Patients with delirium, dementia, and those with both delirium and dementia can be the most challenging patients in the emergency department (ED). Medically and emotionally complex, these patients often require multidisciplinary resources, astute coordination of care, and vigilant observation. ED physicians, psychiatrists, nurses, social workers, primary care physicians, hospitalists, and sometimes geriatricians may comprise the medical team. Family members and caretakers provide necessary perspectives and are recognized and integrated into the evaluation and management process when caring for these patients. Only with teamwork will these patients be cared for optimally. Dementia most often occur in adults 65 years of age or older. One quarter of all ED visits are for older adults, and of those, one quarter are for cognition-related presentations . Half of all hospital days are for older adults and their care amounts to billions of dollars annually . ED visits for older adults are increasing, and they often present by ambulance with more severe medical illness requiring more tests and longer ED stay . Because studies have shown that ED physicians tend to miss a diagnosis of delirium or other cognitive impairment approximately 75% of the time, the American College of Emergency Physicians and the Society for Academic Emergency Medicine Geriatric Task Force in 2009 have selected “cognitive assessment” as one of the three quality indicators for improvement of geriatric emergency care .
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