Chapter 49 Confusion and Dementia Copyright 2017 Elsevier

Chapter 49 Confusion and Dementia Copyright © 2017, Elsevier, Inc. All rights reserved.

2 Changes in the Brain Changes in the brain and nervous system occur with aging and diseases. Cognitive function and quality of life may be affected. Cognitive function involves: Memory Thinking Reasoning Ability to understand Judgment Behavior Copyright © 2017, Elsevier, Inc. All rights reserved.

3 Confusion has many causes. Diseases and infections Hearing and vision loss Drug side effects Brain injury Age-related changes resulting in reduced blood supply to the brain The person may be: Angry Restless Depressed Irritable Copyright © 2017, Elsevier, Inc. All rights reserved.

4 Confusion (Cont. ) Acute confusion (delirium) occurs suddenly. It is usually temporary. Causes include infection, drugs, illness, surgery, and injury. Treatment is aimed at the cause. Confusion from physical changes cannot be cured. Some measures help to improve function. Copyright © 2017, Elsevier, Inc. All rights reserved.

5 Dementia is the loss of cognitive function that interferes with routine personal, social, and occupational activities. Dementia is a group of symptoms that may occur with certain diseases or conditions. Dementia is not a normal part of aging. Most older people do not have dementia. Copyright © 2017, Elsevier, Inc. All rights reserved.

6 Dementia (Cont. ) Early warning signs of dementia include: Recent memory loss that affects job skills Problems with common tasks Problems with language; forgetting simple words Getting lost in familiar places Misplacing things and putting things in odd places Personality changes Poor or decreased judgment Loss of interest in life Copyright © 2017, Elsevier, Inc. All rights reserved.

7 Dementia (Cont. ) If brain changes have not occurred, some dementias can be reversed. Treatable causes include: Drugs and alcohol Delirium and depression Tumors Heart, lung, and blood vessel problems Head injuries Infection Vision and hearing problems Copyright © 2017, Elsevier, Inc. All rights reserved.

8 Dementia (Cont. ) Permanent dementias result from changes in the brain. They have no cure. Alzheimer’s disease is the most common type of permanent dementia. Pseudodementia means false dementia. The person has signs and symptoms of dementia. There are no changes in the brain. This can occur with delirium and depression. Both can be mistaken for dementia. Copyright © 2017, Elsevier, Inc. All rights reserved.

9 Dementia (Cont. ) Delirium is a state of sudden, severe confusion and rapid changes in brain function. Usually temporary and reversible It occurs with physical or mental illness. It often lasts for about one week. Causes include: Acute or chronic illness Surgery Drug or alcohol abuse Infections Delirium is an emergency. It signals physical illness. The cause must be found and treated. Copyright © 2017, Elsevier, Inc. All rights reserved.

10 Dementia (Cont. ) Depression is the most common mental health problem in older persons. It is often overlooked. Depression, aging, and some drug side effects have similar signs and symptoms. Mild cognitive impairment (MCI) is a type of memory change. The person with MCI has problems with memory, language, and other mental functions. However, the problems do not interfere with daily life. The person with MCI is at risk for Alzheimer’s disease. Copyright © 2017, Elsevier, Inc. All rights reserved.

11 Alzheimer’s Disease Alzheimer’s disease (AD) is a brain disease. Many nerve cells that control intellectual and social function are damaged and die. The following functions are affected: Memory Thinking Reasoning Judgment Language Behavior Mood Personality Copyright © 2017, Elsevier, Inc. All rights reserved.

12 Alzheimer’s Disease (Cont. ) AD onset is gradual. Usually, symptoms first appear after age 60. Nearly half of the persons age 85 and older have AD. More women than men are affected. The cause is unknown. AD is not a normal part of aging. A family history of AD increases a person’s risk of developing the disease. The classic sign of AD is gradual loss of short-term memory. At first, the only symptom may be forgetfulness. Copyright © 2017, Elsevier, Inc. All rights reserved.

13 Alzheimer’s Disease (Cont. ) Stages of AD Signs and symptoms become more severe as the disease progresses. The disease ends in death. AD is often described in terms of 3 stages: mild, moderate, and severe. The Alzheimer’s Association describes 7 stages: Stage 1 - No impairment Stage 2 - Very mild cognitive decline Stage 3 - Mild cognitive decline Stage 4 - Moderate cognitive decline Stage 5 - Moderately severe cognitive decline Stage 6 - Severe cognitive decline Stage 7 - Very severe cognitive decline

14 Alzheimer’s Disease (Cont. ) Alzheimer’s disease changes how a person behaves and acts. Health-related issues can make the problems worse. Examples include illness, infection, drugs, lack of sleep, constipation, hunger, thirst, poor vision or hearing, alcohol, and caffeine. Copyright © 2017, Elsevier, Inc. All rights reserved.

15 Alzheimer’s Disease (Cont. ) Problems in the person’s setting may also make changes in behavior worse. According to the National Institute on Aging (NIA), they include: A strange setting Too much noise Stepping from one type of flooring to another Not understanding signs Mirrors Copyright © 2017, Elsevier, Inc. All rights reserved.

16 Care of Persons with AD and Other Dementias Usually, the person is cared for at home until symptoms are severe. Adult day care may help. Often, assisted living or nursing center care is required. Sometimes, hospital care is needed for other illnesses. You may care for persons with AD or other dementias. The person and family need your support and understanding. Copyright © 2017, Elsevier, Inc. All rights reserved.

17 Care of Persons with AD and Other Dementias (Cont. ) Currently, AD has no cure. Symptoms worsen over many years. The rate varies from person to person. The following needs must be met: Safety Hygiene Nutrition and fluids Elimination Activity Comfort and sleep Copyright © 2017, Elsevier, Inc. All rights reserved.

18 Care of Persons with AD and Other Dementias (Cont. ) You must treat these persons with dignity and respect. They have the same rights as persons who are alert and active. Talk to them in a calm voice. Always explain what you are going to do. Range-of-motion exercises and touch are important therapies. The person may need hospice care as death nears. Copyright © 2017, Elsevier, Inc. All rights reserved.

19 Care of Persons with AD and Other Dementias (Cont. ) The person can have other health problems and injuries. The person may not be aware of signs and symptoms. The person cannot fully tend to self-care. Infection is a risk. It can occur from poor hygiene. Inactivity and immobility can cause pneumonia and pressure ulcers. The person needs to feel useful, worthwhile, and active. Therapies and activities focus on the person’s strengths and past successes. Copyright © 2017, Elsevier, Inc. All rights reserved.

20 Care of Persons with AD and Other Dementias (Cont. ) The family Health care is sought when the family cannot deal with the situation or meet the person’s needs. Home health care may help for a while. Adult day care is an option. Long-term care is needed when: Family members cannot meet the person’s needs. The person no longer knows the caregiver. Family members have health problems. Money problems occur. The person’s behavior presents dangers to self and others. Copyright © 2017, Elsevier, Inc. All rights reserved.

21 Care of Persons with AD and Other Dementias (Cont. ) Home care and nursing center care stressful. The family has special needs. Physical Emotional Social Financial Adult children are in the sandwich generation. They are caught between their own children needing attention and an ill parent needing care. Asking family and friends for help is important. However, asking for help is hard for some people. Copyright © 2017, Elsevier, Inc. All rights reserved.

22 Care of Persons with AD and Other Dementias (Cont. ) Caregivers need much support and encouragement. AD support groups are helpful. Support groups share coping and caregiving ideas. The family often feels hopeless. No matter what is done, the person gets worse. Anger and resentment may result. Guilt feelings are common. The family is an important part of the health team. They help plan care whenever possible. The nurse and support group help the family learn how to give needed care. Copyright © 2017, Elsevier, Inc. All rights reserved.

23 Care of Persons with AD and Other Dementias (Cont. ) Validation therapy may be part of the person’s care plan. The health team decides if validation therapy might help a person. If therapy is used in your agency, you will receive the training needed to use it correctly. Copyright © 2017, Elsevier, Inc. All rights reserved.