Elderly patients in the ED



Background

  • You may be temporarily able bodied but we are all geting older!
  • Older patients deserve the very best care. They have longer lenghts of stay but you should seek to safely avoid admission as most do not wish to be in an acute hospital bed.
  • Delirium by definition is acute. It is treatable and should prompt investigation (e.g. infection, ACS, metabolic disturbance).
  • Many elderly patients with ACS do not initially complain of chest pain.
  • Most elderly patients with abdominal pain have a surgical cause (beware biliary pathology).
  • Sepsis (e.g. urinary or respiratory) may be SIRS negative and can easily be missed - yet mortality is high (40%).
  • Intracranial bleed may present without headache.

Delirium

  • Delirium, characterised by inattention, is treatable/reversible and is not dementia.
  • Please read the delirium page.
  • Check MOTYB (months of the year backwards [sensitive but not specific]).
  • Always reread the medication list (and cut if you can).

ADLs

  1. Bathing
  2. Dressing
  3. Toileting
  4. Transferring
  5. Continence
  6. Feeding

Investigations

  • "Proper" lying and standing BP in all.
  • More on the MMSE.


Content By Dr Íomhar O' Sullivan . Last review Dr ÍOS 2/09/20.