We frequently have to decide if an elderly patient has an altered mental status. This can be a bit tricky because the patient might be a little “off” at baseline so sometimes, we have to try a little bit harder to determine if the patient is altered or not.
The other night, the intern (doctor in training) told me an eighty-year-old woman was confused because she was not able to give the exact date. After meeting her, I asked her if she knew where she was and she named, exactly, our hospital.
I asked her if she knew the date. She said, “No,” without even trying. When I pressed her, she gave the year, off by only one.
I then asked her who was the President of the United States. “Obama,” she answered confidently.
“Who is going to be the president next year?” I then asked.
“I have no idea.”
Well, who are you going to vote for, Trump or Clinton?”
“Trump.” Again, with confidence.
“You are the first person I have ever met who supports Trump. Why do you think he would make a good president?”
“Because he is very rich and has a beautiful wife.”
Since my purpose was not to delve into her politics, I stopped the interview there. If she knew those two facts about the man running for president, it was hard for me to believe she might have any significant confusion.
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