How do you approach evaluating sudden mental status changes in telepsychiatry patients, particularly older adults, when medical causes such as infection or metabolic disturbance may be contributing factors?

What red flags prompt you to recommend urgent in-person evaluation? Are there particular strategies or screening questions you have found helpful to distinguish psychiatric from medical causes of altered mental status remotely? How do you assess when a patient may no longer be appropriate for telehealth care because of the severity of mental status changes, progression of dementia, or other factors limiting safe remote management?