Geriatric Neuropsych Emergencies

Delirium in older adults, like other geriatric syndromes such as falls and incontinence, seldom has a single isolated cause but is typically multi-factorial.  Thinking about the interaction of multiple causes for a patient’s condition is contrary to our training as emergency providers, where we are encouraged to search for a single unifying explanation for symptoms. Therefore, it is important to emphasize that, after identifying a potential cause for a patient’s delirium, such as infection, the EM provider is not finished with the assessment but should continue to consider that other causes may also be contributing.  

Many of these potential causes are commonly missed by emergency providers because we are not trained to check for them and because they may not be immediately life-threatening.  Nevertheless, they can be important contributors to delirium, which is a potentially life-endangering syndrome.  

To assist busy EM providers with remembering these additional potential causes that should be assessed, we have developed a mnemonic: A-B-C-D-E-F. 

• A-Analgesia
• B-Bladder – urine retention
• C-Constipation.
• D-Dehydration.
• E-Environment.
• F-Farmacy (medications).

Improving assessment and treatment of these commonly missed contributing causes is a central component of our protoocl.