Assessing cognition in elderly patients presenting to the emergency department

Delirium occurs frequently among elderly patients in the Emergency Department (ED), and accurate assessment is difficult without knowledge of the patient's usual cognitive functioning. This audit was designed to determine whether routine cognitive screening of elderly patients in ED could lead to early identification of delirium.

An audit using the abbreviate mental test (AMT) and Confusion Assessment Method (CAM) tools assessed 28 elderly ED patients for the presence of delirium.

Fourteen (50%) of the 28 patients had no cognitive deficit on admission. Eleven (39.3%) displayed a cognitive deficit other than delirium and three (10.7%) had delirium, but only one had been diagnosed prior to the audit.

The prevalence rate of delirium in elderly ED patients was similar to those reported in the literature. The audit demonstrated the importance of cognitive assessment, as cognitive changes can be an early and sensitive indicator of physiological dysfunction. However, the AMT had limitations which inhibited its use in ED. A four question version known as the AMT4 may be more suitable.

ED nurses should routinely establish baseline cognitive functioning and assess for delirium. The AMT4 may be more suitable because of its brevity, but requires further research.