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Altered Mental Status in the Elderly

Instructor: Alyssa Campbell

Alyssa is an active RN and teaches Nursing and Leadership university courses. She also has a Doctorate in Nursing Practice and a Master's in Business Administration.

Altered mental status can occur in the older adult for many different reasons. Read this lesson to learn more about how an altered mental status affects the elderly and what it is commonly caused by.

Introduction

As a physician assistant in a local nursing home, Chuck plays in important role in the health monitoring and maintenance of the facility's residents. Because Chuck has been caring for older adults for some time, he is aware that the elderly population is at risk for underlying health problems. Chuck is always looking for altered mental status in the residents, as this would be one of the most common signs requiring medical attention.

Signs and Symptoms

Altered mental status (AMS) is a condition that affects a person's cognition, or ability to think, reason, and make decisions. In the older population, signs and symptoms of AMS may occur gradually over time, or suddenly over a few short hours. Some of the hallmark signs and symptoms of AMS include:

  • Confusion
  • Difficulty making decisions
  • Disorientation (unable to identify date or location)
  • Forgetfulness
  • Lack of body coordination (in severe instances)
  • Lethargy, or extreme fatigue (in severe instances)

As a caregiver, it is important for Chuck to be familiar with his patients' baseline, or usual and expected state of cognition. This is important for Chuck to know so that he can follow up on any change in condition and medically examine the patient for cause.

Infections

Infections or illnesses are common causes of AMS in the elderly. Underlying conditions like pneumonia or urinary tract infections may not be noticeable at first, but a change in mental status can alert the health care provider than something is abnormal.

For example, when the average adult is experiencing the flu, an expected response occurs: elevated temperature, general malaise (not feeling well), a sore throat, and coughing. As part of the aging process, older adults may not always present clearly with a fever or with other common symptoms of infection. Instead, the older adult may feel some generalized fatigue and weakness over a period of time, along with a slow change in mental status.

Dehydration

Chuck is also aware that AMS can be a sign of dehydration. Due to an older adult's decreasing ability to feel a sensation of thirst, dehydration is dangerous and can happen quickly in this population. To identify dehydration as the true cause of the change in mental status, Chuck depends on:

  • Physical assessment: To see if any skin dryness or tenting occurs (in dehydrated individuals, a provider may softly pinch the skin together to see if it stays pointed). These are late signs of dehydration.
  • Blood work: During the aging process, the kidneys are less able to manage fluids in the body. Through appropriate blood work, Chuck can monitor kidney function and also the severity of the dehydration.
  • Nursing documentation: To determine whether or not the patient has had sufficient fluid intake.

Trauma

Chuck knows to keep an eye out for the residents in the nursing home, as they are at risk for falls and other trauma. While the impact of car accident related trauma is obvious, trauma occurring to older individuals may not be as noticeable. Often, Chuck finds out that one of his patient's has fallen a day or two after a bruise has developed, as the event can be quite embarrassing to admit.

It is very important for Chuck to be aware of a patient's change in mental status, as it can indicate that trauma has occurred. Chuck may consider ordering diagnostic testing if he suspects trauma:

  • X-Ray: To rule out any broken bones that would cause pain, and potentially AMS.
  • CT Scan: If a patient has fallen and hit their head, they may have bruising, swelling, or bleeding on their brain. This could be the direct cause of AMS.

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