Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec 22;13(12):e20616.
doi: 10.7759/cureus.20616. eCollection 2021 Dec.

Emergency Clinicians' Perceptions of Communication Tools to Establish the Mental Baseline of Older Adults: A Qualitative Study

Anita Chary  1 , Christopher Joshi  2 , Noelle Castilla-Ojo  3 , Ilianna Santangelo  1 , Kei Ouchi  4   5 , Aanand D Naik  6   7 , Christopher R Carpenter  8   9 , Shan W Liu  1   10 , Maura Kennedy  1   10
Affiliations

Emergency Clinicians' Perceptions of Communication Tools to Establish the Mental Baseline of Older Adults: A Qualitative Study

Anita Chary et al. Cureus. .

Abstract

Background Evaluating older adults with altered mental status in emergency settings can be challenging due to the inability to obtain a history from patients directly and limited collateral information about the change from a patient's mental status baseline. Documents and videos establishing a patient's mental baseline could represent useful communication tools to aid emergency clinicians. Methods Qualitative interviews conducted with 22 emergency clinicians (12 physicians and 10 advanced practice providers) identified methods they use to determine baseline mental status of older adults in the ED and the perceived utility of document- and video-based information about an older adult's baseline mental status. Interview transcripts were coded for dominant themes using deductive and inductive approaches. Results Participants determine an older adult's baseline mental status by obtaining information about the patient's baseline cognition (memory and communication) and function (activities of daily living and mobility). The techniques they use include 1) reviewing the electronic medical record, 2) speaking with family members or caregivers by phone or in person, and 3) obtaining verbal or phone reports from emergency medical services personnel or health care providers from short- or long-term care facilities. The majority of participants thought that a document or video with information about a patient's baseline mental status would be useful (n=15, 68%), qualifying that content ought to be brief, clearly dated, and periodically updated. Conclusions Documents or videos could assist emergency clinicians in establishing baseline cognitive function when evaluating geriatric patients and may have implications for improving the detection of delirium.

Keywords: altered mental status; communication tools; delirium; emergency medicine; geriatrics.

PubMed Disclaimer

Conflict of interest statement

ANC and ADN receive support from the Houston Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety (CIN13-413). CRC serves on the Society for Academic Emergency Medicine Board of Directors, the American College of Physicians (ACEP) Geriatric Emergency Department Accreditation (GEDA) Advisory Panel, the Geriatric Emergency Applied Research Network 2.0-Alzheimer’s Dementia Research Core, and the Clin-STAR leadership core. SL serves on the ACEP Geriatric Emergency Medical Services Executive Board, is a reviewer for GEDA and an Executive Member of the IFEM Geriatric Emergency Medicine Special Interest Group, and was past-president of the Academy of Geriatric Emergency Medicine. MK serves on the ACEP GEDA Board of Governors. Otherwise, the authors declare no conflicts of interest.

Figures

Figure 1
Figure 1. Sources of collateral information and information sought to establish baseline mental status
See this image and copyright information in PMC

References

    1. The prevalence and documentation of impaired mental status in elderly emergency department patients. Hustey FM, Meldon SW. Ann Emerg Med. 2002;39:248–253. - PubMed
    1. Altered mental status in older patients in the emergency department. Han JH, Wilber ST. Clin Geriatr Med. 2013;29:101–136. - PMC - PubMed
    1. Altered mental status in older emergency department patients. Wilber ST. Emerg Med Clin North Am. 2006;24:299-316, vi. - PubMed
    1. Altered mental status and delirium. Wilber ST, Ondrejka JE. Emerg Med Clin North Am. 2016;34:649–665. - PubMed
    1. Prevalence and detection of delirium in elderly emergency department patients. Élie M, Rousseau F, Cole M, Primeau F, McCusker J, Bellavance F. https://www.cmaj.ca/content/163/8/977.long. Canadian Medical Association Journal. 2000;163:977–981. - PMC - PubMed

LinkOut - more resources