Presentation on theme: "The Three Ds of Confusion Delirium, Depression, Dementia"— Presentation transcript:
1The Three Ds of Confusion Delirium, Depression, Dementia
2Confusion Is not a normal part of aging Delirium and Depression are treatableDementia is manageable
3Delirium More common than fever or pain in older adults About 50% of hospitalized older adults experience deliriumOnly 3 out of 10 older adults with delirium are diagnosed by health care personnelAs many as 1/3 of those affected by delirium will dieIs a medical emergency and should be treated as suchSt. Pierre, J. (1996). Delirium in hospitalized elderly patients. Critical Care Nursing, 8(1),
4Delirium Onset: hours to days Causes: medications fluid and electrolyte imbalances (What is a common fluid imbalance that also begins with the letter “D”?)infection (rule out urinary and respiratory infections)elimination (urinary retention / constipation)changes in chronic illnessnewly-developed disease processpsychosocial / environmental issues
5Delirium: Diagnosis need to repeat questions perseveration (What does this term mean?)disorganized thinkingreduced LOC (level of consciousness)perceptual disturbancessleep-wake disturbance or psychomotor activitydisorientation to time, place, personmemory impairment
6Delirium : AssessmentPerson, place and time are the least sensitive markers for deliriumFocus on aspects of Attention and ConcentrationAsk client to count backward from 20 by 3’sAsk client to copy a drawing of intersecting pentagons
7Delirium: Interventions Rule out drug-related causes and infections firstUrinary tract and respiratory infections are the most commonObtain data about the individual’s baseline cognitive functioningProvide orienting cues and supportEye glasses, hearing aids, calendar, clock, etc.
8Depression Onset: weeks to months Causes: heredity biochemical changes drugsillnesssensory deficitsstressseasons (seasonal affective disorder,frequently seen in the Northwest)
9predispose an individual to a depressive Losses with AgingbiologicalpsychologicalpersonalsocialidentitypossessionsreligiousSometimes thecumulative effectof several losses canpredispose an individual to a depressiveepisode.Think of some examples of how these losses may be experienced.
10Depression: Diagnosis Symptoms include…loss of interest or pleasure in activitiespersistent depressed mood, including feelings of sadness or emptinessfeeling slowed down or restless, can’t sit stillfeeling worthless or guiltyincrease or decrease in appetite or weightthoughts of death or suicideproblems thinking, concentrating, or making decisionstrouble sleeping, or sleeping too muchloss of energy or feeling tired all of the time; constant fatigue
11Depression: Assessment Geriatric Depression ScaleSelf-administeredWell tested and used by all health care providersCornell Scale for Depression in DementiaUseful in assessing depression in individuals with dementiaCan be used by family members or caregivers to articulate their observations, as some individuals may minimize the severity of their symptoms
12Risk Factors for Late in Life Suicide malesignificant losspoor healthisolationfeeling hopelessprevious attemptdrug / alcohol abusefamily historyfinancial insecurityThe risk of suicide is high in older adults.Health care providers must intervene if an individual makes statements related to the taking of his or her own life.
13Depression: Interventions AntidepressantsMonitor for side effectsEncourage and support counselingRecommend a referral to Medical Social Worker (MSW)May be able to link individual with resources and community support
14Dementia Onset: months to years Causes: Alzheimer’s Disease (AD) (most common)Vascular Dementia (multi-infarct; MID)Mixture of AD & MIDPick’s, Parkinson’s, AIDSTo learn more about AD, see the booklet Alzheimer’s Disease: UnravelingThe Mystery, produced by the NationalInstitute on Aging.
15Delirium + DementiaIndividuals with dementia still have acute illnesses such as pneumonia, UTI’s, medication side effects, and electrolyte imbalances. This means that they can have a delirium superimposed on their dementia. If an client with AD is more confused than usual (within hours to days) and experiencing the s/s of delirium as discussed earlier, you must intervene.Therefore, your assessment must include information about the client’s baseline cognitive functioning. Family members and caregivers must be included in the assessment process.
16Dementia: Interventions Obtain client’s baseline cognitive functioning.Observe for potential delirium and/or depression that may magnify cognitive impairment (both of these conditions are treatable even in the individual with dementia).Provide and encourage an environment that supports the individual’s highest level of functioning.
17The Three Ds of Confusion was prepared by Catherine Van Son, Ph.D., R.N., for the Older Adult Focus Project, OHSU School of Nursing.