1. 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)
(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