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Confusion, Dementia, and Alzheimer’s Disease CHAPTER 19 Learning Objectives • Describe normal changes of aging in the brain • Discuss confusion and delirium • Describe dementia and Alzheimer’s disease (AD) • List strategies for better communication with residents with AD • Describe interventions for ADLs • Describe interventions for common difficult behaviors related to AD • Describe creative therapies for residents with AD Cognition, Confusion & Delirium Cognition • Ability to think logically and clearly Cognitive Impairment • Loss of ability to think logically • Concentration and memory are affected Normal Age-Related Changes • Loss of some ability to think logically and clearly • Loss of memory of recent events • Slower reaction time • Hard to find the right word Confusion Inability to think clearly Temporary OR permanent with gradual OR sudden onset Causes include UTI, low blood sugar, head trauma, dehydration, fever, lack of oxygen, medications, or illnesses Delirium State of severe confusion Usually temporary with sudden onset Causes include infections, disease, fluid imbalance, drugs, alcohol, or poor nutrition Dementia & Alzheimer’s Disease (AD) Dementia Alzheimer’s Disease (AD) • Serious loss of mental abilities • NOT a normal part of aging • Progressive, incurable disease that causes tangled nerve fibers and protein deposits to form in the brain • NOT a normal part of aging Communication Strategies when working with patients with AD General Frightened or anxious Forgets or shows memory loss Trouble finding words •Front approach •Reduce noise/distraction •Identify yourself/use their name •Speak slow, in a low tone •Break complex tasks into simpler ones •Keep them calm •Speak in low, calm voice •Describe what you are doing •Use simple words/short sentences •Check their body language •Repeat yourself •Use a different word if they don’t understand one •Simple messages and tasks •Answer questions each time they are asked •Suggest a word that sounds correct •Do NOT correct a resident who uses an incorrect word Paranoid or accusing Wants to do something unsafe Wants to talk, but can’t Not understanding basics •Don’t take it personally •Redirect or ignore •Limit the times you say “don’t” •Redirect •Encourage them to point, gesture or act it out •Offer comfort with a smile •Ask them to repeat your words •Watch for nonverbal and body language •Use short words, signs, pictures •Simple steps for tasks Depressed or lonely Repeatedly asks to “go home” Verbally abusive Loss of verbal skills •One-on-one time •Listen •Involve them in activities •Report depression to the nurse •Remind them they are home •Do NOT argue •Redirect •Expect the questions to continue •Remain patient and gentle •It is the disease, not the person •Try to ignore and redirect •Use nonverbal skills (touch, smiles, laughter) •Use signs, labels and gestures •Assume they understand more than they can express • Prevent infections • Observe and report potential problems • Watch for signs of pain • Maintain daily exercise routines Mental/Emotional Health • Consistent meal times • Familiar foods • Minimize noise • Do NOT serve steaming or very hot foods/drinks • Simple place setting • Verbal cues • Adaptive equipment • Encourage socialization • Observe for any issues Physical Health • Mark the bathroom with a sign or picture • Encourage fluids • Check them every 30 minutes • Observe toilet patterns – take before and after meals • Be professional Eating • Avoid delays or interruptions • Encourage them to pick out clothes to wear • Lay their clothes out in order • Do NOT rush • Use a friendly/calm voice Toileting/Incontinence • Schedule when least agitated • Well-lit and comfortable temperature • Privacy • Be calm and quiet • Ensure safety • Promote selfcare Grooming/Dressing Bathing ADL Interventions • Encourage independence • Offer enjoyable activities • Reward positive and independent behavior with smiles, hugs and warm touches Interventions for Difficult Behaviors Agitation • Remove triggers • Keep routines • Familiar activities • Remain calm Sundowning • • • • • • • • Remove triggers Avoid stress Play soft music Set a bedtime routine and keep it Plan a calming activity Remove caffeine Distraction Encourage daily exercise Violent Behaviors • Block blows • NEVER hit back • Step out of reach • Call for help • Do NOT leave the resident alone • Remove triggers • Use calming techniques Hallucinations & Delusions Inappropriate Sexual Behavior Pillaging & Hoarding • Ignore if they are harmless • Reassure if they are upset or worried • Do NOT argue • Stay calm • Be sensitive • Direct them to a private area • Distract them • Consider other ways to provide physical stimulation • Do NOT reprimand them • Provide a rummage drawer • Do NOT tell others the resident is stealing • Ask family to report unfamiliar items Creative Therapies Reality Orientation • Uses calendars, clocks, signs, lists • Useful in the early stages of AD – it may frustrate residents in later stages of AD Validation Therapy • Lets residents believe they live in the past or in imaginary circumstances; can give comfort and reduce agitation • Useful in cases of moderate to severe disorientation Reminiscence Therapy • Encourages residents to remember and talk about the past; focus on a time in life that was pleasant • Useful in many stages of AD, but especially with moderate to severe confusion Activity Therapy • Uses activities residents enjoy to prevent boredom and frustration; promotes self-esteem • Useful in most stages of AD Review • Normal changes of aging in the brain • Confusion and delirium • Dementia and AD • Communication strategies • ADL interventions • Difficult behaviors and interventions • Creative therapies
