Dementia vs. Delirium What’s the difference, and strategies to help the patient and caregiver
Definition • Delirium • Disturbance of consciousness with reduced ability to focus, sustain, or shift attention • A change in cognition, a perceptual disturbance not accounted for by preexisting, established or evolving dementia • Occurs over a short time period and fluctuates during the day • Has a causal component • Dementia • Chronic acquired decline in memory and at least on other cognitive function • Decline usually evident over longer periods with mild to severe cognitive decline, hallucinations, and delusions
Delirium vs. Dementia Delirium Dementia • Acute • Reversible • Consciousness: fluctuating • Decreased awareness of self • Perceptions: illusions, hallucinations common • Speech: slow, incoherent • Disorientation: time, others • Cognitive dysfunction • Illness, med. toxicity: often • Diurnal disruptions • Outcome: excellent if corrected early • Gradual • Irreversible • Consciousness: rarely alters • Decreased awareness of self • Perceptions: Hallucinations not common • Speech: repetitive difficulty finding words • Disorientation: time, person, place • Memory impairment • Illness, med. toxicity: rarely • Diurnal disruptions • Outcome: poor
Delirium • A medical emergency • Triggered by • Oxygen deprivation • Drug use/poisons, meds • Infections, recent surgery, or trauma • Severe chronic illness • Electrolyte imbalances • Pre-morbid brain conditions, and functional status • Preexisting cognitive impairment • Old age/ sensory losses
Prevention Risk factors Intervention • Cognitive impairment • Dehydration/electrolyte imbalance • Sensory deprivation/ sleep disturbances • Pharmacy • Routine mental status assessment, staff education • I&O, skin assessment, early recognition • Non pharmacologic sleep aids, decreased noise and light at night, frequent rest periods, daytime activities • Staff education of medication side effects, pharmacy liaison, start low go slow
Dementia • C Comes on over time, short term memory loss loss becomes evident • May progress slowly or quickly • May affect younger persons as well as elderly • Different kinds of dementia • Treatment generally depends on the stage/ severity of the disease • Becoming old doesn’t mean you will develop dementia • Is terrifying while the client is still able to realize that they are not thinking properly
Communication • Is often what relationships are built on • When communication becomes faulty our relationships crumble • Our communication strategies can help anolder adult with advancingdementia feel safe, lessanxious, and less likely to become upset or aggressive
Getting their attention • Gain the persons attention • Turn off extraneous noise • Stand in front of the person and maintain eye contact • Go slow, direct and redirect their attention
Be aware of your tone of voice • Do not shout! • Do not speak in a condescending tone • Speak slowly
Take care with your use of language • Use adult language • Concrete simple language, short phrases • Be positive and reassuring • Don’t talk about the person as if they weren’t there
Try yes or no questions • Use 2 choice questions like do you want juice or soda? • Are you hungry? • Are you tired? • Can I read to you?
Repeat rephrase and repair: • This is a difficult strategy but is helpful to maintain conversation and helps fill in the missing information the person with dementia may omit • Repeating-helps fill in speech Ex: I want a cup of…. If you repeat this the elder may add the word coffee, water or juice • Rephrasing- helps the person hear the corrected response if they say juice you might point to a juice container and say I want a glass of juice • Repairing-uses both tactics to fix or fill in missing information for example a person points at a pantry cabinet and says, “look there.”, you might say, “your Hungry?”
Orient and reorient frequently • Use visual aids • Make sure they have hearing aids or glasses if they need them • Calendars and message boards • Keep them up to date, make sure they are easy to locate • Orient the person with your language
Use touch • Touch makes us human and is reassuring • Helps maintain attention during conversation • Can be calming
Learn to be a good listener • Listen and watch/ wait for the response • Do not interrupt • Be willing to talk about old times then redirect
Lastly-DON’T ARGUE • You won’t win • The person with dementia is not trying to be disagreeablethey are usually unaware that they are making mistakes • If the person is in immediate danger then correcting the thought or behavior might be appropriate. If not- • DON”T ARGUE you will only cause frustration, fear and anger so what’s the point?
References • Bell, L. (November, 2011). AACN practice alert: Delirium assessment and management. American Association of Critical Care Nurses. • Cason-McNeeley, D. (2004). Delirium the Mistaken Confusion. PESI Healthcare, Eau Claire, Wisconsin • Galik, E. M., Sparks, M., Spurlock, W. (2008). Effective communication and behavior management strategies in the care and treatment of Alzheimer’s disease. Counseling Points, 1(2). • Kohler, S. (2004). How to Communicate with Alzheimer’s. Granny’s Rocker Publishing, Venice, CA.