Confusion And Dementia

Confusion and Dementia By C Spain RMN

Objectives of this workshop.
To understand what is meant by the term “Confusion”.
To understand the difference between confusion and dementia.
To help understand the dementing person.
To look at ways of managing challenging behaviours.

WHAT IS DEMENTIA?
Dementia is a decline in a person’s usual
state of functioning.
This could be physical, mental, social or as is normal a combination of all three.
It is most often seen in persons over the age of 65 but can affect anyone of any age.

There are several forms of Dementia, the most common one being termed, Alzheimer’s disease so we shall concentrate on that one.

Other forms of Dementia include ---
Vascular dementia
Lewy bodies’ dementia
Huntington’s disease
Korsakoffs desease
Jakob-creutzfeldt desease
Aids related dementia
Multiinfact dementia
And others.

DEMENTIA
It is worth bearing in mind that you cannot diagnose correctly between most types of dementia until after death and the brain is looked at in a post mortem.
Because of the high incidents of Alzheimer's most doctors refer to it as a diagnoses of “ A dementia of the Alzheimer's type.”

Dementia.
Dementia develops when the parts of the brain that deal with leaning, memory, decision-making and language are affected by one or more of a variety of infections and/or diseases

Dementia
Most forms of dementia including Alzheimer’s disease are not curable unfortunately.
Not everyone will get dementia but the incidence of it does increase with age

WHO GETS DEMENTIA?

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS
The early signs of dementia are very vague, and may not be immediately obvious.
However common symptoms include.---
Progressive and frequent memory loss.
Confusion.
Personality change.
Apathy and withdrawal.
And the loss of the ability to perform everyday tasks.

SIGNS AND SYMPTOMS
As the disease progresses these symptoms become more and more severe and the person becomes completely “lost”, wander some and unable to attend to any of their basic needs including eating, dressing, washing and toileting.

SIGNS AND SYMPTOMS
They will lose their short term memory , and may become more and more agitated and confused.
The diagnosis is poor as there is no known cure but there are medications to help them deal with the symptoms of dementia.

CAUSES OF DEMENTIA
There are many ideas why dementia happens, but no one knows the real cause.
Ideas include---
Heditory factors
Head injury ie stroke or a bleed
Aluminium ie in the water, Atherstone.
Chromosome as in a gene deficiency
Alcohol as in Korsakoffs
Among others.

PROBLEMS WITH DEMENTIA
Dementia brings many problems and difficulties to both the sufferer and the carer looking after them.
In the early days of the illness the sufferer may have insight and know that some thing is not right with them. They will no doubt be an amount of confusion and short term memory loss this will cause the sufferer to have wandersome behaviour as if they were searching for some thing or some one.

They may show some degree of agitation and delusional thoughts may be evident.
This phase is often referred to as “First stage dementia,” and is some times the most difficult to help with.
We will talk about the stages in dementia later.

As the illness progresses They may lose other functions, such as the ability to eat, drink, use the toilet, wash, dress, mobility issues, to name but a few.
Also they may become depressed, memory and concentration reduces to a minimal amount, and language difficulties emerge either their understanding of other people or making themselves understood to others.

As the brain shuts down, in order to help them make sense of the world around them they may have hallucinations and delusions these can be either visual (more common in Korsakoffs ) or auditory.
They will appear to make up stories for their actions (They may fill in the gaps that their brain has, to try and make sense of the world around them) This is some times referred to as “ Confabulation .”

Some statistics
Less than 100 years ago 4 per cent of the population were aged 65 or over.
Now this figure is 17 per cent or about eight million people.
Why do you think this increase has occurred and what factors have resulted in this increase

Some statistics
Better living conditions, toilets, piped water, electricity, heating and better food provision.
Better health conditions and facilities.
Advances in medication. Antibiotics, less infant deaths.
As a result the demand on health and social services continues to grow.

Some statistics
When the population reaches its peak, it is estimated that there will be about one million people with dementia.
This represents one in ten of over 65’s or one in five of the over 85’s
It is estimated that five per cent of the over 65’s are in care. The remaining 95 per cent are helped by their families.

Confusion
Along with incontinence perhaps the most common problem in the elderly is confusion.
The causes of confusion can be identified in two main areas.
Physiological.
Situational.

Physiological.
The causes are linked with some of the processes of aging. As blood vessels become “furred up” and the walls harden, oxygen and nourishment fail to pass in the required amounts to the brain cells.
These then become starved and die and unlike other tissues, brain tissue does not repair itself.

Physiological.
Therefore the capacity of the brain reduces.
In addition blood vessels that are old develop “faults” and many people have small tiny haemorrhages or bleeds which go unnoticed except that they may create problems with memory, sight, ect.

Physiological.
The process of memory retention is not fully understood, but it is known that deep seated, well established memories are more likely to be retained rather than short term memories.
It is this problem which can cause confusion over their every day life or “changed” environment.

Physiological.
The inability of the person to adapt to new situations and demands stems from this process that makes new ideas difficult to grasp and retain.
This can be worsened by such things as poor hearing, sight problems, depression ect, which makes concentration poor and motivation an effort.

Hearing problems
Hearing or sight difficulties can also contribute to an elderly persons confusion. If they find it difficult to make sense of the world around them, Then they may well act differently than you would expect them to normally.
Best to ensure that any aids are working correctly, as is the body parts concerned.

SITUATIONAL CONFUSION.
Moving into a new, different environment with lots of other people such as a home, hospital ward or another type of institution can bring many problems.
Loss of personal identity.
Forming new relationships.
Loss of individuality.
Loss of independence and new demands on their life styles.

Situational confusion
Probably the most difficult confusion to deal with is that brought on by psychological causes.
If brain damage has occurred and the pathways in the brain cannot compensate. Then the residents level of inability will either remain or increase.

Situational confusion
Ways to help reduce this include----
Try and maintain familiar routines
Offer a sympathetic ear and patience
Try to keep them in touch with reality
Help them to establish their new identity
At all times offer them comfort and listen to their point of view.

Causes of confusion
Drugs---Overdose,
Accumulation of medication
Reaction to the medication
Interaction between medications
Infections---Urinary tract
Chest infection
Fever
Constipation

Causes of confusion
Nutrition---Uncontrolled diabetes
Vitamin deficiency
Too much protein
Electrolyte imbalance
Cardiac problems
Brain tumours

Causes of confusion
Strokes
Anxiety
Phobias
Depression---Don’t forget that the elderly
far to often suffer from
multiple pathologies.
Bereavement or loss

Treatment and management.
Drugs to help increase oxygen delivery to the brain
Focus more on social and emotional needs, rather than physical tasks
Provide an activity programme to help with simulation, maintain their existing skills, enhance their confidance and their self esteem.

Treatment and management.
Reality orientation, in order to reinforce what's going on around them as well as where they are.
A balanced nutritional diet.
Medication review. To ensure that they only take medication that they need.

Dementia.
Senile dementia is a brain disease, sometimes called “brain failure”.
It affects about ten people in one hundred over the age of 65.
Although much less common, it can occur in younger people.
There are several types of dementia, but the main ones are.?

Dementia.
Alzheimer's disease—Which is caused by changes in the nerve cells within the brain.
More and more fail to work properly with a resulting slow decline in mental abilities
AND

Dementia.
Multi-infarct dementia– which is caused by lots of “mini” strokes.
These cut off the blood supply to a small part of the brain causing it to die.
After each “mini stroke” the sufferer will get gradually worse
Men are more likely to be affected with this than women.

The stages of dementia.
There are three stages in dementia and the following lists are –
Not exhaustive.
Dependant on the individual.
The younger a person is at the onset of the disease. Then usually the quicker in will progress from one stage to the next.

Mild dementia.
Becoming forgetful and repeating themselves.
Getting lost in familiar surroundings.
Being upset or irritable when failing to do something.
Having mood or personality changes.
Becoming anxious or apathetic.
Being slower to grasp ideas or to make decisions.

Moderate dementia.
Increasing memory loss and confusion.
Being confused about the time and place.
Forgetting names of family and friends.
Unable to find to right words.
Becoming angry or upset very quickly
Poor personal hygiene.
Living dangerously ie leaving the gas on.

Severe dementia.
Being unable to find their way around.
Being unable to remember what just happened.
Repeating sounds and/or phrases.
Being unable to communicate at all.
Failing to recognise family, friends or even them selves in a mirror.
Needing help with meeting their personal care needs.
Taking clothes off inappropriately.

Communicating and dementia.
Try to keep eye contact when you are speaking or listening. This helps to create a feeling of understanding.
Ensure that if the person has sight or hearing problems , these are helped by the way of hearing aids and/or glasses, which are appropriate and functioning correctly.

Remain calm and still while talking .This shows that you are giving them your attention and are reassuring. Moving around can only cause distraction and the conversation will then be harder to maintain.
Speak slowly and clearly with a low tone of voice
Ensure that there are no disturbing background noises.

Smile, Appear unflustered and relaxed when you approach the person. This will encourage them to feel the same.
Use appropriate body language and gestures to help them understand. But don’t overdo this or it may appear to them that you are treating them as a child.
Sit down next to them, at their level. Don’t tower over them.
Speak in their lingo, speaking at their level of understanding.

When speaking, do use short , simple sentences. Try and deal with one thing at a time.
If the person appears not able to understand you then rephrase the sentence in an other way to help.
Use touch as a method of friendship and reassurance whilst talking to them, for example holding their hand.

At all times show patience and be tactful with them . Although this can be difficult at times, for example, if they keep repeating either their answer or you own question.
Encourage laughter. Humour is a great way of helping to reduce anxiety and getting people together. As well as a good safety valve, for those difficult moments.

Sometimes the person may become verbally abusive for no apparent reason or they may say hurtful things. Try to see this as part of the illness and do not take it personaly. They will probably forget about it ten minutes later.
Be aware that the persons perspective has differed and reality and fantasy can become confused. Be tactful and don’t embarrass them ,Use distraction to try a change the subject.

If the person appears to have difficulty finding a word or finishing a sentence then give then time and be encouraging . Ask them to explaqin in a different way. As a last resort guess at the meaning and ask if you are right
observe their expression,movments and manners in order to better understand what they are trying to say.

As said before affection can help to keep you close , holding the persons hand or giving them a hug are ways of reassuring them and showing them that you do care.
Try to mirror their body language , and sit at an angle of about 33 degrees

FACTS ABOUT DEMENTIA
Dementia describes a broad range of symptoms, such as memory loss, intellect, rationality, social skills and normal emotional reactions.
There are different forms of dementia
There is no cure for most forms of dementia but certain medication can help with the symptoms.

FACTS ABOUT DEMENTIA
About 5-8 per cent of people over the age of 65 have some form of dementia
It is estimated that half of the people in their 80s may suffer from dementia.
The most common type of dementia is Alzheimer’s disease making up about 80 per cent of all dementias.

THANK YOU
C Spain 2007
Thanks to the Alzheimer’s disease society.

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Confusion And Dementia

by chris271154 on Mar 04, 2009

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Confusion And Dementia — Presentation Transcript