Dementia, Depression, and Delirium in Aging There are approximately 5.1 million Americans 65 years and older with dementia. 1 in 8 persons 65 and over and nearly 50% of all persons over the age of 85 have some type of dementia. It is the sixth leading cause of death in the United States and the third most expensive disease after cardiovascular disease and cancer. CAM Screen for Delirium (Confusion Assessment Method) 1 + 2 + (3 or 4) 1=Acute Onset & Fluctuating course PLUS 2 = Inattention AND EITHER 3 = Disorganized Thinking OR 4 = Altered LOC (Most Common = HYPOACTIVE Form) Inouye et al. Ann Intern Med 1990 . Diagnostic Approach Pt Admitted with Known or Suspected Dementia CAM Identify Underlying Cause of Delirium and Treat No Delirium PHQ2 (If Possible) Mini-Cog IF AT ANY TIME PATIENT REQUIRES PHYSICAL RESTRAINTS, DOCUMENT IN CHART REASON WHY AND NOTIFY FAMILY Discuss Dementia with Family Evaluation & Diagnosis Prognosis Associated Behavioral Symptoms Safety Issues Community Resources No Action Equivocal or Inconsistent with Depression Consistent with Depression Treat Depression or Discuss Options Not Impaired Impaired Schedule Family Meeting Normal Abnormal Re-Evaluate After Treatment PHQ-2 Screen for Depression Over the past two weeks, how often have you been bothered by any of the following problems? Little interest or pleasure in doing things. 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day Feeling down, depressed, or hopeless. Total point score: ______________ Thibault JM, Prasaad Steiner, RW. (2004). “Efficient identification of adults with depression and dementia.” American Family Physician (70):6. Feil, D.G., et al. (2007) Quality Indicators for the Care of Dementia in Vulnerable Elders. JAGS(55): S293-S301. National Alzheimer’s Association 2009 Facts and Figures Aging Q3 is funded by the D.W. Reynolds Foundation