dementia vs. delirium
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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 - PowerPoint PPT PresentationTRANSCRIPT
What’s the difference, and strategies to help the patient and caregiver
DefinitionDelirium
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 componentDementia
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 DementiaAcuteReversibleConsciousness: fluctuatingDecreased awareness of
selfPerceptions: illusions,
hallucinations commonSpeech: slow, incoherentDisorientation: time, othersCognitive dysfunctionIllness, med. toxicity: oftenDiurnal disruptionsOutcome: excellent if
corrected early
GradualIrreversibleConsciousness: rarely
altersDecreased awareness of
selfPerceptions: Hallucinations
not commonSpeech: repetitive difficulty
finding wordsDisorientation: time,
person, placeMemory impairmentIllness, med. toxicity: rarelyDiurnal disruptionsOutcome: poor
DeliriumA medical emergencyTriggered by
Oxygen deprivationDrug use/poisons, medsInfections, recent surgery, or traumaSevere chronic illnessElectrolyte imbalancesPre-morbid brain conditions, and functional statusPreexisting cognitive impairmentOld age/ sensory losses
PreventionRisk factors InterventionCognitive 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
DementiaC Comes on over time, short term
memory loss loss becomes evident May progress slowly or quicklyMay affect younger persons as well as elderly Different kinds of dementiaTreatment generally depends on the stage/
severity of the diseaseBecoming old doesn’t mean you will develop
dementia Is terrifying while the client is still able to
realize that they are not thinking properly
CommunicationIs 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 attentionGain 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 voiceDo not shout!
Do not speak in a condescending tone
Speak slowly
Take care with your use of languageUse 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 questionsUse 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 omitRepeating-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 frequentlyUse 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 touchTouch makes us human and is reassuring
Helps maintain attention during conversation
Can be calming
Learn to be a good listenerListen and watch/ wait for the response
Do not interrupt
Be willing to talk about old times then redirect
Lastly-DON’T ARGUEYou 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?
ReferencesBell, 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.