Managing Delirium in Older Emergency Department Patients With an Embedded Geriatric Emergency Department Nurse Practitioner

Delirium is a neurocognitive emergency that affects 6% to 35% of older adults in the Emergency Department (ED) and is associated with increased mortality, longer hospitalizations, cognitive decline, and rehospitalization. Delirium, however, is missed in the ED more than 50-80% of the time. A Geriatric ED nurse practitioner specialist dedicated to screening and assessing older ED patients to help facilitate care transitions and safe discharges was established in a high-volume, tertiary care, academic ED. Our objectives were to ascertain baseline rates of delirium as part of GED screening in patients likely to be discharged from the ED.

Descriptive, observational study from May to September 2025. A convenience sample of patients aged ≥65, ESI ≥2 were screened for delirium with the Confusion Assessment Method (CAM). Screening occurred during the weekday afternoons and was performed by an Geriatric ED Nurse Practitioner dedicated to seeing older ED patients who were likely to be discharged from the ED. Demographic characteristics and CAM results were analyzed descriptively to determine the prevalence of delirium and associated factors.

The ED sees an annual volume of over 120K patients with 25% of patients over 65 with an ESI > 2. A total of 214 patients were identified as eligible and screen by the GED NP; men age was 87.4 ± 6.2 years; 57.5% were female; 74.8% White, 4.2% Black, 4.2% Asian, 0.9% Southern American Indian, and 7% declined to state; 8.9% Hispanic. A total of 23 (11%) screening positive for delirium, with 5 (2.3%) having indeterminate results (e.g., dementia histories and unavailable baseline), indicating up to 13% of older adults likely to be discharged were positive for probable delirium.

Delirium remains prevalent and under detected in up to 1:10 older ED patients likely to be discharged from the ED. Routine CAM screening by an embedded Geriatric Nurse Practitioner effectively identified at-risk individuals and aligned with national prevalence estimates. These preliminary findings highlight opportunities for earlier detection through ED staff dedicate geriatric care including delirium management protocols in the ED.