295 Positive Cognition Screening a Geriatric Emergency Department

Abstract

Geriatric emergency departments (EDs) have become more common in recent years. Along with these expansions have come targeted interventions and assessments for older adult patients in the ED to assess several social and clinical factors specific to a patient. Cognitive tests are frequently used to assess older patients’ ability to make decisions to gauge resources that they may need. The objective of this study was to understand who may be more likely to have positive cognitive test in the ED. This was a retrospective multicenter study among older adult patients (>=65 years) presenting to two EDs (urban level one trauma center and suburban academic hospital with combined annual census of ∼80,000). Patients were qualified for specialized geriatric screenings if they were identified as being at risk by the Identification of Seniors at Risk (ISAR) screen and has an Emergency Severity Score (ESI) of 3. Screening tools used to identify potential cognitive issues included the Montreal Cognitive Assessment (MoCA), and the Abbreviated Mental Test 4 (AMT4). Demographic and clinical characteristics were assessed for all patients who received a screen. Logistic regression was used to identify factors independently associated with a positive test. Adjusted odds ratios (AOR) and 95% Confidence Intervals (CI) are reported. There were a total of 1850 cognitive tests ordered. Of those tests ordered, 903 (48%) were able to be completed and scored. Of those 903 tests scored, 226 (25%) were positive. Between those who tested positive and negative, individuals were more likely to have a positive test if they were age 85+ compared to 65-74, (AOR=2.01, 95% CI=1.36, 2.97; p=<0.001) and less likely if they were patients who were non-Hispanic Whites compared to other Races and Ethnicities (AOR=0.59, 95% CI=0.42, 0.83; p=0.002). Sec, mode of arrival and disposition were not associated with a positive cognitive score. Screening tools are important instruments to help identify patients with potentially cognitive issues. Although their use in the ED have been limited in the past, they are becoming utilized more often with the increasing senior population and the development of geriatric ED in the United States. Findings from these assessments help to inform providers of the needs of older adult patients and their caregivers.