1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 33 Delirium and Dementia

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Fear of loss of normal cognition Losses that result from impaired cognition With aging there is increased risk of –Delirium: generally reversible –Dementia: irreversible Differences between delirium and dementia

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Delirium Causes Signs and symptoms –Rapid; altered level of consciousness Nursing assessment Prompt treatment may reverse condition and prevent permanent damage Treatment/management –Depends on the cause

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Delirium—(cont.) Consider coexisting factors Interventions during the initial acute stage –Establishing medical stability –Minimizing stimulation –Consistency in care –Prevention of harm to self and others –Support and realistic expectations

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Several coexisting factors can be responsible for a delirium.

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True As older adults often have multiple health conditions, it is important to remember that several coexisting factors can be responsible for a delirium.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Dementia Irreversible Progressive Impairment in cognitive function affects –Memory, orientation, reasoning, attention, language, and problem solving Caused by damage or injury to the brain 4.5 million older adults are affected

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Alzheimer’s Disease (AD) Most common form of dementia Incidence/prevalence Changes in the brain: –Neuritic plaques containing beta-amyloid protein –Neurofibrillary tangles in the cortex –Loss or degeneration of neurons and synapses –Changes in neurotransmitter systems

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins AD—(cont.) Possible causes –Genetics –Environmental factors –Chromosomal abnormalities –Free radicals –Levels of aluminum and mercury in brain –Slow-acting virus

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins AD—(cont.) Symptoms develop gradually and progress at different rates among individuals Staging –Global Deterioration Scale/Functional Assessment Staging (GDS/FAST) Early disease changes Diagnosis

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins AD—(cont.) Treatment/management –No current treatment to prevent/cure AD –Clinical trials in place to improve function and slow disease progression –Research on estrogen–conflicting results –Antioxidants, anti-inflammatory agents, folic acid, vitamins B 6 and B 12, and gene therapy –Medications that slow acetylcholinesterase

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Dementias Vascular dementia Frontotemporal dementia Lewy body dementia Creutzfeldt-Jakob disease Wernicke encephalopathy Parkinson’s disease AIDS Trauma and toxins

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following statements best describes Creutzfeldt-Jakob disease? a.Neuronal atrophy of the frontal lobes of the brain b.Rare disease with a rapid onset and progression of the disease to death c.Behavioral rather than cognitive impairments in the early stages d.Caused by cerebral infarctions and history of cardiovascular disease

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b.Rare disease with a rapid onset and progression of the disease to death Creutzfeldt-Jakob disease is an extremely rare brain disorder that causes dementia. It has a rapid onset and progression and is characterized by severe neurological impairment that accompanies the dementia. The disease progresses rapidly, and death typically occurs within 1 year of diagnosis.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia Ensuring patient safety –Problems related to poor judgment and misperceptions –Consistent, structured environment –Items to trigger memory –Controlled environment –Wandering behavior –Prevention of abuse

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia — (cont.) Promoting therapy and activity –Occupational and expressive therapy –Varying degrees of reality orientation –Stimulation through other activities –Touch –Modified communication techniques

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia— (cont.) Providing physical care –Close observation and attention to physical needs Eating and drinking Bathing and skin care Consideration of inability to communicate needs and discomforts Consistency in caregivers

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? The onset of behavioral problems in a person with dementia indicates the need for medications to suppress the behavior problem identified.

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Consideration must be given to the potential inability of the older adult with dementia to communicate their needs and discomforts. A subtle change in behavior or function, a facial grimace, or repeated touching of a body part may give clues that a problem exists. The underlying cause must be determined.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia— (cont.) CAM therapies –Nutritional supplements Vitamins Minerals Herbs Therapeutic exercise –Qigong

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia— (cont.) Respecting the individual –Know the person’s unique life history –Need to promote: Individuality Independence Freedom Dignity Connection

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Caring for Persons with Dementia— (cont.) Supporting the patient’s family –Consideration of physical, emotional, and socioeconomic burdens of caregiving –Review/educate basic care techniques –Help prepare for feelings that may accompany the role of caregiver –Community resources