Management of Demented Patients in Emergency Department

Abstract

The hospitalization of the elderly with acute illness is one of the most discussed in the organization of health services, it is not yet clear whether the hospital is really the best response to the needs of the elderly, especially those with cognitive impairment. Despite evidence of possible adverse effects of hospitalization (immobilization, acute confusional state resulting in sedation, risk of falls, intestinal sub-ileus), there has been an increasing use of the hospital, particularly to specialist services. Regardless of the benefits from the shelter (instrumental diagnosis and prompt treatment of acute somatic disease), in people with dementia it needs to identify the characteristics of the person (cognitive impairment, functional status, somatic comorbidity, social and familial status), the personal needs and, therefore, diagnostic and therapeutic targets which must be assumed for that sick person during hospitalization. To this end, it is fundamental the role of assessment and diagnostic orientation that takes place in the Department of Emergency and Acceptance (DEA), which mainly receives patients at the hospital. Even before the hospital recovery it is therefore essential to check how many elderly patients with cognitive impairment that belong to the DEA, and what are their needs.

Behavioral emergency in the elderly: a descriptive study of patients referred to an Aggression Response Team in an acute hospital

“…The management of severely agitated elderly patients in the acute hospital setting is not easy 1–4. Urgent safety issues for both patient and staff coexist with diagnostic priorities in a setting not geared to first-line nonpharmacological strategies of meeting psychosocial and emotional needs of patients 5.…”

A follow‐up intervention in severely demented patients after discharge from a special Alzheimer acute care unit: impact on early emergency room re‐hospitalization rate

“…Indeed, they can have a negative impact on the patient's quality of life and lead to drug induced effects or functional decline (Rutschmann et al, 2005;Jönsson et al, 2006;Sampson et al, 2006;Han et al, 2011;Valeriani, 2011). Indeed, they can have a negative impact on the patient's quality of life and lead to drug induced effects or functional decline (Rutschmann et al, 2005;Jönsson et al, 2006;Sampson et al, 2006;Han et al, 2011;Valeriani, 2011).…”

“…Nevertheless, the choice of ER re-hospitalization rate as outcome measure seemed to us an appropriate one, as such repeated admission can be damaging. Indeed, they can have a negative impact on the patient's quality of life and lead to drug induced effects or functional decline (Rutschmann et al, 2005;Jönsson et al, 2006;Sampson et al, 2006;Han et al, 2011;Valeriani, 2011). Some authors have stressed the need to recognize the poor short-term prognosis of severe dementia, as with cancers in the terminal stage, and have discussed the possibility of starting palliative care before hospital admission (Mitchell et al, 2009 ;Sampson et al, 2009).…”

“…Nevertheless, some of these emergency admissions seem inappropriate, being the only response offered by the healthcare system to the complex needs of this population (Salvi et al, 2007). In addition, repeated ER admissions appear to have a negative impact on the quality of life of the AD patient and can lead to iatrogenic disorders, functional decline, and adverse events such as confusion and falls (Valeriani, 2011;Sampson et al, 2006). To attempt to reduce repeated hospital admissions, several types of interventions have been developed in the demented older population, with varying degrees of success (Mittelman et al, 1996;Eloniemi-Sulkava et al, 2001;Clark et al, 2004;Callahan et al, 2006;Bellantonio et al, 2008).…”

Fever with incontinence in the elderly: an approach for emergency medicine

“…Furthermore, the patient may be unwilling or unable to participate in diagnostic or interventional measures that become indicated through the course of care. 4 Pain management is especially difficult and no less important for patients with dementia. Though not ideal, primary care physicians must take care to detect surrogate markers of pain, such as confusion, gesturing or posturing, through the physical examination.…”