SUDDEN INCREASED DEMENTIA CAUSED BY INFECTION

Her mom was diagnosed with mild dementia, but now she has significantly increased dementia. And it has happened so suddenly. From being able to walk independently around her neighborhood, handling her own finances and even helping with her granddaughter. To suddenly not only was all of that gone, but now she is unable to speak, only babbling incoherent sentences. Mom is now total care with all of her needs from dressing to toileting and eating.

The first sentence she wrote me said it all, Mom is 88 years old and has had a urinary infection. At her advanced age, and with already a diagnosis of mild dementia, it is no surprise that she has had an increase in her dementia since being sick. The urinary tract infection was resistant to several antibiotics and after the 5th try her blood still shows a low grade infection.

Once the elderly person has a decline in cognitive function due to infection, the person even after the infection is resolved never returns to their previous level of function. And this mom just hasn’t recovered from the infection.

Preventing a infection is the only sure defense against this type of sudden increase in dementia. Taking advantage of the things we know that prevent infection. Taking a oral probiotic daily, especially something fermented such as sauerkraut. Taking a vitamin D supplement as well as an Oregano capsule. We have all now seen the chicken commercials from Perdue where they tell how they have moved away from antibiotics in their chickens water by the addition of Oregano.  So the elderly can also benefit not only from a little chicken soup but the Oregano that is keeping the chickens healthy.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

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REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA Part III

As stated in Part I of this series on Sudden Dementia, the key here is to have the diagnosis, of delirium. Once the patient has the diagnosis, the nursing home is mandated by Medicare to investigate all of the previously mentioned  probable causes. The nurse or nursing assistant may be very concerned, and listen to the story of how rapid this change came over this patient, but there will be little follow though with this information. Only physicians, and nurse practitioners are able to write a diagnosis,and the delirium diagnosis is what drives the investigation.

As well as the previously mentioned possible causes in part I and part II, there will be attention given to the circulatory system, the respiratory system and metabolism. Circulatory – did the patient possibly have a stroke, are they in congestive heart failure, have they had a heart attack, or are they possibly suffering from severe anemia?  Respiratory – does the patient have asthma, emphysema, or is in respiratory failure? Lack of oxygen to the brain caused by a circulatory or respiratory condition can cause confusion.

Does the patient have a metabolic problem – diabetes, or thyroid disease? Anyone familiar with and experiencing these disease processes knows how they can impact so many other areas of the patient’s health. Ruling out these very significant  disease states is extremely important.

The center for Medicare Services has created this special focus for delirium showing how seriously this condition is viewed. When a patient in a nursing home, covered by Medicare, the patient’s power of attorney for healthcare is able to ask to see the patient’s diagnosis. Reviewing the diagnoses and making sure that someone who doesn’t know the patient’s history has called this sudden confusion, Alzheimer’s disease, is very important. Once the patient has the diagnosis of Alzheimer’s , the healthcare community finds no need to look any further.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA Part II

The Center for Medicare requires healthcare professionals to investigate causes and reasons for sudden dementia including these changes:

SIGNS OF POSSIBLE DEHYDRATION

  • recent decrease in volume of urine, more concentrated urine or a darker color
  • recent decrease in eating habits, skipping meals, leaving food uneaten, weight loss
  • nausea, vomiting, diarrhea, or blood loss
  • receiving IV drugs
  • receiving diuretics or drugs that might cause electrolyte imbalance

FUNCTIONAL DECLINE

  • falls or increased risk for falls
  • recent decline in the ability for self-care in hygiene, dressing, walking, eating, etc.

MEDICATION REVIEW

This area requires the services of the pharmacist. A medication review would first focus on new or recent medications and possible interactions with other medications the patient is taking. All narcotics need to be investigated, the elderly may become unreasonable, angry, or argumentative on narcotic medications. All behaviors that are different for the patient since beginning a new medication must be explored. Especially so for any drugs used to change or modify  behaviors such as anti-anxiety, antidepressants, sleep medications and of course anti-psychotic medications.

SOCIAL CHANGES

  • social withdrawal – recent loss of a family member or friend
  • recent changes in mood – crying or anxious\
  • a recent move – out of state or from home to facility

UNUSUAL BEHAVIORS

  • recent change in sleep habits, sleeplessness at night and sleeping during the day – nightmares
  • unusual, inappropriate or unsafe movements
  • hyper-active or hypo-active, a recent change to the extreme in a person’s level of activity

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA – Part I

The increase number of people experiencing sudden dementia has caused delirium to be a focus of Medicare. As with everything else the way to capture attention is to create a monetary connection. In this case, Medicare reimbursement for sudden dementia is tied to identifying the cause of the patient’s delirium. The list of possible reasons, is to be a guide for consideration for every patient on Medicare with sudden dementia or delirium. Or any person admitted to a nursing facility who has sudden dementia as a diagnosis.

The basic physical changes that can cause a person to become delirious:

CHANGES IN VITAL SIGNS – COMPARED TO BASELINE (baseline, you always want to compare with what is usual)

  •  elevated temperature – 2.4 degrees higher than baseline
  • pulse rate less than 60 or higher than 100 beats per minute
  • breathing slower than 16 breaths a minute or higher than 25
  • a significant drop in blood pressure compared to baseline
  • a significant increase in blood pressure compared to baseline

ABNORMAL LABORATORY VALUES

  • electrolytes
  • kidney function
  • liver function
  • blood sugar
  • thyroid function
  • arterial blood gases (this is blood tested from an artery instead of a vein to check the ph of the blood as well as to see how well the lungs are moving oxygen into the blood and removing carbon dioxide out of the blood)

PAIN

  • how often is the pain, how intense, how long does it last, what is the quality of the pain?
  • how is the pain affecting the patient’s ability to function?

A complete pain assessment must be conducted at this time.

SIGNS OF INFECTION

  • fever
  • cloudy or foul smelling urine
  • congested lungs or cough
  • shortness of breath – or painful breathing
  • diarrhea
  • abdominal pain
  • wound draining pus
  • any redness around an incision or wound

Some of these symptoms may be present but if there isn’t a good reason for something such as a slow pulse –  that is related to a medication the patient is on, then this symptom must be considered as a cause for the sudden dementia, and investigated further.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

SUDDEN CONFUSION – CAN THE PERSON WITH DEMENTIA GET DELIRIUM?

Many people, including those in healthcare use the terms dementia and delirium interchangeably. Even tho they are not the same, patients can have both conditions at the same time. A person with dementia can certainly develop delirium, they are even more inclined under certain circumstances, to develop delirium.

The person with several disease processes as well as dementia, will be the person at most risk for developing delirium. Research has shown that the person with dementia has a lower mental reserve and less ability to adjust to a physical assault. That assault can come in the form of an infection such as a urinary infection or upper respiratory infection. Because the person is more vulnerable due to their dementia, they can under these circumstances develop delirium.

Other factors creating an increased likely hood of developing delirium are advanced age, history of alcohol abuse, poor nutrition, poor physical function, poor vision, hearing loss, dehydration, congestive heart failure, extreme pain (such as that related to a fracture), and many medications especially narcotics. Many times the cause of the delirium will not be found.

When the person is admitted to the hospital they are at increased risk to develop delirium if they have dementia. Due to the nature of the running of a hospital, the confused person may have physical restraints to keep them safe if they are trying to get out of bed unassisted. The elderly who are incontinent may now have a catheter for the purpose of obtaining urine specimens as well as easier care considerations. These possibilities as well as the likelihood of the elder now having an increased number of medications can result in an increased risk of developing delirium.

In the United States, hospital emergency rooms are currently seeing approximately 18 million patients 65 years and older. As the population ages, the number of visits to the emergency room by the elderly will increase dramatically as well. The potential for large numbers of the elderly population going to the emergency room for sudden confusion and developing confusion when admitted to the hospital is increasing. All of this adds up to an expectation of  not only the increase in elderly persons with dementia but also the increase in cases of delirium.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing