FAST ONSET DEMENTIA – PROBABLY DELIRIUM

PART II

Delirium is a sudden change in a person’s mental abilities and is common in the elderly with acute medical illness. The elder with dementia will have a greater risk of developing delirium when ill, than the elder without dementia.

Delirium can be caused by infections, pain, sleep deprivation, dehydration, metabolic or electrolyte disturbances, constipation, and many times medications especially psychoactive medications. The evaluation process can be extensive because of the large number of possible causes.

Finding out the cause of the delirium is the first priority. Once the medical cause is brought under control it will usually still take some time for the delirium to resolve, even months.  During the time of recovery it is important to:

  • Provide optimal nutrition and hydration
  • Ensure the elder’s safety
  • Encourage a routine sleep – wake cycle
  • Provide a calm environment
  • Make sure that eye glasses are clean, hearing aids are working and dentures are in.
  • Provide good lighting, even during the day keep lights on
  • Simplify – reduce clutter, noise, few visitors

 

In his later years my father would become delirious every time he was hospitalized. I would position myself in front of him, smile and reassure him all was well. When staff would come into the room I would introduce them to Dad and tell him why they were there and what they were doing. I avoided side conversations with staff or visitors and only concentrated on Dad. When he recovered he would remember the bugs running up and down the walls, but he would also remember me just sitting there smiling.

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

FAST ONSET DEMENTIA – PROBABLY DELIRIUM

PART I

THE DEFINITION OF DELIRIUM: A condition of acute and sudden onset of impairment of attention, memory, orientation, language usage, consciousness, perception, behavior and/or emotions that may fluctuate. This is a condition that is directly related to a medical cause and is not due to dementia. It is often called “acute confusion.”

This is not the confusion associated with a terminal condition that occurs in the days before dying. This “terminal delirium” is irreversible and often calls for the use of anti-psychotic medications for the comfort of the patient. Sudden onset delirium is reversible and requires testing for possible cause.

Delirium caused by a medical condition is often confused with dementia and requires a clear history from the family. The areas to report to your healthcare provider are;

  • Is the person more confused today than yesterday? Was this a sudden change in the person’s mental status? If the person is more confused and the increase came on suddenly, you need to consider delirium.
  • Is the person more easily distracted, unable to focus his attention or unable to follow what is being said, than previously? A person with mild cognitive impairment can usually say the days of the week backwards or recite the months of the year backwards. The person with delirium is too distracted to focus on a task like this.
  • Is the person’s thinking disorganized or incoherent? Is the person rambling, has an illogical flow of ideas, or engages in irrelevant conversation? Ask the person a few questions to assess their train of thought:
  1. Will a stone float on water?
  2. Are there fish in the sea?
  3. Does one pound weigh more than two pounds?
  4. Can you use a hammer to pound a nail?

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

CREATING ENVIRONMENTS AS PART OF DEMENTIA CARE

Some elements in the environment can cause unwanted behaviors in persons with dementia. Unsettling noises, unpleasant people, being constantly directed or told “no,” all of these things can cause agitation in a person with dementia. Thinking about what is pleasant, and comfortable, this is when the term “homey” comes to mind. Everyone knows when a home feels homey.

The feeling of homey can mean pleasant smells. Smells like bread baking, apple or pumpkin pie, roast beef, cookies baking, all of these words can trigger memories of those comforting smells. Having certain smells over the course of a day can help cue a confused person as to what is happening. Greeting an elder in the morning with “good morning” while the smells of bacon frying and fresh brewed coffee are coming from the kitchen helps the elder know it is morning.

Create a homey room with furniture in limited patterns and choosing colors that are warm. Select seating that is comfortable and looks like an invitation to sit and spend some time. Many colors and patterns can make a room look “busy.” Use basic solid color carpet that is a contrasting color from the furniture so the elder can see where the furniture ends and the carpet begins. Reduce clutter on all surfaces, but include familiar items for the comfort they bring.

Throw rugs will become tripping hazards as are small glass tables. Anything that causes a glare or is difficult to see the edges of, are potential safety hazards. This includes shiny dark flooring. Lighting that is too low or creates especially dark areas of the room, can cause paranoia as well as be unsafe.

A safe secure outdoor space that is accessible to the confused elder to use independently is a very positive activity, as well as good dementia care. Giving the elder the chance of more options by choosing to be inside or outside maintains self-esteem and independence. The elder can enjoy safe interaction with nature while rocking in that homey old rocker, and maybe another one of those cookies.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SUGAR CRAVINGS AND THE ELDER WITH DEMENTIA

Please, please can’t you open the ice cream parlor now?” the elderly woman begged the activity aide. Once again the young activity aide explained to Hannah, that it was 8 o’clock in the morning, and they don’t open the ice cream parlor till 2 in the afternoon.

The pain was easy to see in the elderly woman as she was turned away. Anyone who has experienced cravings can understand how she felt. Sugar craving is nothing new to millions of people with diabetes and pre-diabetes.

The craving for sugar is physical and so mental. For the elder with dementia and sugar cravings the time of day doesn’t matter. The fact that she had just had breakfast doesn’t matter. The fact that this tiny old lady just couldn’t be physically hungry doesn’t matter.

Hannah doesn’t remember that breakfast she just had. She will clearly tell you that no body feeds her at the nursing home. Because she believes it. Hannah knows what it feels like to be hungry and right now she is craving some ice cream and so she must be hungry.

For persons like Hannah it might have been the toast loaded with “sugar free” jam that triggered this craving. Or the large bowl of corn cereal she had with the toast. Maybe the 5 packets of sugar substitute she insists on putting in her morning coffee.

Loading up on a breakfast with empty carbs and sugar free products – served up by kind hearted nursing assistants, wanting to make all those Hannah’s happy is her problem.

Would she go back to her unit in the nursing home angry? Of course she did.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

LET MUSIC HELP WITH DEMENTIA CARE

Anyone who has ever attended a concert has experienced a large group of people with synchronized brains. As a piece of music is played with emotion, dopamine is released in the brain and a person experiences pleasure. Added to that, a recognizable rhythm pattern and everyone’s brain is happy and synchronized.

Music affects deep emotions in the brain, releasing dopamine. As soon as a well-loved melody begins, small amounts of dopamine are released in the brain in anticipation. Anticipation, of the strong emotional, well remembered places in the music, yet to come. You know those parts that everyone remembers and sings along to. During especially emotional moments in the music an increase of dopamine is released. Dopamine makes, listening to familiar music with familiar rhythm, very rewarding for the listener.

Dopamine has long been considered the feel good neurotransmitter in the brain. A high level of dopamine helps with physical movement, positive emotions and is the reward transmitter. Many positive things in life can increase dopamine in the brain and music is one of them.

When a piece of music is unfamiliar the brain tries to search for that familiar rhythm, or note sequence. In the case of a jazz piece where there are odd or unexpected rhythms. The brain can’t connect to something familiar. Not only will dopamine not be released, but the experience may become difficult, stressful and unpleasant.

Give the confused person with dementia an opportunity to have that happy, good feeling music has to offer. Play some familiar music that allows the listener to “feel” a memory. Then go the extra step and synchronize your brains, sing along.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing