1. Chapter 10: Nursing Management of Dementia

2. Learning Objectives
Differentiate among dementia, depression, and delirium.
Identify the stages and clinical features of dementia.
Describe procedures for diagnosing dementia.
Recognize and address the common causes of delirium.
Discuss the theoretical foundations of nursing care for persons with dementia.
Contrast pharmacological and nonpharmacological interventions for dementia, delirium, and depression.

3. Learning Objectives (cont’d)
Apply basic principles to provide safe and effective care for persons with dementia.
List specific nursing interventions for behavioral and psychological symptoms of dementia.
Recognize the role of adult day services in the care of persons with dementia.
Identify the role that palliative care/hospice care plays for individuals with dementia and their families.

4. Dementia
Progressive, degenerative brain dysfunction, including deterioration in memory, concentration, language skills, visuospatial skills, and reasoning, that interferes with a person’s daily functioning
Not considered a normal part of aging

5. Dementia (cont’d) Most common types of dementia in older adults
Alzheimer’s disease (most common)
Vascular dementia (second most common)
Mixed Alzheimer’s/vascular dementia
Parkinson’s dementia
Lewy body dementia (LBD)
Frontotemporal lobe dementia

6. Dementia (cont’d) Risk factors for dementia Age Family history
Genetic factors
apolipoprotein E-e4 (APOE-e4)
History of head trauma
Vascular disease
Certain types of infections

7. Dementia (cont’d) Alzheimer’s Disease
Medical diagnosis (Box 10-5, P. 382; Box 10-8, p. 385)
Stages (mild, moderate, severe) (Box 10-9, p. 386)
Pharmacological intervention
cholinesterase inhibitors (CEIs): Aricept
N-methyl-D-aspartate (NMDA) receptor antagonists: Namenda
Medications that cause or worsen confustion
Anticholinergic (Box 10-6)
Medications with central nervous system effects

8. Delirium Acute confusion (dementia-chronic confusion)
Develops over hours or days
Hyperalert (agitated) or hypoactive states (lethargic)
Confusion Assessment Method (CAM) is developed based on 4 features of delirium:
Acute onset or fluctuating course
Inattention
Disorganized thinking
Altered level of consciousness
Common Causes of Delirium (Box 10-12, p. 391)

9. Sundowner Syndrome
A form of delirium and refers to behavior problems that are sometimes seen in the late afternoon or early evening when the sun sets.
Nocturnal confusion
Confusion “as the sun goes down”
Increased with unfamiliar surrounding
Often disturbed sleep patterns
May result from excess sensory stimulation or deprivation

10. Depression
Risk increases in older adults with chronic illnesses or dementia (box 10-13)
Symptoms
can be incorrectly attributed to normal aging
may overlap with dementia
often include anxiety, agitation, and insomnia
Potentially life-threatening
Treatable
Often under recognizing, undertreated

11. Caring for the Person with Dementia
Behavioral and Psychological Symptoms (Box 10-15)
Pharmacological Treatment (Box 10-16)
Nonpharmacological Treatment for Dementia (Box 10-17, 18)
Pain Management and Alzheimer’s Disease (Box 10-19, 20, 21)
Activity Interventions
Communication Interventions (Box 10-22)
Interventions for Particular Behaviors (p )
Activities of Daily Living

12. Settings for Care: Focus on Adult Day Services
Recreational therapy/activities
Meals
Social services
Transportation
Personal care: bathing, hair and nail care
Nursing services
Rehabilitation services (less commonly offered)
Medical services (less commonly offered)

13. Hospice/Palliative Care
comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases. (Box 10-32)
Advance directives

14. Legislative Action
National Alzheimer’s Project Act (2011) calls for the expansion and coordination of research and health service delivery across federal agencies for Alzheimer’s disease and related dementias.
The top priorities of the Act are to place significant focus on the dementia people to improve patient outcomes and to reduce disparities.

15. Summary As population ages, cases of dementia will grow
Reliable assessment tools are available
Interventions for the common behaviors encountered among persons with dementia can help those persons and their caregivers