Delirium and other cognitive impairment in older adults in an emergency department.

STUDY OBJECTIVE: To determine the prevalence of delirium and other alterations in mental status in older adults in the emergency department setting.

DESIGN: Prospective, cross-sectional study.

SETTING: Private, nonprofit, academic medical center in a densely populated urban area.

PARTICIPANTS: One hundred eighty-eight adults 70 years or older who presented to the ED.

INTERVENTIONS: None.

RESULTS: Delirium and other alterations in mental status were present in 39.9% of the patients studied; 24% of these patients had delirium. Age and severity of illness were positively correlated with alteration in mental status. Patients with alterations in mental status were more likely to be admitted to an inpatient unit. Among those admitted from home, alterations in mental status in the ED were associated with a higher likelihood of institutionalization at discharge.

CONCLUSION: Alterations in mental status are prevalent in ED patients. Older adults with alterations in mental status, particularly alterations in consciousness and delirium, are at high risk for admission to an inpatient unit and institutionalization after discharge. Standardized mental status testing identified high-risk older adults in the ED.