1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 44 Confusion and Dementia

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  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: Cognitive function involves:  Memory  Thinking  Reasoning  Ability to understand  Judgment  Behavior

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  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 Age-related changes resulting in reduced blood supply to the brain Age-related changes resulting in reduced blood supply to the brain

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  Acute confusion (delirium) occurs suddenly. It is usually temporary. It 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 to improve function. Some measures help to improve function.

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  DEMENTIA  Dementia is the loss of cognitive function that interferes with routine personal, social, and occupational activities.  Dementia is a group of symptoms that may occur with certain diseases or conditions. Dementia is not a normal part of aging. Dementia is not a normal part of aging.

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  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

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  If changes in the brain have not occurred, some dementias can be reversed. Treatable causes include: Treatable causes include:  Drugs and alcohol  Delirium and depression  Tumors  Heart, lung, and blood vessel problems  Head injuries  Infection  Vision and hearing problems

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  Permanent dementias result from changes in the brain. 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.  Pseudodementia means false dementia. The person has signs and symptoms of dementia. The person has signs and symptoms of dementia. There are no changes in the brain. There are no changes in the brain.  This can occur with delirium and depression.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  Delirium is a state of temporary but acute mental confusion. Onset is sudden. Onset is sudden.  It is common in older persons with acute or chronic illnesses. Common causes include: Common causes include:  Infections  Heart and lung diseases  Poor nutrition  Hormone disorders  Hypoglycemia  Alcohol and many drugs Delirium is an emergency Delirium is an emergency  The cause must be found and treated.

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  Depression is the most common mental health problem in older persons. It is often overlooked. It is often overlooked. Depression, aging, and some drug side effects have similar signs and symptoms. Depression, aging, and some drug side effects have similar signs and symptoms.  Mild cognitive impairment (MCI) People with MCI have on-going memory problems but do not have other losses like confusion, attention problems, and difficulty with language. People with MCI have on-going memory problems but do not have other losses like confusion, attention problems, and difficulty with language.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  ALZHEIMER’S DISEASE (AD) IS A BRAIN DISEASE.  Nerve cells that control intellectual and social function are damaged. These functions are affected: These functions are affected:  Memory  Thinking  Reasoning  Judgment  Language  Behavior  Mood  Personality

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  AD is gradual in onset.  It usually occurs after the age of 60. The risk increases with age. The risk increases with age.  The cause is unknown. A family history of AD increases a person’s risk of developing the disease. A family history of AD increases a person’s risk of developing the disease.  The classic sign of AD is gradual loss of short- term memory.

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  Stages of AD Signs and symptoms become more severe as the disease progresses. Signs and symptoms become more severe as the disease progresses.  The disease ends in death. AD is often described in terms of 3 stages. AD is often described in terms of 3 stages. The Alzheimer’s Association describes 7 stages: The Alzheimer’s Association describes 7 stages:  No impairment  Very mild cognitive decline  Mild cognitive decline  Moderate cognitive decline  Moderately severe decline  Severe cognitive decline  Very severe decline

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  These behaviors are common with AD: Wandering Wandering Sundowning (signs, symptoms, and behaviors of AD increase during hours of darkness) Sundowning (signs, symptoms, and behaviors of AD increase during hours of darkness) Hallucinations (seeing, hearing, smelling, or feeling something that is not real) Hallucinations (seeing, hearing, smelling, or feeling something that is not real) Delusions (false beliefs) Delusions (false beliefs) Catastrophic reactions (extreme responses) Catastrophic reactions (extreme responses) Agitation and restlessness Agitation and restlessness Aggression and combativeness Aggression and combativeness Screaming Screaming Abnormal sexual behaviors Abnormal sexual behaviors Repetitive behaviors Repetitive behaviors

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  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. Adult day care may help.  Often assisted living or nursing center care is required.  Sometimes hospital care is needed for other illnesses.  The person and family need your support and understanding.

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  Currently AD has no cure. Symptoms worsen over many years. Symptoms worsen over many years.  The rate varies from person to person. Comfort and safety are important. Comfort and safety are important. Good skin care and alignment prevent skin breakdown and contractures. Good skin care and alignment prevent skin breakdown and contractures. You must treat these persons with dignity and respect. You must treat these persons with dignity and respect. Range-of-motion exercises are important. Range-of-motion exercises are important. The person may need hospice care as death nears. The person may need hospice care as death nears.

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17 The person can have other health problems and injuries. The person can have other health problems and injuries.  The person may not be aware of signs and symptoms. The person cannot fully tend to self-care. The person cannot fully tend to self-care.  Infection is a risk.  Inactivity and immobility can cause pneumonia and pressure ulcers. The person needs to feel useful, worthwhile, and active. The person needs to feel useful, worthwhile, and active.  Therapies and activities focus on the person’s strengths and past successes.

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18  The family Health care is sought when the family cannot deal with the situation or meet the person’s needs. Health care is sought when the family cannot deal with the situation or meet the person’s needs. Home health care may help for a while. Home health care may help for a while. Adult day care is an option. Adult day care is an option. Long-term care is needed when: 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

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 The person’s medical care can drain family finances. The person’s medical care can drain family finances. The family has special needs. The family has special needs. Adult children are in the sandwich generation. Adult children are in the sandwich generation.  They are caught between their own children who need attention and an ill parent who needs care. Caregivers need much support and encouragement. Caregivers need much support and encouragement.  Many join AD support groups. The family often feels hopeless. The family often feels hopeless. The family is an important part of the health team. The family is an important part of the health team.  They need support and understanding from the health team.

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20  Validation therapy may be part of the person’s care plan. 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 agency, you will receive the training needed to use it correctly. If the therapy is used in your agency, you will receive the training needed to use it correctly.