Confusion, Dementia, and Alzheimer’s Disease Chapter 19

Learning Objectives Describe normal changes of aging in the brain Discuss confusion and delirium Describe dementia and Alzheimer’s disease (AD) List strategies for better communication with residents with AD Describe interventions for ADLs Describe interventions for common difficult behaviors related to AD Describe creative therapies for residents with AD

Cognition, Confusion & Delirium Ability to think logically and clearly Cognition Loss of ability to think logically Concentration and memory are affected Cognitive Impairment Loss of some ability to think logically and clearly Loss of memory of recent events Slower reaction time Hard to find the right word Normal Age-Related Changes Confusion Inability to think clearly Temporary OR permanent with gradual OR sudden onset Causes include UTI, low blood sugar, head trauma, dehydration, fever, lack of oxygen, medications, or illnesses Delirium State of severe confusion Usually temporary with sudden onset Causes include infections, disease, fluid imbalance, drugs, alcohol, or poor nutrition

Dementia & Alzheimer’s Disease (AD) Serious loss of mental abilities NOT a normal part of aging Alzheimer’s Disease (AD) Progressive, incurable disease that causes tangled nerve fibers and protein deposits to form in the brain

Communication Strategies when working with patients with AD General Front approach Reduce noise/distraction Identify yourself/use their name Speak slow, in a low tone Break complex tasks into simpler ones Frightened or anxious Keep them calm Speak in low, calm voice Describe what you are doing Use simple words/short sentences Check their body language Forgets or shows memory loss Repeat yourself Use a different word if they don’t understand one Simple messages and tasks Answer questions each time they are asked Trouble finding words Suggest a word that sounds correct Do NOT correct a resident who uses an incorrect word Not understanding basics Ask them to repeat your words Watch for nonverbal and body language Use short words, signs, pictures Simple steps for tasks Wants to talk, but can’t Encourage them to point, gesture or act it out Offer comfort with a smile Wants to do something unsafe Limit the times you say “don’t” Redirect Paranoid or accusing Don’t take it personally Redirect or ignore Depressed or lonely One-on-one time Listen Involve them in activities Report depression to the nurse Repeatedly asks to “go home” Remind them they are home Do NOT argue Expect the questions to continue Remain patient and gentle Verbally abusive It is the disease, not the person Try to ignore and redirect Loss of verbal skills Use nonverbal skills (touch, smiles, laughter) Use signs, labels and gestures Assume they understand more than they can express perseveration

ADL Interventions Bathing Grooming/Dressing Toileting/Incontinence Schedule when least agitated Well-lit and comfortable temperature Privacy Be calm and quiet Ensure safety Promote self-care Grooming/Dressing Avoid delays or interruptions Encourage them to pick out clothes to wear Lay their clothes out in order Do NOT rush Use a friendly/calm voice Toileting/Incontinence Mark the bathroom with a sign or picture Encourage fluids Check them every 30 minutes Observe toilet patterns – take before and after meals Be professional Eating Consistent meal times Familiar foods Minimize noise Do NOT serve steaming or very hot foods/drinks Simple place setting Verbal cues Adaptive equipment Encourage socialization Observe for any issues Physical Health Prevent infections Observe and report potential problems Watch for signs of pain Maintain daily exercise routines Mental/Emotional Health Encourage independence Offer enjoyable activities Reward positive and independent behavior with smiles, hugs and warm touches

Interventions for Difficult Behaviors Agitation Remove triggers Keep routines Familiar activities Remain calm Sundowning Avoid stress Play soft music Set a bedtime routine and keep it Plan a calming activity Remove caffeine Distraction Encourage daily exercise Violent Behaviors Block blows NEVER hit back Step out of reach Call for help Do NOT leave the resident alone Use calming techniques Hallucinations & Delusions Ignore if they are harmless Reassure if they are upset or worried Do NOT argue Stay calm Inappropriate Sexual Behavior Be sensitive Direct them to a private area Distract them Consider other ways to provide physical stimulation Do NOT reprimand them Pillaging & Hoarding Provide a rummage drawer Do NOT tell others the resident is stealing Ask family to report unfamiliar items REMEMBER

Family members Community Resources Creative Therapies Community Resources Reality Orientation Uses calendars, clocks, signs, lists Useful in the early stages of AD – it may frustrate residents in later stages of AD Validation Therapy Lets residents believe they live in the past or in imaginary circumstances; can give comfort and reduce agitation Useful in cases of moderate to severe disorientation Reminiscence Therapy Encourages residents to remember and talk about the past; focus on a time in life that was pleasant Useful in many stages of AD, but especially with moderate to severe confusion Activity Therapy Uses activities residents enjoy to prevent boredom and frustration; promotes self-esteem Useful in most stages of AD

Review Normal changes of aging in the brain Confusion and delirium Dementia and AD Communication strategies ADL interventions Difficult behaviors and interventions Creative therapies