Mental status exam should be thorough
Multiple studies have shown that ED nurses and physicians miss cognitive derangement in elderly patients because no one does an adequate mental status screening on them, notes Terasita Hogan, MD, FACEP, director of emergency medicine residency program at Resurrection Medical Center in Chicago.
"Because of society’s prejudice accepts that grandma is a little bit confused, clinicians often don’t make an issue of it," she says. (See explanation of the difference between dementia and delirium, p. 122.)
In your evaluation of the geriatric patient, do a mini mental status exam. "You can do this in 90 seconds, and if it’s abnormal, follow that up," says Hogan. "This is a skills set we need to learn and incorporate into our practice."
Here are the steps for a mini-mental status exam, according to Hogan:
1. Orientation.
Ask, "Who are you?"
Ask, "Where are you?"
Ask, "What is the date?"
2. Attention.
Is the patient able to follow your actions? Tell him/her why you are there; then see if he/she understands it.
3. Agitation/depression.
Is the patient restless or agitated vs. depressed or withdrawn?
4. Reality/hallucinations.
Assess visual hallucinations: seeing imaginary objects.
Assess auditory hallucinations: hearing voices or music.
5. Memory.
Ask, "What are your children’s names?"
Say, "Name the last three presidents."
Introduce yourself, then see if the patient remembers you a minute later.
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