Objective: delirium is a common complication in elderly hospitalised patients. Prompt recognition and appropriate treatment of delirium can improve patients comfort, optimise quality of life and help patients to preserve their ability to communicate with their relatives. To recognize earlier delirium we tried to introduce systematically a test to assess cognitive function and an instrument to distinguish delirium from other causes of cognitive impairment in our pain and palliative care consultation in the Department of Geriatrics. The aim of this study was to measure the feasibility of such assessment in a daily clinical activity.
Method: during 40 consecutive consultations in the Geriatric Department, the Confusion Assessment Method (CAM) and the Short Orientation Memory Concentration Test (SOCMT) were completed by the pain and palliative care consultation team. SOCMT was chosen rather than the Mini Mental Status Examination because it was shorter to complete and patients didn't need to use a pen. Other data were also collected.
Results: 30W/10M were included. Mean age of patients was 80 years (65-97). At time of consultation, patients were hospitalised since 18 days (median). Mean reasons for consultations were pain management (n:25), help to organise discharge (n:6), ethical problems (n:5) and other symptoms management (n:4). 12 patients had a documented dementia (Alzheimer disease (n:8), vascular (n:4)). CAM was completed in 36 consultations and 6 patients had a diagnosis of delirium according to CAM (4 of these patients had also dementia). SOCMT was completed in only 5 situations and 4 patients had cognitive impairment according to SOCMT. No patients have been revaluated with an assessment tool during the follow-up.
Conclusion: The systematic use of assessment tools to detect delirium during a pain and palliative care consultation remains difficult, even if cognitive impairment is frequent. Some existent tools should be adapted for a consultation team.