THE USE OF THE MINI-MENTAL STATUS EXAMINATION IN THE ED EVALUATION OFTHE ELDERLY

This study was done to examine the impact of the mini-mental status ex amination (MMSE) in the emergency department (ED) evaluation of the el derly patient. The study was a prospective study of the MMSE applied b y the investigators with a comparison to the findings of the treating physician, in a university hospital ED with annual volume of 60,000, P articipants were a convenience sample of patients older than 65 years of age without apparent mental status abnormality presenting to the ED . Seventy four patients were entered in the study with 43 exclusions ( 23 with low educational level, 5 with Glasgow Coma Scale score of <15, and 15 other) leaving 31 cases for analysis. Of the 31 patients, 20 p atients had an MMSE score of <24. The MMSE findings agreed with the tr eating physicians' assessments in 21 (67%) cases. Disagreement occurre d in 10 (32%) cases in which the treating physician believed that both the patient's mental status and results of the investigator's MMSE we re normal; these 10 cases all involved low MMSE scores as performed by the investigator. When informed of the abnormal MMSE, both the physic ian's estimate of the patient's mental status and the patient's ED cou rse were altered in all cases. These results show that the MMSE is a v aluable screening tool to assess the mental status of the elderly in t he ED setting. Unexpected abnormality was noted in a significant minor ity of patients in this study, altering the patient's course in all in stances. The MMSE should be considered in evaluation of all geriatric patients encountered in the ED. Copyright (C) 1998 by W.B. Saunders Co mpany.