Confusion And Dementia

Confusion and Confusion and DementiaDementia

By C Spain RMNBy C Spain RMN

Objectives of this workshop.Objectives of this workshop.

To understand what is meant by the To understand what is meant by the term “Confusion”.term “Confusion”.

To understand the difference To understand the difference between confusion and dementia.between confusion and dementia.

To help understand the dementing To help understand the dementing person.person.

To look at ways of managing To look at ways of managing challenging behaviours.challenging behaviours.

WHAT IS DEMENTIA?WHAT IS DEMENTIA?

Dementia is a decline in a person’s usualDementia is a decline in a person’s usual

state of functioning. state of functioning. This could be physical, mental, social or This could be physical, mental, social or

as is normal a combination of all three.as is normal a combination of all three. It is most often seen in persons over the It is most often seen in persons over the

age of 65 but can affect anyone of any age of 65 but can affect anyone of any age.age.

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

Other forms of Dementia include ---Other forms of Dementia include --- Vascular dementiaVascular dementia Lewy bodies’ dementiaLewy bodies’ dementia Huntington’s diseaseHuntington’s disease Korsakoffs deseaseKorsakoffs desease Jakob-creutzfeldt deseaseJakob-creutzfeldt desease Aids related dementiaAids related dementia Multiinfact dementiaMultiinfact dementia And others.And others.

DEMENTIADEMENTIA

It is worth bearing in mind that you It is worth bearing in mind that you cannot diagnose correctly between cannot diagnose correctly between most types of dementia until after most types of dementia until after death and the brain is looked at in a death and the brain is looked at in a post mortem.post mortem.

Because of the high incidents of Because of the high incidents of Alzheimer's most doctors refer to it Alzheimer's most doctors refer to it as a diagnoses of “as a diagnoses of “A dementia of the A dementia of the Alzheimer's type.” Alzheimer's type.”

Dementia.Dementia.

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

DementiaDementia

Most forms of dementia including Most forms of dementia including Alzheimer’sAlzheimer’s disease are not curable disease are not curable unfortunately.unfortunately.

Not everyone will get dementia but Not everyone will get dementia but the incidence of it does increase with the incidence of it does increase with age age

WHO GETS DEMENTIA?WHO GETS DEMENTIA?

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS


The early signs of dementia are very vague, The early signs of dementia are very vague, and may not be immediately obvious. and may not be immediately obvious.

However common symptoms include.---However common symptoms include.--- Progressive and frequent memory loss.Progressive and frequent memory loss. Confusion.Confusion. Personality change.Personality change. Apathy and withdrawal.Apathy and withdrawal. And the loss of the ability to perform And the loss of the ability to perform

everyday tasks.everyday tasks.


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


They will lose their They will lose their short term short term memorymemory, and may become more and , and may become more and more agitated and confused.more agitated and confused.

The diagnosis is poor as there is no The diagnosis is poor as there is no known cure but there are known cure but there are medications to help them deal with medications to help them deal with the symptoms of dementia. the symptoms of dementia.

CAUSES OF DEMENTIACAUSES OF DEMENTIA

There are many ideas why dementia There are many ideas why dementia happens, but no one knows the real cause.happens, but no one knows the real cause.

Ideas include---Ideas include--- HeditoryHeditory factors factors Head injury ie stroke or a bleedHead injury ie stroke or a bleed Aluminium ie in the water, Atherstone.Aluminium ie in the water, Atherstone. Chromosome Chromosome as in aas in a gene deficiencygene deficiency Alcohol as in KorsakoffsAlcohol as in Korsakoffs Among others.Among others.

PROBLEMS WITH DEMENTIAPROBLEMS WITH DEMENTIA

Dementia brings many problems and Dementia brings many problems and difficulties to both the sufferer and the carer difficulties to both the sufferer and the carer looking after them.looking after them.

In the early days of the illness the sufferer In the early days of the illness the sufferer may have may have insightinsight and know that some thing and know that some thing is not right with them. They will no doubt be is not right with them. They will no doubt be an amount of confusion and short term an amount of confusion and short term memory loss this will cause the sufferer to memory loss this will cause the sufferer to have wandersome behaviour as if they were have wandersome behaviour as if they were searching for some thing or some one.searching for some thing or some one.


They may show some degree of They may show some degree of agitation and agitation and delusionaldelusional thoughts thoughts may be evident.may be evident.

This phase is often referred to as This phase is often referred to as “First stage dementia,” and is some “First stage dementia,” and is some times the most difficult to help with. times the most difficult to help with.

We will talk about the stages in We will talk about the stages in dementia later.dementia later.


As the illness progresses They may lose As the illness progresses They may lose other functions, such as the ability to eat, other functions, such as the ability to eat, drink, use the toilet, wash, dress, mobility drink, use the toilet, wash, dress, mobility issues, to name but a few.issues, to name but a few.

Also they may become depressed, Also they may become depressed, memory and concentration reduces to a memory and concentration reduces to a minimal amount, and language difficulties minimal amount, and language difficulties emerge either their understanding of other emerge either their understanding of other people or making themselves understood people or making themselves understood to others.to others.


As the brain shuts down, in order to help As the brain shuts down, in order to help them make sense of the world around them make sense of the world around them they may have them they may have hallucinations and hallucinations and delusionsdelusions these can be either visual (more these can be either visual (more common in common in KorsakoffsKorsakoffs) or auditory.) or auditory.

They will appear to make up stories for They will appear to make up stories for their actions (They may fill in the gaps that their actions (They may fill in the gaps that their brain has, to try and make sense of their brain has, to try and make sense of the world around them) This is some the world around them) This is some times referred to as “ times referred to as “ ConfabulationConfabulation.”.”

Some statisticsSome statistics

Less than 100 years ago 4 per cent Less than 100 years ago 4 per cent of the population were aged 65 or of the population were aged 65 or over.over.

Now this figure is 17 per cent or Now this figure is 17 per cent or about eight million people.about eight million people.

Why do you think this increase has Why do you think this increase has occurred and what factors have occurred and what factors have resulted in this increase resulted in this increase


Better living conditions, toilets, piped Better living conditions, toilets, piped water, electricity, heating and better water, electricity, heating and better food provision.food provision.

Better health conditions and facilities.Better health conditions and facilities. Advances in medication. Antibiotics, Advances in medication. Antibiotics,

less infant deaths.less infant deaths. As a result the demand on health and As a result the demand on health and

social services continues to grow.social services continues to grow.


When the population reaches its peak, it When the population reaches its peak, it is estimated that there will be about one is estimated that there will be about one million people with dementia.million people with dementia.

This represents one in ten of over 65’s This represents one in ten of over 65’s or one in five of the over 85’sor one in five of the over 85’s

It is estimated that five per cent of the It is estimated that five per cent of the over 65’s are in care. The remaining 95 over 65’s are in care. The remaining 95 per cent are helped by their families.per cent are helped by their families.

ConfusionConfusion

Along with incontinence perhaps the Along with incontinence perhaps the most common problem in the elderly most common problem in the elderly is confusion.is confusion.

The causes of confusion can be The causes of confusion can be identified in two main areas.identified in two main areas.

Physiological.Physiological. Situational.Situational.

Physiological.Physiological.

The causes are linked with some of The causes are linked with some of the processes of aging. As blood the processes of aging. As blood vessels become “furred up” and the vessels become “furred up” and the walls harden, oxygen and walls harden, oxygen and nourishment fail to pass in the nourishment fail to pass in the required amounts to the brain cells.required amounts to the brain cells.

These then become starved and die These then become starved and die and unlike other tissues, brain tissue and unlike other tissues, brain tissue does not repair itself. does not repair itself.


Therefore the capacity of the brain Therefore the capacity of the brain reduces. reduces.

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


The process of memory retention is The process of memory retention is not fully understood, but it is known not fully understood, but it is known that deep seated, well established that deep seated, well established memories are more likely to be memories are more likely to be retained rather than short term retained rather than short term memories.memories.

It is this problem which can cause It is this problem which can cause confusion over their every day life or confusion over their every day life or “changed” environment.“changed” environment.


The inability of the person to adapt to The inability of the person to adapt to new situations and demands stems new situations and demands stems from this process that makes new from this process that makes new ideas difficult to grasp and retain.ideas difficult to grasp and retain.

This can be worsened by such things This can be worsened by such things as poor hearing, sight problems, as poor hearing, sight problems, depression ect, which makes depression ect, which makes concentration poor and motivation an concentration poor and motivation an effort.effort.

Hearing problemsHearing problems Hearing or sight difficulties can also Hearing or sight difficulties can also

contribute to an elderly persons contribute to an elderly persons confusion. If they find it difficult to confusion. If they find it difficult to make sense of the world around make sense of the world around them, Then they may well act them, Then they may well act differently than you would expect differently than you would expect them to normally. them to normally.

Best to ensure that any aids are Best to ensure that any aids are working correctly, as is the body working correctly, as is the body parts concerned.parts concerned.

SITUATIONAL CONFUSION.SITUATIONAL CONFUSION.

Moving into a new, different Moving into a new, different environment with lots of other people environment with lots of other people such as a home, hospital ward or such as a home, hospital ward or another type of institution can bring another type of institution can bring many problems.many problems.

Loss of personal identity.Loss of personal identity. Forming new relationships.Forming new relationships. Loss of individuality.Loss of individuality. Loss of independence and new Loss of independence and new

demands on their life styles.demands on their life styles.

Situational confusionSituational confusion

Probably the most difficult confusion Probably the most difficult confusion to deal with is that brought on by to deal with is that brought on by psychological causes.psychological causes.

If brain damage has occurred and the If brain damage has occurred and the pathways in the brain cannot pathways in the brain cannot compensate. Then the residents compensate. Then the residents level of inability will either remain or level of inability will either remain or increase. increase.

Situational confusionSituational confusion

Ways to help reduce this include----Ways to help reduce this include----

Try and maintain familiar routines Try and maintain familiar routines Offer a sympathetic ear and patienceOffer a sympathetic ear and patience Try to keep them in touch with realityTry to keep them in touch with reality Help them to establish their new Help them to establish their new

identityidentity At all times offer them comfort and At all times offer them comfort and

listen to their point of view.listen to their point of view.

Causes of confusionCauses of confusion Drugs---Overdose,Drugs---Overdose,

Accumulation of medicationAccumulation of medication

Reaction to the medicationReaction to the medication

Interaction between medicationsInteraction between medications

Infections---Urinary tractInfections---Urinary tract

Chest infectionChest infection

FeverFever

ConstipationConstipation

Causes of confusionCauses of confusion

Nutrition---Uncontrolled diabetesNutrition---Uncontrolled diabetes Vitamin deficiencyVitamin deficiency Too much proteinToo much protein Electrolyte imbalanceElectrolyte imbalance

Cardiac problemsCardiac problems

Brain tumoursBrain tumours

Causes of confusionCauses of confusion

StrokesStrokes AnxietyAnxiety PhobiasPhobias Depression---Don’t forget that the Depression---Don’t forget that the

elderlyelderly

far to often suffer fromfar to often suffer from

multiple pathologies.multiple pathologies. Bereavement or loss Bereavement or loss

Treatment and Treatment and management.management.

Drugs to help increase oxygen Drugs to help increase oxygen delivery to the braindelivery to the brain

Focus more on social and emotional Focus more on social and emotional needs, rather than physical tasksneeds, rather than physical tasks

Provide an activity programme to Provide an activity programme to help with simulation, maintain their help with simulation, maintain their existing skills, enhance their existing skills, enhance their confidance and their self esteem.confidance and their self esteem.

Treatment and Treatment and management.management.

Reality orientation, in order to Reality orientation, in order to reinforce what's going on around them reinforce what's going on around them as well as where they are.as well as where they are.

A balanced nutritional diet.A balanced nutritional diet.

Medication review. To ensure that they Medication review. To ensure that they only take medication that they need.only take medication that they need.

Dementia.Dementia.

Senile dementia is a brain disease, Senile dementia is a brain disease, sometimes called “brain failure”.sometimes called “brain failure”.

It affects about ten people in one It affects about ten people in one hundred over the age of 65.hundred over the age of 65.

Although much less common, it can Although much less common, it can occur in younger people.occur in younger people.

There are several types of dementia, There are several types of dementia, but the main ones are.?but the main ones are.?

Dementia.Dementia.

Alzheimer's disease—Which is Alzheimer's disease—Which is caused by changes in the nerve cells caused by changes in the nerve cells within the brain. within the brain.

More and more fail to work properly More and more fail to work properly with a resulting slow decline in with a resulting slow decline in mental abilitiesmental abilities

AND AND

Dementia.Dementia.

Multi-infarct dementia– which is Multi-infarct dementia– which is caused by lots of “mini” strokes.caused by lots of “mini” strokes.

These cut off the blood supply to a These cut off the blood supply to a small part of the brain causing it to small part of the brain causing it to die.die.

After each “mini stroke” the sufferer After each “mini stroke” the sufferer will get gradually worsewill get gradually worse

Men are more likely to be affected Men are more likely to be affected with this than women.with this than women.

The stages of dementia.The stages of dementia.

There are three stages in dementia There are three stages in dementia and the following lists are –and the following lists are –

Not exhaustive.Not exhaustive. Dependant on the individual.Dependant on the individual. The younger a person is at the onset The younger a person is at the onset

of the disease. Then usually the of the disease. Then usually the quicker in will progress from one quicker in will progress from one stage to the next.stage to the next.

Mild dementia.Mild dementia.

Becoming forgetful and repeating Becoming forgetful and repeating themselves.themselves.

Getting lost in familiar surroundings.Getting lost in familiar surroundings. Being upset or irritable when failing to do Being upset or irritable when failing to do

something.something. Having mood or personality changes.Having mood or personality changes. Becoming anxious or apathetic.Becoming anxious or apathetic. Being slower to grasp ideas or to make Being slower to grasp ideas or to make

decisions.decisions.

Moderate dementia.Moderate dementia.

Increasing memory loss and confusion.Increasing memory loss and confusion. Being confused about the time and Being confused about the time and

place.place. Forgetting names of family and friends.Forgetting names of family and friends. Unable to find to right words.Unable to find to right words. Becoming angry or upset very quicklyBecoming angry or upset very quickly Poor personal hygiene.Poor personal hygiene. Living dangerously ie leaving the gas on. Living dangerously ie leaving the gas on.

Severe dementia.Severe dementia.

Being unable to find their way around.Being unable to find their way around. Being unable to remember what just Being unable to remember what just

happened.happened. Repeating sounds and/or phrases.Repeating sounds and/or phrases. Being unable to communicate at all.Being unable to communicate at all. Failing to recognise family, friends or even Failing to recognise family, friends or even

them selves in a mirror.them selves in a mirror. Needing help with meeting their personal Needing help with meeting their personal

care needs.care needs. Taking clothes off inappropriately.Taking clothes off inappropriately.

Communicating and Communicating and dementia.dementia.

Try to keep eye contact when you Try to keep eye contact when you are speaking or listening. This helps are speaking or listening. This helps to create a feeling of understanding.to create a feeling of understanding.

Ensure that if the person has sight or Ensure that if the person has sight or hearing problems , these are helped hearing problems , these are helped by the way of hearing aids and/or by the way of hearing aids and/or glasses, which are appropriate and glasses, which are appropriate and functioning correctly.functioning correctly.

Remain calm and still while Remain calm and still while talking .This shows that you are talking .This shows that you are giving them your attention and are giving them your attention and are reassuring. Moving around can only reassuring. Moving around can only cause distraction and the cause distraction and the conversation will then be harder to conversation will then be harder to maintain.maintain.

Speak slowly and clearly with a low Speak slowly and clearly with a low tone of voicetone of voice

Ensure that there are no disturbing Ensure that there are no disturbing background noises.background noises.

Smile, Appear unflustered and relaxed Smile, Appear unflustered and relaxed when you approach the person. This when you approach the person. This will encourage them to feel the same.will encourage them to feel the same.

Use appropriate body language and Use appropriate body language and gestures to help them understand. gestures to help them understand. But don’t overdo this or it may appear But don’t overdo this or it may appear to them that you are treating them as to them that you are treating them as a child.a child.

Sit down next to them, at their level. Sit down next to them, at their level. Don’t tower over them.Don’t tower over them.

Speak in their lingo, speaking at their Speak in their lingo, speaking at their level of understanding.level of understanding.

When speaking, do use short , simple When speaking, do use short , simple sentences. Try and deal with one sentences. Try and deal with one thing at a time. thing at a time.

If the person appears not able to If the person appears not able to understand you then rephrase the understand you then rephrase the sentence in an other way to help.sentence in an other way to help.

Use touch as a method of friendship Use touch as a method of friendship and reassurance whilst talking to and reassurance whilst talking to them, for example holding their them, for example holding their hand. hand.

At all times show patience and be At all times show patience and be tactful with them . Although this can tactful with them . Although this can be difficult at times, for example, if be difficult at times, for example, if they keep repeating either their they keep repeating either their answer or you own question.answer or you own question.

Encourage laughter. Humour is a Encourage laughter. Humour is a great way of helping to reduce great way of helping to reduce anxiety and getting people together. anxiety and getting people together. As well as a good safety valve, for As well as a good safety valve, for those difficult moments.those difficult moments.

Sometimes the person may become Sometimes the person may become verbally abusive for no apparent reason verbally abusive for no apparent reason or they may say hurtful things. Try to or they may say hurtful things. Try to see this as part of the illness and do not see this as part of the illness and do not take it personaly. They will probably take it personaly. They will probably forget about it ten minutes later.forget about it ten minutes later.

Be aware that the persons perspective Be aware that the persons perspective has differed and reality and fantasy can has differed and reality and fantasy can become confused. Be tactful and don’t become confused. Be tactful and don’t embarrass them ,Use distraction to try embarrass them ,Use distraction to try a change the subject.a change the subject.

If the person appears to have If the person appears to have difficulty finding a word or finishing a difficulty finding a word or finishing a sentence then give then time and be sentence then give then time and be encouraging . Ask them to explaqin encouraging . Ask them to explaqin in a different way. As a last resort in a different way. As a last resort guess at the meaning and ask if you guess at the meaning and ask if you are right are right

observe their expression,movments observe their expression,movments and manners in order to better and manners in order to better understand what they are trying to understand what they are trying to say. say.

As said before affection can help to As said before affection can help to keep you close , holding the persons keep you close , holding the persons hand or giving them a hug are ways hand or giving them a hug are ways of reassuring them and showing of reassuring them and showing them that you do care.them that you do care.

Try to mirror their body language , Try to mirror their body language , and sit at an angle of about 33 and sit at an angle of about 33 degrees degrees

FACTS ABOUT DEMENTIAFACTS ABOUT DEMENTIA

Dementia describes a broad range of Dementia describes a broad range of symptoms, such as memory loss, symptoms, such as memory loss, intellect, rationality, social skills and intellect, rationality, social skills and normal emotional reactions.normal emotional reactions.

There are different forms of dementia There are different forms of dementia There is no cure for most forms of There is no cure for most forms of

dementia but certain medication can dementia but certain medication can help with the symptoms.help with the symptoms.

FACTS ABOUT DEMENTIAFACTS ABOUT DEMENTIA

About 5-8 per cent of people over the About 5-8 per cent of people over the age of 65 have some form of age of 65 have some form of dementiadementia

It is estimated that half of the people It is estimated that half of the people in their 80s may suffer from in their 80s may suffer from dementia.dementia.

The most common type of dementia is The most common type of dementia is Alzheimer’s disease making up about Alzheimer’s disease making up about 80 per cent of all dementias.80 per cent of all dementias.

THANK YOUTHANK YOU

C Spain 2007C Spain 2007

Thanks to the Thanks to the Alzheimer’s Alzheimer’s disease society.disease society.

Date post:	29-Oct-2014
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Confusion And Dementia

Health & Medicine