Wednesday, July 11, 2012

Altered Mental Status in the Elderly

We learned in Morning Report today that medications are the top culprit when it comes to altered mental status in the elderly population.




The "Beers List" is a consensus list of potentially inappropriate medications for older persons published by the American Geriatrics Society. It was first published in 1991, and most recently updated in 2012.

Please click on the following link for a copy of the paper:

These high risk medications include, but are not limited to drugs in the following broad categories (with examples that follow in brackets):

- Anticholinergics (antihistamines)
- Antiparkinson agents (benztropine)
- Antispasmodics (hyocyamine or Buscopan)
- Antithrombotics
- Antihypertensives (alpha and/or beta blockers)
- Antiarrythmic drugs (amiodarone)
- Antipsychotic drugs
- Barbituates
- Benzodiazepines
- Nonbenzodiazepine hypnotics (zopiclone)
- Insulin
- Hormone therapy (androgen, estrogen)
- Analgesic agents (opioids, NSAIDS)
- Skeletal muscle relaxants (cyclobenzaprine or Flexeril)


There was mention in passing about the purported influence of digitalis toxicity on Van Gogh's works of art later in life, which were characterized by halos and the colour yellow. Click on the link below for a fascinating paper published in JAMA in 1981 entitled, "Van Gogh's Vision: Digitalis Intoxication?":


And, last, but certainly not least, in order to make your Morning Report experience greater than it is already (if that's even possible), please click the link below for Dr. Detsky's guide for "Taking the Stress out of Morning Report":