Altered mental status (geriatrics): Difference between revisions
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==Infectious== | ==Infectious== | ||
[[Encephalitis]] | |||
*Mental status changes - personality/behavior changes | *Mental status changes - personality/behavior changes | ||
*Unlikely to have [[fever]]s, meningismus | *Unlikely to have [[fever]]s, meningismus | ||
*High risk: same for meningitis, live near water | *High risk: same for meningitis, live near water | ||
[[Meningitis]] | |||
*Usually other etiology for altered mental status, but if negative workup do LP | *Usually other etiology for altered mental status, but if negative workup do LP | ||
*Consider [[Ampicillin]] for [[listeria]] | *Consider [[Ampicillin]] for [[listeria]] | ||
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*High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]] | *High risk: [[HIV]], [[DM]], malignancy, s/p [[ceftriaxone]], prior neurosurgery, [[alcoholism]], recent [[sinusitis]] | ||
[[Pneumonia]] | |||
*False negative [[CXR]] ~15-20% | *False negative [[CXR]] ~15-20% | ||
*High morbidity | *High morbidity | ||
[[UTI]] | |||
*Very common etiology for altered mental status in elderly | *Very common etiology for altered mental status in elderly | ||
*Straight cath [[UA]] | *Straight cath [[UA]] | ||
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*High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer | *High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer | ||
[[Cholecystitis]] | |||
*May not have [[RUQ pain]] or GI symptoms | *May not have [[RUQ pain]] or GI symptoms | ||
*Ask about history of gallstones/[[RUQ Ultrasound|US RUQ]] | *Ask about history of gallstones/[[RUQ Ultrasound|US RUQ]] | ||
Skin/Soft Tissue | |||
*Completely undress to examine | *Completely undress to examine | ||
*Often [[decubitus ulcers]] present | *Often [[decubitus ulcers]] present | ||
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==Metabolic/Toxic/Polypharmacy== | ==Metabolic/Toxic/Polypharmacy== | ||
Withdrawal/Overdose | |||
*Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use | *Chronic [[opioid]]/[[benzodiazepine]]/[[zolpidem]] (Ambien) use | ||
*[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]] | *[[ETOH abuse]] - may not experience [[tremor]]s in [[ETOH withdrawal]] | ||
Polypharmacy | |||
*[[NSAIDS]] - may be taking multiple | *[[NSAIDS]] - may be taking multiple | ||
**Long term [[ASA]] | **Long term [[ASA]] | ||
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Other | |||
*[[Cardiac Ischemia]] - no chest pain needed | *[[Cardiac Ischemia]] - no chest pain needed | ||
*[[Seizure]] v Post ictal | *[[Seizure]] v Post ictal | ||
Latest revision as of 09:26, 22 March 2026
Background
- Elderly patients present differently with common issues
- Unique aspects of elderly altered mental status
- See altered mental status for complete differential list
- Dementia should be diagnosis of exclusion
Infectious
- Mental status changes - personality/behavior changes
- Unlikely to have fevers, meningismus
- High risk: same for meningitis, live near water
- Usually other etiology for altered mental status, but if negative workup do LP
- Consider Ampicillin for listeria
- Consider acyclovir for HSV
- High risk: HIV, DM, malignancy, s/p ceftriaxone, prior neurosurgery, alcoholism, recent sinusitis
- False negative CXR ~15-20%
- High morbidity
- Very common etiology for altered mental status in elderly
- Straight cath UA
- Resistant organisms likely, look up old urine culture + sensitivity
- High risk: pelvic relaxation, indwelling foley >2wks (check for one!), BPH, history prostate cancer
Skin/Soft Tissue
- Completely undress to examine
- Often decubitus ulcers present
- Old photos helpful
- Consider fistula, osteomyelitis, necrotizing fasciitis
Metabolic/Toxic/Polypharmacy
Withdrawal/Overdose
- Chronic opioid/benzodiazepine/zolpidem (Ambien) use
- ETOH abuse - may not experience tremors in ETOH withdrawal
Polypharmacy
- NSAIDS - may be taking multiple
- Long term ASA
- Steroids
- Sedatives/Psychoactives
- Anticholinergics - many OTC
- Meperidine, cimetidine, ranitidine, TCAs, antiparkinson, antipsychotics, diphenhydramine
- Dietary - teas, supplements
Other
- Cardiac Ischemia - no chest pain needed
- Seizure v Post ictal
- Urinary retention - uremia
- Fecal impaction
- Occult mesenteric ischemia
- Electrolyte abnormalities (e.g. Ca/Mg/Phos)
See Also
- Altered Mental Status
- Geriatrics (Main)
- https://www.aliem.com/2013/08/a-time-based-approach-to-elderly-patients-with-altered-mental-status/
References
ACEP Academic Affairs Committee Geriatric Video lecture series SAEM Academy of Geriatric Emergency Medicine