Altered mental status (geriatrics)

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Background

  • Elderly patients present differently with common issues
  • Unique aspects of elderly AMS
  • See AMS for complete list

Infectious

Encephalitis

  • mental status changes - personality/behavior changes
  • unlikely to have fevers, meningismus
  • high risk: same for meningitis, live near water

Meningitis

  • usually other etilogy for AMS, but if negative workup do LP
  • consider ampicillin for listeria
  • consider acyclovir for HSV
  • high risk: HIV, DM, Malignancy, s/p ctx, prior NSG, alcoholism, recent sinusitis

Pneumonia

  • false negative CXR ~15-20%
  • high morbidity

UTI

  • very common etiology for AMS in elderly
  • resistant organisms likely, look up old UCx + sensetivity
  • high risk: pelvic relaxation, indwelling foley >2wks (check for one), BPH, hx prostate CA


Cholecystitis

  • may not have RUQ pain or GI sxs
  • ask about hx of gallstones/US RUQ


Metabolic/Toxic/Polypharmacy

Withdrawl/Overdose

  • chronic opiate/Benzo/Ambien use
  • Etoh abuse - may not experience tremors in withdrawl

Polypharmacy

  • NSAIDS - may be taking multiple
    • long term ASA
  • Steroids
  • Sedative/Psychoactives
  • Anticholinergics- many OTC
    • meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, benadryl
    • dietary - teas

Other

  • Seizure v Post ictal
  • urinary retention - uremia
  • fecal impaction
  • occult mesenteric ischemia


DDx

Treatment

Disposition

See Also

Source

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