An evaluation of two screening tools for cognitive impairment in older emergency department patients.
*Psychiatric Status Rating Scales; Aged; Cognition Disorders/*diagnosis; Cross-Sectional Studies; Emergency Medicine/*instrumentation; Emergency Service; Female; Geriatrics/*instrumentation; Hospital; Humans; Male; Prospective Studies; Sensitivity and Specificity
OBJECTIVES: Screening for cognitive impairment in older emergency department (ED) patients is recommended to ensure quality care. The Mini-Mental State Examination (MMSE) may be too long for routine ED use. Briefer alternatives include the Six-Item Screener (SIS) and the Mini-Cog. The objective of this study was to describe the test characteristics of the SIS and the Mini-Cog compared with the MMSE when administered to older ED patients. METHODS: This institutional review board-approved, prospective, randomized study was performed in a university-affiliated teaching hospital ED. Eligible patients were 65 years and older and able to communicate in English. Patients who were unable or unwilling to perform testing, who were medically unstable, or who received medications affecting their mental status were excluded. Patients were randomized to receive the SIS or the Mini-Cog by the treating emergency physician. Investigators administered the MMSE 30 minutes later. An SIS score of
Wilber Scott T; Lofgren Samuel D; Mager Thomas G; Blanda Michelle; Gerson Lowell W
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2005
2005-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2005.01.017" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2005.01.017</a>
Case finding for cognitive impairment in elderly emergency department patients.
*Emergency Service; 80 and over; Aged; Aged/*psychology; Cognition Disorders/*diagnosis; Confidence Intervals; Cross-Sectional Studies; Female; Frail Elderly/psychology; Geriatric Assessment; Hospital; Humans; Male; Memory Disorders/diagnosis; Odds Ratio; Orientation; Regression Analysis
STUDY OBJECTIVES: To determine the feasibility of a case-finding program for cognitive impairment in elderly emergency department patients, and to describe the prevalence of cognitive impairment in screened patients and identify factors associated with impairment. DESIGN: A three-month cross-sectional study. The six-item Orientation-Memory-Concentration (OMC) Test was administered to eligible patients. SETTING: Community teaching hospital with annual ED census of 69,000 adults. PARTICIPANTS: All patients 65 years of age and older physically able to communicate and without a prior diagnosis of dementia were eligible. Five hundred forty-seven of 958 patients (59%) were interviewed; only 95 (10%) refused. Other reasons for exclusion were too ill, 113 (12%); other (sleeping, privacy, repeat visits, incomplete forms), 99 (10%); known dementia, 59 (6%); and communication problems, 45 (5%). RESULTS: A mean time of 1.9 minutes (+/- 0.91 SD) was required to complete the test. One hundred eighty-three of 547 patients (33.5%) had scores that indicated at least moderate cognitive impairment. Logistic regression analyses identified two factors associated with impairment: age of more than 80 years (odds ratio, 3.68; 95% confidence interval, 2.21-6.14) and residence in a nursing home (odds ratio, 13.8; 95% confidence interval, 3.79-50.2). CONCLUSION: Screening for cognitive impairment in elderly ED patients using the OMC Test is feasible. There is a high prevalence of cognitive impairment in elderly ED patients, and the prevalence increases with age. Identification of cognitive impairment is important in the assessment of elderly ED patients and may affect clinical evaluation, patients' understanding of medical information, and compliance with discharge instructions.
Gerson L W; Counsell S R; Fontanarosa P B; Smucker W D
Annals of emergency medicine
1994
1994-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0196-0644(94)70319-1" target="_blank" rel="noreferrer noopener">10.1016/s0196-0644(94)70319-1</a>