1. Confusion and Disorientation in the Elderly
Chapter 10 – Section 4

2. 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

3. 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

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

5. 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

6. Cross Section of brain showing a hemorrhagic stroke

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

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

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

11. 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.

12. 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

13. 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

14. 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

17. 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

18. 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