#188 Using the 4AT to trigger further assessment of cognitive decline in a frail older population presenting to an emergency department

<h3>Introduction</h3> 4AT is a delirium screening tool. 4AT 1-3 may indicate underlying cognitive impairment. Greater than or equal to 4 indicates potential delirium. The Ascertain Dementia (AD8) tool allows underlying longstanding cognitive impairment to be detected and trigger referral for ambulatory memory assessment, allowing earlier signposting to essential dementia supports. <h3>Methods</h3> A prospective observational study of routinely collected data assessed how many patients with 4AT=0, 4AT=1-3 and 4AT&gt;/=4 did not carry a diagnosis of dementia. Consecutive frailty at the front door (FFD) patients in a level 4 Emergency department between January and June 2024 had a 4AT. Age, gender and clinical frailty score (CFS) were recorded. Where AD8 was administered, the positive rate was calculated. Data was entered onto Excel by a trained administrator and analysed using descriptive statistics. <h3>Results</h3> 595 patients had a 4AT from January to June 2024. Average age was 82.7 years (range 56-99). Male: female ratio 1:1.5 with average CFS of 5. 51% ( n=302) had 4AT 0. 27% (n=159) 4AT 1-3 and 22% (n=134) 4 or greater. 97% of patients with 4AT 0 had no background diagnosis of dementia, 80% (n=127) of 4AT of 1-3 and 60% (n=81) 4AT of 4 or greater; this is illustrated in table 1. 71% (n=208) of abnormal 4AT scores had no prior dementia. Of patients with 4AT 1 and above and no history of dementia, 25% (n=52) had an AD8. 47 of 52 (90%) were positive. <h3>Conclusion</h3> Undiagnosed dementia is common in patients with abnormal 4AT scores with or without delirium. Routinely performed AD8 identifies those requiring further cognitive assessment. Early diagnosis of dementia with appropriate supports reduces need for future emergency care. FFD teams using AD8 as an adjunct to the 4AT are instrumental in initiating pro-active case management of cognitive impairment. Next steps will be to embed AD8 assessment into routine FFD practice.