
*Often [[decubitus ulcers]] present
**old photos helpful
**Old photos helpful
*consider fistula, osteo, necrotizing  
*Consider fistula, [[osteomyelitis]], [[necrotizing fasciitis]]


==Metabolic/Toxic/Polypharmacy==
==Metabolic/Toxic/Polypharmacy==


'''Withdrawl/Overdose'''
'''Withdrawal/Overdose'''
*chronic opiate/Benzo/Ambien use
*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use
*Etoh abuse - may not experience tremors in withdrawl
*[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]]


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




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


==See Also==
==See Also==
AMS
*[[Altered Mental Status]]
==Source==
*[[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
ACEP Academic Affairs Committee Geriatric Video lecture series
SAEM Academy of Geriatric Emergency Medicine
SAEM Academy of Geriatric Emergency Medicine


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

Latest revision as of 20:34, 1 October 2019

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 fevers, meningismus
  • High risk: same for meningitis, live near water

Meningitis

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/US RUQ

Skin/Soft Tissue

Metabolic/Toxic/Polypharmacy

Withdrawal/Overdose

Polypharmacy


Other

See Also

References

ACEP Academic Affairs Committee Geriatric Video lecture series SAEM Academy of Geriatric Emergency Medicine

Retrieved from "https://www.wikem.org/w/index.php?title=Altered_mental_status_(geriatrics)&oldid=231413"