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When an emergency leads to dementia

An 82-year-old woman in full command of her faculties arrives at the emergency department with pneumonia. After waiting several hours, she suddenly becomes very confused: she loses contact with reality, no longer recognizes family members, becomes incoherent and refuses treatment. What happened? She is suffering from delirium—a condition that has been extensively documented in patients 65 years and older who are admitted to intensive care or undergo surgery but much less so in people who present at emergency rooms. It is this very gap that the team led by Marcel Émond, emergency room physician at Hôpital de l’Enfant-Jésus and clinical researcher at CHU de Québec and Centre de recherche sur les soins de première ligne at Université Laval, is working to close.

Delirium impacts 9 to 20% of individuals during their stay or 24 hours later.

The experts followed 650 patients in five emergency departments across Québec and were able to determine that delirium impacts 9 to 20% of individuals during their stay or 24 hours later. Risk factors include dehydration, physical constraints, certain medications, undiagnosed cognitive disorders and extended wait times. There’s some bad news for Québecers who wait on average 30 to 40 hours for emergency care: the risk of delirium rises by 2% every hour! And delirium leads to delirium. Indeed, the syndrome extends hospital stays by four days, contributing to overcrowding and long wait times—potential risk factors for delirium.

The researchers developed emergency room tools to quickly detect and prevent delirium. RADAR, an acronym for recognizing acute delirium as part of your routine, is a form designed by a group led by Philippe Voyer, researcher in the Faculty of Nursing at Université Laval, that healthcare teams use to assess a patient’s level of drowsiness, difficulty following instructions and physical coordination in seven seconds. If delirium is suspected, the team will try to pinpoint the causes and provide psychological and physical support. Until someone finds an anti-delirium drug, that is!