PRINCIPLE 1: Cognitive screening
Patients aged 65 years and over will be screened for confusion on admission or within 24 hours of admission using a validated screening tool.
When to screen
Older people aged 65 years and over should have a cognitive screen completed on presentation to hospital. However, if this is not practical, then cognitive screening should be completed within 24 hours of admission (1-3).
Older people should also be screened at a preadmission clinic to determine their baseline cognitive status. Cognitive screening should be performed in conjunction with delirium risk screening.
Aboriginal and Torres Strait Islander people have a higher incidence of dementia at a younger age (4). Therefore, cognitive screening should be considered for Aboriginal and Torres Strait Islander people aged 45 years and over (5).
If the older person is confused and risk factors for delirium are present, then the cause of their confusion should be assessed.
If the older person does not have confusion, then cognitive screening should be repeated if:
- there is any sudden change in the older person’s condition (including behaviour and cognition changes)
- there is a sudden decline in the person’s ability to perform activities of daily living (ADLs)
- a carer or family member expresses concern.
Who can do the screening?
Cognitive screening can be performed by any member of the multidisciplinary team. It is usually completed by the doctor, nurse or occupational therapist.
The person doing the screening should be trained on the use of the agreed tool (2).
- National Institute for Health and Clinical Excellence (NICE). Delirium: diagnosis, prevention and management. NICE, July 2010.
- Clinical Epidemiology and Health Service Evaluation Unit, Melbourne Health in collaboration with the Delirium Clinical Guidelines Expert Working Group. Clinical Practice Guidelines for the Management of Delirium in Older People, 2006.
- Australian Commission on Safety and Quality in Health Care. Evidence for the safety and quality issues associated with the care of patients with cognitive impairment in acute care settings: a rapid review. Sydney: 2013.
- Arkles R JPL, Robertson H, Draper B, Chalkley S, Broe G. Ageing, Cognition and Dementia in Australian Aboriginal and Torres Strait Islander Peoples: A Life Cycle Approach. A review of the literature. Canberra: Neuroscience Research Australia and Muru Marri Indigenous Health Unit, University of New South Wales, 2010.
- Australian Health Ministers Advisory Council [AHMAC]. Delirium Care Pathways Canberra: AHMAC, 2011.