1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 37 Confusion and Dementia

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Changes in the brain and nervous system occur with aging.  Certain diseases affect the brain.  Changes in the brain can affect cognitive function. Cognitive relates to knowledge. Cognitive relates to knowledge.  Cognitive function involves: Memory Memory Thinking Thinking Reasoning Reasoning Ability to understand Ability to understand Judgment Judgment Behavior Behavior

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  CONFUSION  Confusion has many causes. Diseases and infections Diseases and infections Hearing and vision loss Hearing and vision loss Drug side effects Drug side effects Brain injury Brain injury With aging, there is reduced blood supply to the brain. With aging, there is reduced blood supply to the brain.

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Acute confusion (delirium) occurs suddenly and is usually temporary. Causes include infection, illness, injury, drugs, and surgery. Causes include infection, illness, injury, drugs, and surgery. Treatment is aimed at the cause. Treatment is aimed at the cause.  Confusion caused by physical changes cannot be cured. Some measures help improve function. Some measures help improve function.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  DEMENTIA  Dementia is not a normal part of aging.  Some early warning signs include: Recent memory loss that affects job skills Recent memory loss that affects job skills Problems with common tasks Problems with common tasks Problems with language; forgetting simple words Problems with language; forgetting simple words Getting lost in familiar places Getting lost in familiar places Misplacing things and putting things in odd places Misplacing things and putting things in odd places Personality changes Personality changes Poor or decreased judgment Poor or decreased judgment Loss of interest in life Loss of interest in life

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Treatable causes of dementia include: Drugs and alcohol Drugs and alcohol Delirium and depression Delirium and depression Tumors Tumors Heart, lung, and blood vessel problems Heart, lung, and blood vessel problems Head injuries Head injuries Infection Infection Vision and hearing problems Vision and hearing problems  Permanent dementias result from changes in the brain. They have no cure. They have no cure. Alzheimer’s disease is the most common type of permanent dementia. Alzheimer’s disease is the most common type of permanent dementia.

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Pseudodementia means false dementia. The person has signs and symptoms of dementia. The person has signs and symptoms of dementia. This can occur with delirium and depression. This can occur with delirium and depression.  Delirium and depression can be mistaken for dementia. Delirium is a state of temporary but acute mental confusion. Delirium is a state of temporary but acute mental confusion. Delirium signals physical illness in older persons and in persons with dementia. Delirium signals physical illness in older persons and in persons with dementia. Depression is the most common mental health problem in older persons. Depression is the most common mental health problem in older persons. Depression, aging, and some drug side effects have similar signs and symptoms. Depression, aging, and some drug side effects have similar signs and symptoms.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  People with mild cognitive impairment (MCI): Have ongoing memory problems Have ongoing memory problems Do not have other losses like confusion, attention problems, and difficulty with language Do not have other losses like confusion, attention problems, and difficulty with language May develop Alzheimer’s disease May develop Alzheimer’s disease

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  ALZHEIMER’S DISEASE (AD) IS A BRAIN DISEASE  Nerve cells that control intellectual and social function are damaged.  The person has: Problems with work and everyday functions Problems with work and everyday functions Problems with family and social relationships Problems with family and social relationships A steady decline in memory and mental function A steady decline in memory and mental function  The disease is gradual in onset.  AD usually occurs after the age of 60.  The cause is unknown.  The classic sign of AD is gradual loss of short- term memory.

10. Slide 10 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  AD is often described in terms of 3 stages.  The Alzheimer’s Association describes seven stages: No impairment No impairment Very mild cognitive decline Very mild cognitive decline Mild cognitive decline Mild cognitive decline Moderate cognitive decline Moderate cognitive decline Moderately severe decline Moderately severe decline Severe cognitive decline Severe cognitive decline Very severe decline Very severe decline

11. Slide 11 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The following behaviors are common with AD: Wandering Wandering Sundowning Sundowning Hallucinations Hallucinations Delusions Delusions Catastrophic reactions Catastrophic reactions Agitation and restlessness Agitation and restlessness Aggression and combativeness Aggression and combativeness Screaming Screaming Abnormal sexual behaviors Abnormal sexual behaviors Repetitive behaviors Repetitive behaviors

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  CARE OF PERSONS WITH AD AND OTHER DEMENTIAS  Usually the person is cared for at home until symptoms are severe.  Adult day care may help.  Assisted living or nursing center care may be required.  Sometimes hospital care is needed.  The person and family need your support and understanding.  Currently, AD has no cure.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Special care units Many nursing centers have special units for persons with AD and other dementias. Many nursing centers have special units for persons with AD and other dementias. Some units are secured. Some units are secured.  According to OBRA, secured units are physical restraints.  The center must follow OBRA rules. Licensing and accrediting agencies have standards of care for special care units. Licensing and accrediting agencies have standards of care for special care units.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Long-term care is needed when: Family members cannot meet the person’s needs Family members cannot meet the person’s needs The person no longer knows the caregiver The person no longer knows the caregiver Family members have health problems Family members have health problems Money problems occur Money problems occur The person’s behavior presents dangers to self and others The person’s behavior presents dangers to self and others  The family is an important part of the health team.  Validation therapy The health team decides if validation therapy might help a person. The health team decides if validation therapy might help a person. If the therapy is used in your center, you will receive the training needed to use it correctly. If the therapy is used in your center, you will receive the training needed to use it correctly.

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  Quality of life is important for all persons with confusion and dementia.