1. Chapter 39 Confusion and Dementia All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

2. Cognitive Function and Aging   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 function involves:   Memory   Thinking   Reasoning   Ability to understand   Judgment   Behavior 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

3. Confusion   Confusion has many causes.   Diseases and infections   Hearing and vision loss   Medication side effects   Brain injury   With aging, there is reduced blood supply to the brain. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

4. Delirium   Acute confusion (delirium) occurs suddenly and is usually temporary.   Causes include infection, illness, injury, medications, and surgery.   Treatment is aimed at the cause.   Confusion caused by physical changes cannot be cured.   Some measures help improve function. 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

5. Dementia   Dementia is the loss of cognitive function that interferes with routine personal, social, and occupational activities.   Dementia is not a normal part of aging.   Some early warning signs include:   Recent memory loss that affects job skills   Problems with common tasks   Problems with language; forgetting simple words   Getting lost in familiar places   Misplacing things and putting things in odd places   Personality changes   Poor or decreased judgment   Loss of interest in life 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

6. Treatable Causes of Dementia and Permanent Dementia   Treatable causes of dementia include:   Drugs and alcohol   Delirium and depression   Tumors   Heart, lung, and blood vessel problems   Head injuries   Infection   Vision and hearing problems   Permanent dementias result from changes in the brain.   They have no cure.   Alzheimer’s disease is the most common type of permanent dementia. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

7. Pseudodementia   Pseudodementia means false dementia.   The person has signs and symptoms of dementia.   This can occur with delirium and depression.   Delirium and depression can be mistaken for dementia.   Delirium is a state of sudden, severe confusion and rapid brain changes. It is temporary but acute mental confusion.   Delirium signals physical illness in older persons and in those with dementia.   Depression is the most common mental health problem in older persons.   Depression, aging, and some drug side effects have similar signs and symptoms. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

8. Mild Cognitive Impairment   People with mild cognitive impairment (MCI):   Have ongoing problems with memory, language, and other mental functions   Do not have other losses like confusion, attention problems, and difficulty with language   The problems do not interfere with daily life.   May develop Alzheimer’s disease 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

9. Alzheimer’s Disease   Alzheimer’s disease (AD) is a brain disease.   Nerve cells that control intellectual and social function are damaged and die.   The person has: Problems with work and everyday functions Problems with family and social relationships 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. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

10. Stages of Alzheimer’s Disease   AD is often described in terms of three stages: mild, moderate, and severe.   The Alzheimer’s Association describes seven stages:   No impairment   Very mild cognitive decline   Mild cognitive decline   Moderate cognitive decline   Moderately severe decline   Severe cognitive decline   Very severe decline 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

11. Behaviors and Problems   The following behaviors are common with AD:   Getting upset, worried. or angry more easily, acting depressed   Wandering, pacing a lot of the time   Losing interest in things   Sundowning   Hallucinations   Delusions   Catastrophic reactions   Agitation and restlessness   Aggression and combativeness   Abnormal sexual behaviors   Repetitive behaviors   Screaming and communication problems   Rummaging and hiding things, believing others are hiding things 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

12. Behaviors and Problems (Cont’d)   Leaving the center without staff knowledge is called elopement.   With sundowning, signs, symptoms, and behaviors of AD increase during hours of darkness.   A hallucination is seeing, hearing, smelling, or feeling something that is not real.   Delusions are false beliefs.   Paranoia is a disorder of the mind in which the person has false beliefs (delusions) and suspicion about a person or situation. 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

13. Care of Persons with Alzheimer’s Disease 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 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

14. Memory Care Units   Special care units   Many nursing centers have special memory care units for persons with AD and other dementias.   Some units are secured. According to OBRA, secured units are physical restraints. The center must follow OBRA rules. At some point, the person’s condition progresses from stage 2 to stage 3, so the secured unit is no longer needed for safe care. The person is transferred to another unit.   Licensing and accrediting agencies have standards of care for special care units. 14 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

15. The Family as Part of the Health Care Team   Long-term care is needed when:   Family members cannot meet the person’s needs.   The person no longer knows the caregiver.   Family members have health problems.   Money problems occur.   The person’s behavior presents dangers to self and others.   The family is an important part of the health team.   The family has special needs.   Adult children are in the sandwich generation.   Caregivers need much support and encouragement. Many join AD support groups. 15 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

16. Validation Therapy   Validation therapy   The health team decides if validation therapy might help a person.   Validation therapy is based on these principles: All behavior has meaning. Development occurs in a sequence, order, and pattern. If a person does not successfully complete a stage of development, unresolved issues and emotions may surface later in life. A person may return to the past to resolve such issues and emotions. Caregivers need to listen and provide empathy.   If the therapy is used in your center, you will receive the training needed to use it correctly. 16 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

17. Quality of Life   Quality of life is important for all persons with confusion and dementia.   The person has a right to:   Privacy and confidentiality   Personal choice   Keep and use personal items   Be free from abuse, mistreatment, and neglect   Be free from restraints   Activity and a safe setting promote quality of life. 17 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.