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 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 + sensetivity
  • 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

Authors:

Ross Donaldson