Thank you for uploading such an important point. 

Each demented person has each narrative.  Each person's doctor , such as GP, or care person has a lot of information about the patient.  We should know the narrative, think about the viewpoint of the patient depending on his/her own life history, listen to the patient and answer the question with kindness and politeness.  

This was an interesting articles in the NYTimes, which calls for a decrease in agressive medical interventions and a focus on family education and pallitive/hospice consult:  http://www.nytimes.com/2009/10/20/health/20well.html?adxnnl=1&adxnnlx=1428364184-NU1EdrKcSnx8KIYQAce4+A.

Physical/Occupational therapy in the ER would also be a great non-pharmacological intervention. Movement has known effects on delirium and can often decrease agitation. 

Are you aware of TOP5, a protocol for accessing personal support strategies from carers and family?  Please visit our website for extensive information and resources.   www.cclhd.health.nsw.gov.au/patientsandvisitors/CarerSupport/

Thank you for your responses.  I'm interested to know if any of the recommended strategies have been implemented in the Emergency Department setting and assessed/evaluated?  Kind regards Jo

Start searching for these on pubmed:

Lovato E et al, Humanisation in the emergency department of an Italian hospital: new features and patient satisfaction

Wilber ST, Acad Emerg Med 2006

Sanders AB, Journ Am Geriatr Soc 2001

Samaras N, Ann Emerg Med 2010

Hastings SN, Acad Emerg Med 2005

Salvi F, J Am Geriatr Soc 2008

The best strategies is fast tracking for old people and peolple with dementia, as experienced in Ancona (Salvi F) and Treviso (Calabrò M). Now we are going to start here in Trieste with a similar service.

Good luck!

Academic Emergency Medicine

Free virtual geriatric issue

http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291553-2712/homepage/geriatric_virtual_issue.htm

http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291553-2712/homepage/geriatric_virtual_issue.htm

this is a great question and I thank all for their answers

I would suggest you check out the BC Governments implementation of 48-6  https://bcpsqc.ca/clinical-improvement/48-6/ which addressess better assessment and interventions in seniors 70 plus in the first 48 hours of admission. At our health authority this has led to a revisioning and refining of the emergancy department to assess all based on 48-6. This has encouraged all staf in the emergancy ward to do a more focussed assessment of cognitive functioning of the elderly earlier in the process  with screening tools for delerium and dementia.

all the best