Chapter 10: Nursing Management of Dementia

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.

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.

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

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

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

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

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)

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

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

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. 405-407) Activities of Daily Living

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)

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

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.

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