Confusion and Disorientation in the Elderly Chapter 10 – Section 4

Confusion & Disorientation MOST REMAIN MENTALLY ALERT UNTIL DEATH, but some experience periods of confusion and disorientation. Signs include talking incoherently Not knowing their own name Not recognizing others Wandering aimlessly Unaware of time or place Hostile or combative behavior Hallucinations Paying less attention to personal hygiene Unable to respond to simple instructions

TEMPORARY condition caused by a TREATABLE condition Delirium TEMPORARY condition caused by a TREATABLE condition Possible Causes Stress, depression Use of alcohol or drugs Kidney disease – interferes with electrolyte imbalance Respiratory disease – interferes with oxygen to brain Medications accumulating – toxicity Poor nutrition or fluid intake Identification of the cause, and treating it, eliminates the confusion/disorientation/delirium

Disease and damage to the brain can sometimes cause confusion or disorientation.

Cerebrovascular Accident aka: STROKE Damages brain cells Blood clot obstructs blood flow to the brain OR Vessel can rupture and cause hemorrhaging in the brain

Cross Section of brain showing a hemorrhagic stroke

CT Scan showing ischemic stroke This means there was a thrombus that cut off blood flow to the brain.

Arteriosclerosis Condition where the walls of the blood vessels become thick and lose their elasticity Common in elderly people

Atherosclerosis When the vessels become narrow because of deposits of fat and minerals (such as calcium)

These conditions can cause Transient Ischemic Attacks (TIAs) Also known as ministrokes Results in temporary periods of diminished blood flow to the brain. Each time an attack occurs, more damage to brain cells results.

Progressive, irreversible disease DEMENTIA Also called brain syndrome Loss of mental ability characterized by: Decreased intellectual ability Loss of memory Personality change Disorientation Progressive, irreversible disease When caused by high fever, infection, dehydration, lack of oxygen, drug toxicity, etc. – the condition is called delirium (acute) When caused by permanent, irreversible damage  chronic dementia Cerebrovascular accidents Arteriosclerosis TIAs

Alzheimer’s Disease Form of dementia – causes progressive changes Lack neurotransmitter that allows message to pass between nerve cells in the brain Results in death of neurons Frequently occurs in those in their 60s and 70s Cause is unknown and being researched Diagnosis is difficult because there is not a specific test

FULL TIME SUPERVISION IS NECESSARY AT THIS POINT Alzheimer’s Disease Early Stages – self-centered, decreased interest in social activities, memory loss, mood and personality changes, anxiety, agitation, depression, poor judgement Moderate Stages – all of the above AND wandering, frequent mood swings, personal hygiene ignored, confusion, forgetfulness is severe, paranoia, hallucinations FULL TIME SUPERVISION IS NECESSARY AT THIS POINT 3. Terminal Stages – all of the above AND total disorientation to person, place, and time; incoherent, unable to communicate with words, loss of bladder and bowel control, seizures, weight loss, coma, and death

Caring for the Confused or Disoriented Primary concern is safety! Remove dangerous objects (drugs, knives, razors, power tools, cleaning solutions, matches, lighters, etc.) If they tend to wander – doors and windows should be kept secure/locked Follow a routine! Meals, bathing, dressing, walks, and bedtime should occur at the same time every day Keep activities simple and short Calm, quiet environment

Activities to help promote awareness of person, place, and time Reality Orientation Activities to help promote awareness of person, place, and time Important Points: Address them by their name (Ms. Smith, or Mike) State your name and correct them if they call you wrong name Constantly reference day and time (It is 8:00 Tuesday morning and it is time for breakfast) Avoid arguments – instead of saying “you know you aren’t supposed to be here” say “let me show you how to get to your room” Do not argue with incorrect statement – provide correct info, but be gentle and patient