Acute Altered Mental
Status in Elderly Patients
Taken from EMSWORLD.com February 2013
Acute Altered Mental Status in
Elderly Patients
 Can be challenging to determine the cause
Acute Altered Mental Status in
Elderly Patients
 Subtle changes often go unrecognized
Acute Altered Mental Status in
Elderly Patients
 Only 30% of patients with delerium are identified
Acute Altered Mental Status in
Elderly Patients
 Elderly are those 65 and older and make up 10% of the
population
Acute Altered Mental Status in
Elderly Patients
 Altered mental status is present in 10% of all elderly
patients who present to the emergency department
Acute Altered Mental Status in
Elderly Patients
 Many of these patients will present via EMS
Acute Altered Mental Status in
Elderly Patients
 One in nine of these patients ultimately die during their
hospital stay
Acute Altered Mental Status in
Elderly Patients
 Delerium represents a serious underlying condition and
is marked by an acute change in cognition
Acute Altered Mental Status in
Elderly Patients
 Delerium is defined as a disturbance of consciousness
and change in cognition that develops over a short
period of time
Acute Altered Mental Status in
Elderly Patients
 Delerium is not natural and not associated with diseases
such as dementia and Alzheimer's
Acute Altered Mental Status in
Elderly Patients
 Delerium is a hyper or hypoactive alteration in brain
function and affects behavior, memory, actions, and
attitudes.
Acute Altered Mental Status in
Elderly Patients
 Delerium may be the only symptom of a serious
underlying medical condition
Acute Altered Mental Status in
Elderly Patients
 Delerium and Dementia are NOT the same
Acute Altered Mental Status in
Elderly Patients
 Delerium is not the same as a gradual mental status
change
Acute Altered Mental Status in
Elderly Patients
 Things to look for in Delerium
 An acute onset of the condition
 Patient’s inattention
 Disorientated thinking
 Altered level of consciousness
Acute Altered Mental Status in
Elderly Patients
 Dementia is generally thought of as a single disease
caused by decreased brain size and function that
becomes a permanent cognitive impairment worse than
would be expected for the patient’s age.
Acute Altered Mental Status in
Elderly Patients
 Dementia is NOT reversible
Acute Altered Mental Status in
Elderly Patients
 Sepsis is a common cause of mental status change
 The entire body has an increased oxygen demand that can
lead to hypoxia
 Toxins are released into the blood stream that can impair
normal brain function
 Metabolic acidosis occurs which interrupts normal brain
function
Acute Altered Mental Status in
Elderly Patients
 Infection sources are not always obvious
 UTI’s are one of the most common causes of delerium in
patients over 50
 Anytime an elderly patient appears toxic and has a history
of diabetes or immunocompromised, consider a UTI
Acute Altered Mental Status in
Elderly Patients
 Avoid Ringers Lactate
 It contains lactate which may make the situation worse if
they are experiencing lactic acidosis
Acute Altered Mental Status in
Elderly Patients
 It is important to communicate sepsis suspicion to the
physician
 For each hour that passes with no intervention, the patient’s
mortality rate increases by 7.6%
Acute Altered Mental Status in
Elderly Patients
 Remember:
 Delerium may signal a life-threatening underlying medical
condition
 Delerium is not associated with dementia and is not a
normal part of the aging process
 Delerium is often subtle and easy to miss
 Use family and friends to help understand the patient’s
behavior