2023 14th Annual NUBE Conference

Has this ever happened to you? You respond to an over-head call for help with an agitated patient in the emergency department. Physicians, nurses, ED techs and security staff rush to help. When you arrive at the scene, you find an exasperated nurse trying to stop an angry patient from leaving the department. The patient is 89 years old with a history of dementia. What now? A take-down? Medications? The crowd and noise only seem to make things worse. Is there a better way? Neuropsychiatric symptoms (NPS) of dementia and delirium (including confusion, disorientation, refusal of care, and agitation) frequently occur in older adults presenting to the emergency department. An outpatient method called “The DICE Approach ™” (Describe, Investigate, Create, Evaluate), has been developed to help caregivers and clinicians address NPS. However, we could not identify established behavioral approaches for NPS in the acute-care setting. To address this pressing need, we adapted the DICE Approach ™ to combine behavioral and pharmaceutical interventions to address NPS in acute-care settings. Our framework draws from best practices in our ACEP Level 1 accredited Geriatric Emergency Department (GED) as well as our medical center’s delirium-reduction program.Older adults presenting to the emergency department have different needs, and a one-size-fits-all approach to agitation may not be appropriate in many cases. This lecture aims to help acute-care practitioners improve care for older adults exhibiting neuropsychiatric symptoms of dementia and delirium.

Learning Objectives:

1. Learn how describing the problematic behaviors exhibited by older patients with neuropsychiatric symptoms of dementia and delirium is key to improving patient care. 
2. Learn simple tips for investigating underlying causes of behavioral issues in older adults.
3. Learn how to create patient-centered treatment plans for older adults and how to protocolize improved care plans in your emergency department.