Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool.

Aged Aged, 80 and over Delirium / complications Delivery of Health Care Dementia / complications Diagnostic and Statistical Manual of Mental Disorders Emergency Service, Hospital Geriatric Assessment / methods Guidelines as Topic Humans Psychomotor Agitation / diagnosis

Journal

Annals of emergency medicine
ISSN: 1097-6760
Titre abrégé: Ann Emerg Med
Pays: United States
ID NLM: 8002646

Informations de publication

Date de publication:
02 2020
Historique:
received: 14 11 2018
revised: 16 07 2019
accepted: 16 07 2019
pubmed: 30 9 2019
medline: 2 5 2020
entrez: 30 9 2019
Statut: ppublish

Résumé

Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this population in the ED setting can be challenging for emergency physicians. There are several knowledge translation gaps in how to best screen older adults for these conditions and how to manage them. A working group of subject-matter experts convened to develop an easy-to-use, point-of-care tool to assist emergency physicians in the care of these patients. The tool is designed to serve as a resource to address the knowledge translation and implementation gaps that exist in the field. The purpose of this article is present and explain the Assess, Diagnose, Evaluate, Prevent, and Treat tool. Participants were identified with expertise in emergency medicine, geriatric emergency medicine, geriatrics, and psychiatry. Background literature reviews were performed before the in-person meeting in key areas: delirium, dementia, and agitation in older adults. Participants worked electronically before and after an in-person meeting to finalize development of the tool in 2017. Subsequent work was performed electronically in the following months and additional expert review sought. EDs are an important point of care for older adults. Behavioral changes in older adults can be a manifestation of underlying medical problems, mental health concerns, medication adverse effects, substance abuse, or dementia. Five core principles were identified by the group that can help ensure adequate and thorough care for older adults with agitation or delirium: assess, diagnose, evaluate, prevent, and treat. This article provides background for and explains the importance of these principles related to the care of older adults with agitation. It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes and have the tools to screen older adults for those causes, and methods to treat the underlying causes and ameliorate their symptoms.

Identifiants

DOI: 10.1016/j.annemergmed.2019.07.023 PMID: 31563402 PMC: PMC7945005
pubmed: 31563402
pii: S0196-0644(19)30609-2
doi: 10.1016/j.annemergmed.2019.07.023
pmc: PMC7945005
mid: NIHMS1667405
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

136-145

Subventions

Organisme : NHLBI NIH HHS
ID : T32 HL007106
Pays : United States

Informations de copyright

Copyright © 2019 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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Auteurs

Christina Shenvi (C)

Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC. Electronic address: cshenvi@med.unc.edu.

Maura Kennedy (M)

Massachusetts General Hospital Department of Emergency Medicine and Harvard Medical School, Boston, MA.

Charles A Austin (CA)

Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina, Chapel Hill, NC.

Michael P Wilson (MP)

University of Arkansas for Medical Sciences, Department of Emergency Medicine, Little Rock, AR.

Michael Gerardi (M)

Department of Emergency Medicine, Morristown Medical Center, Morristown, NJ; Coalition on Psychiatric Emergencies.

Sandy Schneider (S)

American College of Emergency Physicians, Irving, TX; Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX; Hofstra Northwell School of Medicine, Hempstead, NY.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Délire avec confusion › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Démence › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Sciences de l'information › Sources d'information › Services d'information › Documentation › Vocabulaire contrôlé › Diagnostic and stastistical manual of mental disorders (USA) › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Évaluation gériatrique › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Recommandations comme sujet › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Managing Delirium and Agitation in the Older...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Manifestations neurocomportementales › Troubles psychomoteurs › Agitation psychomotrice › Managing Delirium and Agitation in the Older...