Prevalence and documentation of impaired mental status in elderly emergency department patients

OBJECTIVE: To determine the prevalence and assess documentation by emergency department (ED) physicians (EPs) of impaired mental status in elderly ED patients. METHODS: Cross-sectional, observational study. Subjects: convenience sampling of ED patients greater than or equal to 70 years of age. Patients were screened for cognitive impairment with the Orientation Memory Concentration exam (OMC), and for delirium with the Confusion. Assessment Method screening tool (CAM). A positive OMC or CAM was considered indicative of impaired mental status. Patients with delirium were excluded from the cognitive impairment screen. EPs were blinded to screening results. Physician documentation, dispositions, and referrals were abstracted from chart review. Proportions and 95% confidence intervals (CIs) are reported. RESULTS: 180 patients were screened. 46 patients (26%; 95% CI = 19% to 32%) had impaired mental status. 22 of these (12%; 95% CI = 7% to 17%) had delirium, and 24 (13%; 95% CI = 8% to 18%) had moderate to severe cognitive impairment. Of all patients with impaired mental status, only 14 (30%; 95% CI = 18% to 46%) had documentation of any impairment by the EP (10 with delirium (46%; 95% CI = 24% to 68%), and 5 with cognitive impairment (21%; 95% CI = 7% to 42%). 7 of 22 (32%; 95% CI = 14% to 55%) patients with delirium were discharged home. Only 2 of 16 patients with impaired mental status (12.5%) were discharged home with plans noted to address the impairment. CONCLUSIONS: Impairment in mental status is highly prevalent among older ED patients. Lack of documentation and referrals by EPs suggests lack of recognition of these problems. Further education of physicians is needed to improve care in these areas.