Transcript Confusion, Dementia, and Alzheimer`s Disease

Confusion, Dementia,
and Alzheimer’s Disease
CHAPTER 19
Learning Objectives
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Describe normal changes of aging in the brain
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Discuss confusion and delirium
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Describe dementia and Alzheimer’s disease (AD)
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List strategies for better communication with residents with AD
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Describe interventions for ADLs
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Describe interventions for common difficult behaviors related to AD
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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
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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
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Normal changes of aging in the brain
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Confusion and delirium
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Dementia and AD
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Communication strategies
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ADL interventions
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Difficult behaviors and interventions
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Creative therapies