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.