SUDDEN INCREASE IN CONFUSION IN ALZHEIMER’S PATIENT – IS THAT EVEN POSSIBLE?

Harold came into the skilled nursing facility, admitted from the local hospital. Harold lives at Pleasant Meadows, an assisted living community where he has been independent. The problem arises when the nurse from the skilled facility  calls the nurse from Pleasant Meadows. The Harold that the nurse now describes in not the man the Pleasant Meadows nurse has know for the last 6 month, before he went to the hospital. Harold?  Uncooperative, disoriented, unsteady on his feet, falling, with generalized weakness? No, no the nurse from Pleasant Meadows insists that they (the skilled facility) don’t know what they are doing and don’t know how to take care of Harold.

Sadly this scenario is not unusual, for one healthcare facility to accuse another of not knowing what they are doing. Doesn’t the fact that because Harold already has the diagnosis of Alzheimer’s disease mean that it is understood that he is confused? Yes, Harold is always confused, but this new Harold is in an altered mental state. He was admitted to the hospital with pneumonia. Infections in the elderly many times can cause confusion. This infection caused Harold to experience a rapid decline in his mental functioning and an increase in his confusion.

Sudden increase in confusion can result in very vague symptoms. The family member might say he is “not acting right”, has different behavior, is either more sleepy or more agitated, is extremely distracted,  has recent inappropriate behavior. These sudden changes can come within days or even hours of onset. The great difficulty comes in diagnosing why the individual is suddenly more confused. As well as realizing that it is going to take much more time for the problem to resolve compared to the fast onset.

Harold will continue to have increased confusion even after he has recovered from his pneumonia. And Harold is likely not to return to his previous level of mental functioning.  This infection has tragically caused him to lose some mental clarity  and has resulted in progression of his dementia. Right now Harold needs one on one care, with people who explain the environment and what is going on, as well as protecting him from unsafe activities. All the while giving his mind the time to heal as well as his body.

Yes, it is not only possible for someone with Alzheimer’s disease to suddenly become more confused, it is more than likely when there is an infection involved. A sudden increase in confusion, or delirium continues to be misunderstood.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

ALCOHOL RELATED DEMENTIA – THE DR. JECKEL & MR. HYDE STORY

Howard was a particularly difficult new patient in the dementia unit. Howard was young – only in his mid fifties, strong and very fit at least physically, not mentally.  Howard was easily upset, especially if a staff member told him “No”. And Howard presented us with many opportunities for saying no, as he literally ran through the unit. Having seen other patients like Howard, I asked his wife if Howard had had a drinking problem. She looked very surprise at the question, and yes Howard had been in the habit of drinking daily.

I then asked her if Howard had shown a significant change in personality when drinking, yes he did.  His demeanor changed and she remembered him having almost a “day and night personality change”. Eventually a Dr. Jeckel and Mr. Hyde personality switch was going on. Howard being normally a happy person, when starting to drink would soon become excessively friendly and happy to the point of being obnoxious. He would be very social and then become almost celebratory in his mood. When guest were over frequently jumping into the pool fully clothed.

After a seemingly shorter and shorter time of drinking,  Howard would literally check out, having a flat expression and appearing somewhere else.  His expression would then become very dark and scary while his vocabulary became suggestive and often he was vulgar.

Fortunately  Howard hadn’t been the drinker who becomes immediately angry, aggressive, rage-full and ready to fight. Of the two personality shifts the happy drinker is easier on the family, but maybe makes it harder for them to identify a drinking problem earlier.

So how much is too much, when it comes to drinking? Moderate consumption of alcohol is considered 1-2 drinks a day. A significant history of drinking is 35 or more drinks a week for a man and 28 a week for a woman.  Alcohol is quickly absorbed into the blood stream and goes directly to the neurons in the brain. Alcohol causes an increased release of dopamine in the brain (the pleasure/reward neurotransmitter), and over time you need a larger and larger amount of alcohol to realize the same effect.

When caught early, brain damage due to alcohol can be reversed. Alcoholism is caught too late when long term excessive consumption has been a toxin to the brain, resulting in neurological damage and changes to the brain including brain shrinkage.  Drinking to the point of drunkenness is particularity harmful to the brain.This was Howard’s story, and is he now is at the point where Dr. Jeckel is gone and all that is left of Howard is Mr Hyde.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

IS DEMENTIA THE SAME AS MENTAL ILLNESS?

Mental illness is a broad term for disorders that affect thinking and behaviors. That, at first glance, can sound like dementia. However, there are known causes for many forms of mental illnesses. Also, strong effective treatment programs will include cognitive behavioral therapy, which is not used for persons with dementia.

Mental illnesses range from mood disorders; major depression, anxiety disorders, panic disorders, personality disorders, obsessive-compulsive disorder, to psychiatric disorders; anti-social, narcissistic, schizophrenic, and so many more.  These conditions are traceable to poor parenting practices, childhood trauma, bereavement, unemployment conditions, social stresses including cultural stresses, as well as abuses; drug abuse, cannabis, and alcohol abuse.

Cognitive behavioral therapy involves helping the individual in identifying their distressing thoughts, while seeing how realistic these thought patterns really are. This therapy, stresses working on distorted thinking, and coming up with positive problem solving techniques. Consistently focusing on how valid the person’s thoughts are, as well as examining how useful this thinking is to the individual. Cognitive behavioral therapy when successful will change troubling behaviors.

In order to be successful with this therapy the person has to possess the ability to reason. Loss of reason and judgement are early signs of dementia. As well as loss of the ability to focus, persons with dementia due to Alzheimer’s disease, are very easily distracted.  Persons with dementia, due to Alzheimer’s disease, will have short term and eventually long term memory loss.  Memory loss not a symptom of mental illness.

Above all, despite the changes seen in the individual with a dementing illness, he is not really distressed by his losses. For the most part his frustration is due to misunderstanding the environment and cooping with the loss of communication skills.  In contrast, persons with mental illness are very much distressed by their thoughts and behaviors.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA 101 – DISEASES CAUSING DEMENTIA

Dementia is not a disease, but rather a combination of symptoms that may accompany a disease or physical condition.  These changes or symptoms, begin with memory loss, and slowly progress to the person having difficulty caring for themselves and eventually becoming totally dependent on others. The symptoms must include memory loss and at least one of the following to indicate dementia.

  • Loss of language skills, understanding words, spoken or written as well as the ability to speak coherently.
  • The loss of the ability to recognize objects and eventually people.
  • The loss of the ability to initiate and follow through with motor skills.
  • The loss of reason, judgement, planning and ability to follow through with a plan.

These changes have to be severe enough to interfere with the person’s ability to live independently, to be considered dementia. When the elder suffers only from occasional memory problems, that are not interfering with daily activities, they are considered to have mild cognitive impairment.

Alzheimer’s Disease: is the most common cause of dementia affecting between 50% – 70% of those diagnosed with dementia. By the time a person is 85 years old they will have about a 50% chance of developing Alzheimer’s Disease.

Vascular Dementia: The second leading cause of dementia is experiencing a stroke. This is not a slowly progressing dementia, it progresses as the elder continues to have small strokes causing more damage to the brain.

Lewy Body Dementia:  Named for the round structures, or Lewy bodies found in the brain. This is frequently connected to the person who has, Parkinson’s disease with dementia.

Frontotemporal Dementia: This dementia doesn’t present with memory loss until much later in the disease process. The first signs are personality changes, and lack of empathy for others.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

WHEN DEMENTIA AND CONFUSION AREN’T PERMANENT – SUDDEN DELIRIUM

I receive emails from families who can’t understand what has happened to Mom, Dad, Uncle Charlie and so on. You see this person was just fine a couple of weeks age, driving, shopping, living alone, balancing their check book, and now the doctor says Mom has Alzheimer’s disease and needs to live in a nursing home. What usually happened is that Mom had an infection, an accident, change in medication or surgery and this put Mom into a state of delirium

Synonyms for delirium are; irrational, raving, deranged, and yes even demented. Once the stress is over, the elder returns to their previous state of cognition. But what if Mom is in the hospital when she becomes delirious? The hospital personnel don’t know Mom and  don’t recognize her delirium. Mom will be labelled a confused, demented elder and medicated to keep her under control and “safe.” This will only lead to increased confusion making Mom appear even more confused.

The presence of delirium can indicate that the elder’s brain has a decrease in capacity and may indicate an increased risk of developing dementia. The healthcare community sees delirium frequently with the elderly and infrequently with the young. The same person can have had no history of delirium, even though they have experienced several hospitalizations, yet when they are old, they become confused and disoriented every time they are admitted.

Whenever there is a sudden change in an elder’s ability to think, focus, reason, and remember, look back to whatever stress could have caused the change. The longer the person suffers from delirium, the more chance it will not be resolved.

Remember Alzheimer’s Disease is slow, delirium is fast and doesn’t have to be permanent.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

BUILDING BRAIN HEALTH PROTECTS AGAINST DEMENTIA – DON’T PERFUME YOUR OXYGEN PART III

Whether it is bath soap, air freshener, laundry products, scented candles, or the cologne on the check out clerk at your local grocery, we are surrounded by scented air. While it is law to list ingredients on these products, there is a significant loop-hole. The word “fragrance” in so many products used every day, represents many substances the average person would not consider a pleasant odor. These chemicals masquerading as a fragrance, are for the most part derived from petroleum and coal tar products.  These chemical concoctions are found is products all around us, and are directly related to many health concerns.

These chemical mixtures are protected under a misconception that they are “trade secrets.”  There might have been a time in years gone past that the combination of certain essential oils and flowers were highly protected secrets. However these days, the secret that is being protected, is where these chemicals come from and what they do to human health.

Current research is telling us compared to other senses, the sense of smell is directly connected to brain health. That smells are able to pass the blood brain barrier, that protects the brain from many other forms of attack. These hundreds of fragrances created in laboratories, with many times banned chemicals, are responsible for many disorders. Surrounding ourselves with all of these scents is leading to negative emotions, irritability, brain fog, fatigue, headaches, dizziness, tremors, convulsions, and the list is growing.

There is recently even a new term for that person, who through the use of strong smelling products, intrudes on others. It is “second hand fragrance” similar to second hand smoke. It is when one person makes a decision to use several strong smelling products (shampoo, deodorant, hair spray, perfume, laundry products) and by doing so contaminates the air quality of others. There was a recent report on the news regarding sunscreen products, and they found many people bought a product not on how effective it was for sun protection, but because of the way it smelled.

The elderly as well as the very young are at increased risk for neurological problems connected to fragrances that pass the blood brain barrier. Yet many times the offender is an elderly person who has become so addicted to their fragrance, that they literally no longer smell it.

If you have been guilty of second hand fragrance, do what people did years ago, put a little vanilla extract behind your ears.

Suggested reading: “Get A Whiff of This” by Connie Pitts

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

8 QUESTIONS TO ASK WHEN CAREGIVING FOR THE PERSON WITH DEMENTIA AND DIFFICULT BEHAVIORS

The person with dementia no longer reacts the way they used to, many times resulting in problem behaviors. When you have identified a problem behavior, which can be anything from the elder spitting, to striking out at a caregiver, or even becoming sexually inappropriate, start with identifying exactly what is happening.

8 Steps to understanding difficult behaviors in the person with dementia:

  1. Identify the problem or behavior. Make sure you are clear as to what the problem is, and whose problem is it. In the case of the elder with dementia who spits; it is embarrassing, someone has to clean it up, and many times it is hard to find a caregiver for the elder.
  2. Identify when this behavior occurs. Does this behavior only happen during times of direct care? Such as the elder who strikes out during times of dressing, bathing, or brushing teeth.
  3. Identify how often this behavior happens. Does this behavior only happen occasionally, as during a large holiday get together? Does this behavior happen only later in the day when the elder is tired?
  4. Identify how long the behavior lasts. Is this behavior of short duration, and once the incident is over it is quickly forgotten by the elder?
  5. Identify what is going on in the environment when the behavior happens. Is the environment understandable to the elder? Remember the elder with dementia needs a time of transition between activities. He can no longer just switch from one conversation to another, or do several things at the same time such as eating and watching TV.
  6. Identify who is present when the behavior happens. Does someone present tend to startle or surprise the elder? Does someone seem to not know how to approach the elder? Is someone asking a lot of questions the elder is no longer able to understand? Does someone have expectations of the elder that they are no longer able to meet? Does someone present seem to be critical of the elder.
  7. Identify how intense the behavior is. Is this behavior of such intensity that is scares the elder as well as all who are present?
  8. Identify if there is more than one thing contributing to the problem. Especially if the elder has been having trouble sleeping and may be suffering from sleep deprivation. If the elder’s behavior becomes more difficult in the late afternoon, see if the elder has an problem with oxygen deprivation. Many elders who are more agitated later in the day may benefit from a sleep study.

Finding out what happened right before, or what is happening during the behavior, is of the most importance, when care giving for the person with dementia.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

BUILDING BRAIN HEALTH PROTECTS AGAINST DEMENTIA – BY INCREASING OXYGEN – PART II

Blood is the transport system of oxygen to the brain. The brain uses three times the amount of oxygen as the muscles. An oxygen rich, blood supply, is very important to brain function. Known ways to improve in-door air quality and oxygen levels, are surprisingly simple.

Start with opening a window. Even sleeping with a window slightly cracked will increase the quality of the air in a bedroom. Bedroom are loaded with carpeting and fabrics know to have toxic chemicals. These chemicals can cause headaches, eye and nose irritation, as well as skin problems. Any allergic reaction will cause inflammation, possibly reducing quality air exchange, between heart, lungs and brain.

But more proven ways to improve air quality, come from straight from NASA. The NASA study tells us what plants produce the most oxygen and remove what chemicals. Opposite of us, plants take in carbon dioxide and give off oxygen. NASA recommends easily found houseplants, that are shown to be effective at removing toxic substances in the air, like formaldehyde, benzene and trichloethylene, while giving us increased levels of oxygen.

Especially sleeping in a room with increased levels of oxygen and reduction in toxic air quality, can help the person with dementia, avoid periods of agitation related to low oxygen levels. More than the general population, the person with dementia needs special brain support and increased oxygen provides that.

While searching for great oxygen producing, air cleaning plants be aware that many houseplants are toxic to children, pets and the elderly with dementia. The person with dementia will benefit greatly from increased oxygen to the brain, but needs to be protected from ingesting anything toxic. Even if the confused person has never attempted to ingest a non-food item, a person with dementia has that potential.

NASA recommended plants that are non-toxic include: dwarf date palm, areca palm, boston fern, kimberly queen fern, lily turf, spider plant, bamboo palm, broadleaf lady palm, barberton daisy, rubber plant and banana plant. While these plants are actually taking in carbon dioxide and producing oxygen, they are also adjusting the humidity in your home.

Due to the fact that houseplants are subtropical they do well inside with low light levels. The NASA study suggests one plant for every 100 square foot of living space. Some of these plants, (even with minimal attention) will grow to a very large, even ceiling height, providing even more improved air return.

When visiting a large greenhouse you will frequently hear comments about how much easier it is to breath in the greenhouse. There are also known psychological benefits for the person with dementia, when living in an environment with a large amount of plants.  The color green is known to be calming and also to help with memory. More oxygen to help the brain function, a pretty, calming color green and helping with memory. Plants, thank you NASA, what a good deal.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

BUILDING BRAIN HEALTH PROTECTS AGAINST DEMENTIA – PART I

There is an often repeated saying in healthcare, “what is good for the heart is good for the brain.” And I might add vise-versa, what is good for the brain is also good for the heart. So what is the heart brain connection, blood supply and oxygen.

The brain has 100 billion cells, which is also the number of stars in the galaxy. All of those cells need to be constantly fed, requiring a constant blood supply to keep up the metabolic demands. At all times over 20% of the blood in the body is located in the brain. That blood supply always needs to be highly oxygenated. Loss of oxygen for even 8-10 minutes can result in brain damage.

What is good for the heart and brain:

  • a oxygen rich environment
  • highly nutritious diet and hydration
  • low stress life style

We know that when a person has been diagnosed with dementia, they have already lost brain cells. Brain cells will die due to disease and poor life style choices. Smoking will not only suffocate the lungs but reduce that brain sustaining oxygen supply. Bad dietary choices create inflammation and are now proven to be as harmful as smoking.

This complex organ, the brain, is only 3-4 pounds depending on the size of the individual, about the size of a cantaloupe. When a baby is born they already have their 100 billion cells, what they don’t have is the connections between the cells. And those trillions of cell connections we call learning. To support that development, and even to survive, the brain needs the nutrients and oxygen from the heart.

The blood supply to the brain is so important that when the body experiences a reduction in oxygen it will automatically redirect blood to the brain. Increasing the blood supply even two times the normal volume.

Improving the supply of oxygen and nutrition to the heart and brain, can be accomplished day by day, meal by meal, through life style changes. Start by opening a window.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

 

EXERCISE LIKE YOU ARE IN GRADE SCHOOL AND YOU WILL HAVE BETTER BRAIN FUNCTION

Remember when you were in grade school and you went out for recess three times a day? Well research now tells us that having those short bursts of exercise will support brain health. Over 25% of the oxygen in your body is in the brain. Increasing the percent of oxygen to the brain increases alertness, supports increased focus, is calming, and will even regulate behaviors.

When children are going out for recess, people will frequently say, “Its good for them, gives them a chance to run off their energy.” What those children are really doing, instead of running something off, they are taking in more oxygen through exercise. All the while improving their oxygen supply to the brain. Short bursts of exercise have been shown to be beneficial for brain function in all age groups. Everyone is able to benefit from increased oxygen through exercise.

There are very positive effects to periodic physical activity.  Short bursts of exercise have been shown to especially bring more oxygen to the frontal areas of the brain. Increasing oxygen to the frontal lobe of the brain helps with increased self control and emotional control. The ability to self regulate behavior is important whether in a social, academic, or religious setting, as well as just sitting on the couch at home.

Finding those opportunities for oxygen promoting exercise throughout the day are so necessary. Whether just stepping outside for a quick walk around the parking lot at work, opening a window while you vacuum for 15 minutes,  or popping in a short exercise video, whatever, call it your “recess.”

For the student studying, the restless child on a long car trip, or the elderly person with dementia who is getting agitated. Everyone it seems can benefit from a regular recess.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing