The screener

Introduction
The APOP screener has been developed to be used by caregivers at the emergency department. Data from more than 2700 older ED patients from four different hospitals (LUMC, Alrijne hospital, HMC Bronovo and Erasmus MC) were used to develop the instrument. The APOP screening consists of nine questions to the patient and it takes a nurse less than two minutes to perform the screening.

The questions
The nine questions of the APOP screener being asked to all older patients (70 years and older) at the ED are:

- Age
- Sex
- Arrival by ambulance
- Did the patient need help on a regular basis from someone before the ED visit?
- Did the patient need assistance in bathing or showering before the ED visit?
- Has the patient been hospitalized in the past six months?
- Is the patient diagnosed with dementia?
- Memory question: In what year are we now?
- Memory question: Can you name the months in reverse order?
The last two questions are questions to test attention and memory. These questions were selected from the validated 6-item Cognitive Impairment Test.

What do the results mean?
In about 70% of the screened older patients, no abnormal results are found. In 30% one (or both) divergent results are found:

High risk of undesirable outcomes
 

This group includes the 20% of older patients with the highest risk of mortality or functional decline within 3 months. As a group, all patients in this high-risk group have a risk of 60% of these undesirable outcomes. This may have consequences for diagnostic and therapeutic choices. It is also important to start immediately with (plans for) assistance with recovery and rehabilitation.

Indications for cognitive disorders
 

This can be either because there were disorders previously (such as the presence of dementia), or because there are new disorders in the context of a delirium or another acute cause. As a group, all these older people are at high risk of having or developing a delirium. Prevention, early recognition and treatment thereof are of great importance.