What’s the difference, and strategies to help the patient and caregiver

Definition Delirium Disturbance of consciousness with reduced ability to focus, sustain, or shift attention A change in cognition, a perceptual disturbance not accounted for by preexisting, established or evolving dementia Occurs over a short time period and fluctuates during the day Has a causal component Dementia Chronic acquired decline in memory and at least on other cognitive function Decline usually evident over longer periods with mild to severe cognitive decline, hallucinations, and delusions

Delirium vs. Dementia Delirium Dementia Acute Reversible Consciousness: fluctuating Decreased awareness of self Perceptions: illusions, hallucinations common Speech: slow, incoherent Disorientation: time, others Cognitive dysfunction Illness, med. toxicity: often Diurnal disruptions Outcome: excellent if corrected early Gradual Irreversible Consciousness: rarely alters Decreased awareness of self Perceptions: Hallucinations not common Speech: repetitive difficulty finding words Disorientation: time, person, place Memory impairment Illness, med. toxicity: rarely Diurnal disruptions Outcome: poor

Delirium A medical emergency Triggered by Oxygen deprivation Drug use/poisons, meds Infections, recent surgery, or trauma Severe chronic illness Electrolyte imbalances Pre-morbid brain conditions, and functional status Preexisting cognitive impairment Old age/ sensory losses

Prevention Risk factorsIntervention Cognitive impairment Dehydration/electrolyte imbalance Sensory deprivation/ sleep disturbances Pharmacy Routine mental status assessment, staff education I&O, skin assessment, early recognition Non pharmacologic sleep aids, decreased noise and light at night, frequent rest periods, daytime activities Staff education of medication side effects, pharmacy liaison, start low go slow

Dementia C Comes on over time, short term memory loss loss becomes evident May progress slowly or quickly May affect younger persons as well as elderly Different kinds of dementia Treatment generally depends on the stage/ severity of the disease Becoming old doesn’t mean you will develop dementia Is terrifying while the client is still able to realize that they are not thinking properly

Communication Is often what relationships are built on When communication becomes faulty our relationships crumble Our communication strategies can help an older adult with advancing dementia feel safe, less anxious, and less likely to become upset or aggressive

Getting their attention Gain the persons attention Turn off extraneous noise Stand in front of the person and maintain eye contact Go slow, direct and redirect their attention

Be aware of your tone of voice Do not shout! Do not speak in a condescending tone Speak slowly

Take care with your use of language Use adult language Concrete simple language, short phrases Be positive and reassuring Don’t talk about the person as if they weren’t there

Try yes or no questions Use 2 choice questions like do you want juice or soda? Are you hungry? Are you tired? Can I read to you?

Repeat rephrase and repair: This is a difficult strategy but is helpful to maintain conversation and helps fill in the missing information the person with dementia may omit Repeating-helps fill in speech Ex: I want a cup of…. If you repeat this the elder may add the word coffee, water or juice Rephrasing- helps the person hear the corrected response if they say juice you might point to a juice container and say I want a glass of juice Repairing-uses both tactics to fix or fill in missing information for example a person points at a pantry cabinet and says, “look there.”, you might say, “your Hungry?”

Orient and reorient frequently Use visual aids Make sure they have hearing aids or glasses if they need them Calendars and message boards Keep them up to date, make sure they are easy to locate Orient the person with your language

Use touch Touch makes us human and is reassuring Helps maintain attention during conversation Can be calming

Learn to be a good listener Listen and watch/ wait for the response Do not interrupt Be willing to talk about old times then redirect

Lastly- DON’T ARGUE You won’t win The person with dementia is not trying to be disagreeable they are usually unaware that they are making mistakes If the person is in immediate danger then correcting the thought or behavior might be appropriate. If not- DON”T ARGUE you will only cause frustration, fear and anger so what’s the point?

References Bell, L. (November, 2011). AACN practice alert: Delirium assessment and management. American Association of Critical Care Nurses. Cason-McNeeley, D. (2004). Delirium the Mistaken Confusion. PESI Healthcare, Eau Claire, Wisconsin Galik, E. M., Sparks, M., Spurlock, W. (2008). Effective communication and behavior management strategies in the care and treatment of Alzheimer’s disease. Counseling Points, 1(2). Kohler, S. (2004). How to Communicate with Alzheimer’s. Granny’s Rocker Publishing, Venice, CA.