Clinical Review of Elderly Patients Who Visited the Emergency Department with Altered Mental Status

ABSTRACT

PURPOSE: The number of geriatric patients admitted to the emergency department (ED) is growing as the elderly population grows. The altered mental status of the elderly is more difficult to evaluate and manage than others. The purpose of this study was to determine the etiologies of altered mental status in elderly patients visiting the ED. METHODS: A retrospective study was made of 119 patients who visited the ED of Kyungpook National University Hospital for altered mental status from January 2001 to June 2002. RESULTS: The results of this study showed that extracranial causes (67.8%) were more than intracranial causes (31.9%) metabolic (35.3%), cerebrovascular (29.4%), extracranial infection (16.0%), cardiovascular (8.4%), drugs/toxins (8.4%), and intracranial infection (2.5%). The group with underlying disease or with brain imaging done showed more intracranial causes than extracranial causes. The results showed that the age, the initial Glasgow coma scale (GCS) score, a new positive finding on a brain image, and the causes of the mental change had significant influence on improvement of the mental status and on the survival rate (p < 0.05). CONCLUSION: Initial evaluation of the underlying disease, the GCS score, an early study of brain imaging, and a search for possible metabolic causes, as well as others should be done simultaneously to deliver high quality care to elderly patient. Knowledge of the most frequent causes of altered mental status in elderly patients may assist the emergency physician in the approaching these potentially ill patients and managing their care.