Depression, Delirium, and Dementia in Older Adults

Depression, Delirium, and Dementia in Older Adults

Steve Bartels, MD, MSSteve Bartels, MD, MSProfessor of Psychiatry & Professor of Psychiatry &

Community and Family MedicineCommunity and Family MedicineCoCo--Director Dartmouth Center for the AgingDirector Dartmouth Center for the Aging

ObjectivesObjectives

Describe the prevalence of depression in older adultsUse an assessment instrument for depression in older adultsDiscuss symptoms and treatment strategies for depression in older adultsDescribe the prevalence of delirium and dementia in older adults

Describe the prevalence of depression in older Describe the prevalence of depression in older adultsadultsUse an assessment instrument for depression in Use an assessment instrument for depression in older adultsolder adultsDiscuss symptoms and treatment strategies for Discuss symptoms and treatment strategies for depression in older adultsdepression in older adultsDescribe the prevalence of delirium and Describe the prevalence of delirium and dementia in older adultsdementia in older adults

ObjectivesObjectives

Discuss the symptoms of delirium and dementia

Discuss the assessment and treatment strategies for delirium and dementia

Contrast criteria for differentiating depression, delirium, and dementia in older adults.

Discuss the symptoms of delirium and dementiaDiscuss the symptoms of delirium and dementia

Discuss the assessment and treatment strategies Discuss the assessment and treatment strategies for delirium and dementiafor delirium and dementia

Contrast criteria for differentiating depression, Contrast criteria for differentiating depression, delirium, and dementia in older adults.delirium, and dementia in older adults.

Prevalence of Mental Disorders Age 65+

Prevalence of Mental Disorders Age 65+

Psychiatric Psychiatric 16.3%16.3%Dementia Dementia 10%10%Mental disorders: Mental disorders: 26.3%26.3%(including dementia)(including dementia)

Jeste, et al., 1999

IMPACT: Worldwide Causes of DisabilityIMPACT: Worldwide Causes of Disability

0% 4% 8% 12% 16% 20% 24%

All Other Causes of Disability

Migraine

Diabetes

Cancer (Malignant neoplasms)

Communicable Diseases

Digestive Diseases

Injuries (Disabling)

Sense Organ Diseases

Cardiovascular Diseases

Respiratory Diseases

Musculoskeletal Diseases

AlzheimerÕs Disease and Dementias

Alcohol and Drug Use Disorders

Mental Illnesses

As a Percentage of All Disabilities

As a Percentage of All Disabilities

Prevalence of Late-Life DepressionPrevalence of Late-Life Depression

Clinically significant Clinically significant depressive symptomsdepressive symptoms

15% community15% community25% primary care25% primary care25% medical inpatients25% medical inpatients40% nursing home40% nursing home

Major depressive Major depressive disorderdisorder

11--3% community3% community10% primary care10% primary care15% medical inpatients15% medical inpatients15% nursing home15% nursing home

Worse outcomesWorse outcomesHip fracturesHip fracturesMyocardial infarctionMyocardial infarctionCancerCancer ((Mossey Mossey 1990; 1990; Penninx Penninx et al. 2001; Evans 1999) et al. 2001; Evans 1999)

Increased mortality ratesIncreased mortality ratesMyocardial InfarctionMyocardial Infarction ((FrasureFrasure--Smith 1993, 1995)Smith 1993, 1995)

Long term Care ResidentsLong term Care Residents (Katz 1989, (Katz 1989, Rovner Rovner 1991, 1991, Parmelee Parmelee 1992; Ashby1991; 1992; Ashby1991; Shah 1993, Samuels 1997)Shah 1993, Samuels 1997)

Depression Is a Medical Illness Depression Is a Medical Illness with Poor Health Outcomeswith Poor Health Outcomes

Depression and Mortality in Older Women Following Hip Fracture

Depression and Mortality in Older Women Following Hip Fracture

Osteoporotic Fractures Research Group, 1998

Number of Depressive Symptoms 7-Year Follow Up

0

5

10

15

20

25

30

35

0 1-2 3-5 6-10 >10

Mortality(%)

(n = 2773) (n = 2953) (n = 1319) (n = 402) (n = 71)

N=7518

Depression Following Heart Attack and Mortality

Depression Following Heart Attack and Mortality

Frasure-Smith, Lespérance. 1996.

% Cardiac Mortality% Cardiac Mortality

Depressed (n = 35)Depressed (n = 35)

Nondepressed Nondepressed (n = 187)(n = 187)

Odds ratio = 3.6Odds ratio = 3.63030

2525

2020

1515

1010

55

006 6 12 12 1818

MonthsMonths

Suicide in the USSuicide in the US

Suicide in Older AdultsSuicide in Older Adults

65+: highest suicide rate of any age group65+: highest suicide rate of any age group85+: 2X the national average 85+: 2X the national average (CDC 1999)(CDC 1999)

Men>Women; Whites>African AmericansMen>Women; Whites>African AmericansPeak suicide rates: Peak suicide rates:

Suicide rate goes up continuously for men Suicide rate goes up continuously for men Peaks at midlife for women, then declines Peaks at midlife for women, then declines

20% older men saw PCP on day of suicide20% older men saw PCP on day of suicide40% older men saw PCP on week of suicide40% older men saw PCP on week of suicide70% older men saw PCP on month of suicide70% older men saw PCP on month of suicide

Suicide risk factorsSuicide risk factors

Depression, HopelessnessSerious medical illnessLiving aloneRecent bereavement, divorce, or separation,Unemployment or retirementSubstance abuse (alcohol and medication misuse

Risk Factors for Late Life DepressionRisk Factors for Late Life Depression

Medical IllnessMedical IllnessSelfSelf--report of poor health and disabilityreport of poor health and disabilityPain; Use of pain medicationPain; Use of pain medicationCognitive ImpairmentCognitive ImpairmentMedications; Substance AbuseMedications; Substance AbusePrior Depressive EpisodePrior Depressive EpisodeFinancial difficultiesFinancial difficultiesBereavementBereavementIsolation; dissatisfaction with social networkIsolation; dissatisfaction with social networkPhysiological changes associated with agingPhysiological changes associated with aging

What We KnowWhat We Know

Depression is complex and can be difficult to Depression is complex and can be difficult to identify (identify (““depression without sadnessdepression without sadness””))Treatments are pretty goodTreatments are pretty goodEffects of treatment may be slowed and Effects of treatment may be slowed and incomplete (incomplete (““response but not remissionresponse but not remission””))LongLong--term approaches are needed to keep people term approaches are needed to keep people wellwellWe know what to doWe know what to do

Definition of DepressionDefinition of Depression

Clinical syndrome characterized by low mood tone, difficulty thinking, and somatic changes precipitated by feelings of loss and / or guilt.

Diagnostic labels: minor depression, major depression, adjustment disorder with depressed mood, dysthymia, bipolar depression, seasonal affective disorder

MAKING THE DIAGNOSIS:ANHEDONIAMAKING THE DIAGNOSIS:ANHEDONIA

Loss of interest or pleasure in things that you normally enjoy.

May be the most important and useful symptom.

Loss of interest or pleasure in things that Loss of interest or pleasure in things that you normally enjoy.you normally enjoy.

May be the most important and useful May be the most important and useful symptom.symptom.

MAKING THE DIAGNOSIS:PHYSICAL SYMPTOMSMAKING THE DIAGNOSIS:PHYSICAL SYMPTOMS

Sleep disturbance.

Appetite or weight change.

Low energy or fatigue .

Psychomotor retardation or agitation.

Sleep disturbance.Sleep disturbance.

Appetite or weight change.Appetite or weight change.

Low energy or fatigue .Low energy or fatigue .

Psychomotor retardation or agitation.Psychomotor retardation or agitation.

MAKING THE DIAGNOSIS:PSYCHOLOGICAL SYMPTOMSMAKING THE DIAGNOSIS:PSYCHOLOGICAL SYMPTOMS

Low self-esteem or guilt.

Poor concentration.

Suicidal ideation or persistent thoughts of death.

Low selfLow self--esteem or guilt.esteem or guilt.

Poor concentration.Poor concentration.

Suicidal ideation or persistent Suicidal ideation or persistent thoughts of death.thoughts of death.

Depression: “SIG-E-CAPS”Depression: “SIG-E-CAPS”

SS Sleep disturbance (insomnia or hypersomnia)Sleep disturbance (insomnia or hypersomnia)II Interests (anhedonia or loss of interest in usually pleasurableInterests (anhedonia or loss of interest in usually pleasurableactivities)activities)GG Guilt and/or low selfGuilt and/or low self--esteemesteemEE Energy (loss of energy, low energy, or fatigue)Energy (loss of energy, low energy, or fatigue)CC Concentration (poor concentration, forgetful)Concentration (poor concentration, forgetful)AA Appetite changes (loss of appetite or increased appetite)Appetite changes (loss of appetite or increased appetite)PP Psychomotor changes (agitation or slowing/retardation)Psychomotor changes (agitation or slowing/retardation)SS Suicide (morbid or suicidal ideation)Suicide (morbid or suicidal ideation)

Depression Screening and MonitoringDepression Screening and Monitoring

PHQPHQ--9: Nine Item Patient Health9: Nine Item Patient HealthQuestionnaireQuestionnaire

Geriatric Depression ScaleGeriatric Depression Scale

Cornell Scale for Depression in DementiaCornell Scale for Depression in Dementia

More than NearlyNot Several half the every

at all days days day0 1 2 3

PHQ PHQ -- 9 Symptom Checklist9 Symptom Checklist

a. Little interest or pleasure in doing things

b. Feeling down, depressed, or hopeless

c. Trouble falling or staying asleep, or sleeping too much

d. Feeling tired or having little energy

e. Poor appetite or overeating

f. Feeling bad about yourself, or that you are a failure . . .

g. Trouble concentrating on things, such as reading . . .

h. Moving or speaking so slowly . . .

i. Thoughts that you would be better off dead . . .

1. Over the last two weeks have you beenbothered by the following problems?

Subtotals: 4 6 6TOTAL: 16

2. ... how difficult have these problems madeit for you to do your work, take care of thingsat home, or get along with other people?

Ger

iatri

c D

epre

ssio

n S

cale

Source: Yesavage, 1983

Cor

nell

Sca

le fo

r Dep

ress

ion

in D

emen

tia

Source:Alexopoulos, 1998

Treatment of Depression: Non-pharmacologicalTreatment of Depression: Non-pharmacological

Support groupsSupport groupsIndividual psychotherapy Individual psychotherapy

(PST, IPT, CBT)(PST, IPT, CBT)

Involvement in productive activitiesInvolvement in productive activitiesRemaining physically activeRemaining physically active

PSYCHOTHERAPY/ BEHAVIORAL THERAPYPSYCHOTHERAPY/ BEHAVIORAL THERAPY

Can be effective as medication for mild to moderate major depression or dysthymia

Should be offered as option .

Also useful adjunct to medication.

Particularly useful with underlying psychosocial issues, abuse issues, family dysfunction, life transitions

Can be effective as medication for mild to moderate Can be effective as medication for mild to moderate major depression or major depression or dysthymiadysthymia

Should be offered as option .Should be offered as option .

Also useful adjunct to medication.Also useful adjunct to medication.

Particularly useful with underlying psychosocial Particularly useful with underlying psychosocial issues, abuse issues, family dysfunction, life transitionsissues, abuse issues, family dysfunction, life transitions

ANTIDEPRESSANTSANTIDEPRESSANTS

Tricyclics (e.g. elavil, sinequan)Side effects, but less expensive.

SSRIscitalopram (Celexa)fluoxetine (Prozac)paroxetine (Paxil)sertraline (Zoloft)

Tricyclics Tricyclics (e.g. (e.g. elavilelavil, , sinequansinequan))Side effects, but less expensive.Side effects, but less expensive.

SSRIsSSRIscitalopram citalopram ((CelexaCelexa))fluoxetine fluoxetine (Prozac)(Prozac)paroxetine paroxetine ((PaxilPaxil))sertraline sertraline (Zoloft)(Zoloft)

ANTIDEPRESSANTSANTIDEPRESSANTSANTIDEPRESSANTS

OTHER (nonOTHER (non--SSRI) AGENTS:SSRI) AGENTS:bupropion bupropion ((WellbutrinWellbutrin))

mirtazapine mirtazapine ((RemeronRemeron))

nefazodone nefazodone ((SerzoneSerzone))

venlafaxine venlafaxine ((EffexorEffexor))

TRICYCLIC ANTIDEPRESSANTSTRICYCLIC ANTIDEPRESSANTS

As effective as newer agents, at least for major depressive episodes.

Side effects can be common, bothersome.

Adherence an issue, especially over time.

Can be lethal in overdose.

As effective as newer agents, at least for major depressive As effective as newer agents, at least for major depressive episodes.episodes.

Side effects can be common, bothersome.Side effects can be common, bothersome.

Adherence an issue, especially over time.Adherence an issue, especially over time.

Can be lethal in overdose.Can be lethal in overdose.

Treatment of Depression: Other Somatic TreatmentsTreatment of Depression: Other Somatic Treatments

Phototherapy for seasonal depressionPhototherapy for seasonal depression

Electroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT)

The Key to Successful Rx: FOLLOW UP!The Key to Successful Rx: FOLLOW UP!

Time

Seve

rity

Normalacy

Symptoms

SyndromeAcutePhase

ContinuationPhase

MaintenancePhase

Response

RemissionRemission

Relapse

RelapseRecurrence

> 50% STOP

Rx

65 to 70%STOPRx

Only 25%Have ≥ 3Visits

RecoveryRecovery

Points to consider……Points to consider……

Comorbidities

Monitor every 1 – 2 weeks

Assess response every 4 – 6 weeks

Care Manager

Encourage AdherenceProblem Solve Barriers

Measure Treatment Response

Monitor Remission

Com

mun

i ca t

e w

i th C

li ni c

i an s

Nursing InterventionsNursing Interventions

Institute safety precautions Institute safety precautions for suicide riskfor suicide riskMonitor / promote nutrition, Monitor / promote nutrition, elimination, sleep, rest, elimination, sleep, rest, comfort, pain controlcomfort, pain controlEnhance physical function Enhance physical function and social supportand social supportMaximize autonomyMaximize autonomy

Structure and encourage daily Structure and encourage daily participation in therapiesparticipation in therapiesRemove etiologic agentsRemove etiologic agents

Monitor / document responsesMonitor / document responsesProvide practical assistance, Provide practical assistance, such as problemsuch as problem--solvingsolving

Provide emotional supportProvide emotional support

Case StudyCase StudyMs. G is a 75Ms. G is a 75--year old female living alone in her apartment in year old female living alone in her apartment in New York City. Her husband died suddenly two years ago of a New York City. Her husband died suddenly two years ago of a heart attack. Their two children are alive and living outheart attack. Their two children are alive and living out--ofof--state. Both of her sons maintain weekly phone contact with Ms. state. Both of her sons maintain weekly phone contact with Ms. G and visit usually once a year. Ms. G has been doing well G and visit usually once a year. Ms. G has been doing well until about 6 weeks ago when she fell in her apartment and until about 6 weeks ago when she fell in her apartment and sustained bruises but did not require a hospital visit. Since tsustained bruises but did not require a hospital visit. Since then, hen, she has been preoccupied with her failing eyesight and she has been preoccupied with her failing eyesight and decreased ambulation. She does not go shopping as often, decreased ambulation. She does not go shopping as often, stating she doesnstating she doesn’’t enjoy going out anymore and feels t enjoy going out anymore and feels ““very sad very sad and teary.and teary.”” Ms. G states that her shopping needs are less, since Ms. G states that her shopping needs are less, since she is not as hungry as she used to be and she is not as hungry as she used to be and ““besides Ibesides I’’m getting m getting too old to cook for one person only.too old to cook for one person only.””

QuestionsQuestions

1. What risk factors might account for Ms. G’s symptoms of depression?

2. What are Ms. G’s depressive symptoms?

3. What might be some treatment strategies for Ms. G?

1. What risk factors might account for Ms. G’s symptoms of depression?

2. What are Ms. G’s depressive symptoms?

3. What might be some treatment strategies for Ms. G?

Delirium and DementiaDelirium and Dementia

Delirium Delirium –– a a reversible confusional statereversible confusional state, a mental , a mental disturbance characterized by acute onset, disturbed disturbance characterized by acute onset, disturbed consciousness, impaired cognition, and an identifiable consciousness, impaired cognition, and an identifiable underlying medical cause (medications, anesthesia, underlying medical cause (medications, anesthesia, sleep disturbance, electrolyte imbalance, etc.)sleep disturbance, electrolyte imbalance, etc.)Dementia Dementia –– an an irreversible confusional stateirreversible confusional state,, acquired acquired impairment of mental function, not the result of impairment of mental function, not the result of impaired level of arousal, with compromise in at least impaired level of arousal, with compromise in at least three areas of mental activity.three areas of mental activity.

DeliriumDelirium

35% of U.S. population aged ≥ 65 years hospitalized each year accounting for nearly 50% of inpatient days.

Delirium: 14% - 56% of elderly hospitalized patients

Mortality: 10% - 65%.

Prevalence of Alzheimer’s Disease by AgePrevalence of Alzheimer’s Disease by Age

05

101520253035404550

%

65-74 75-84 85+

65-7475-8485+

SOURCE: Evans, D.A. et al. (1989). Journal of the American Medical Association. Vol. 262: 2251-2256.

SymptomsSymptoms

Easily distracted, Easily distracted, inappropriate anxiety, labile inappropriate anxiety, labile to apathyto apathy

Labile variable; fear / Labile variable; fear / panic, euphoria, disturbedpanic, euphoria, disturbed

AffectAffectMonth to yearsMonth to yearsHours to < monthHours to < monthDurationDuration

Worse in evening; Worse in evening; ““sundowningsundowning””, reversed , reversed sleepsleep

Worse at night in Worse at night in darkness and on darkness and on awakening, insomniaawakening, insomnia

Sleep/WakeSleep/WakeSlow and continuousSlow and continuousHours, weeks, or longerHours, weeks, or longerCourseCourse

Vague symptoms, loss of Vague symptoms, loss of intellect, agitated, aggressiveintellect, agitated, aggressive

Disoriented, fluctuating Disoriented, fluctuating moodsmoods

PresentationPresentationInsidious and gradualInsidious and gradualShort, rapid, hours/daysShort, rapid, hours/daysOnsetOnsetDementiaDementiaDeliriumDeliriumParameterParameter

SymptomsSymptoms

Short term memory deficit in Short term memory deficit in early course, progresses to early course, progresses to longlong--term deficits, term deficits, confabulation, perseverationconfabulation, perseveration

Impaired, but remote Impaired, but remote memory is intactmemory is intact

Recent MemoryRecent Memory

Intact Intact DisturbedDisturbedLevel of Level of ConsciousnessConsciousness

Misperceives people and Misperceives people and events as threatening; late events as threatening; late delusions, hallucinationsdelusions, hallucinations

DelusionsDelusionsPsychotic Psychotic symptomssymptoms

Impaired, bad / inappropriate Impaired, bad / inappropriate decisions, denies problemsdecisions, denies problems

Impaired; difficulty Impaired; difficulty separating facts and separating facts and hallucinationshallucinations

JudgmentJudgment

DementiaDementiaDeliriumDeliriumParameterParameter

Common Causes of Delirium

Toxicity (Prescribed and OTC Medications) Toxicity (Prescribed and OTC Medications) Drugs of abuse, Withdrawal statesDrugs of abuse, Withdrawal statesTraumatic injuries, Traumatic injuries, Cerebrovascular Cerebrovascular accidentsaccidentsInfectious processes: (e.g. systemic infection, Infectious processes: (e.g. systemic infection,

urinary tract infections, meningitis, encephalitis)urinary tract infections, meningitis, encephalitis)Metabolic derangementsMetabolic derangements

Endocrine: (thyroid, adrenal, diabetes)Endocrine: (thyroid, adrenal, diabetes)Nutritional Nutritional

Amyloid Plaques and Neurofibrillary Tangles in Alzheimer’s Disease vs. Normal AgingAmyloid Plaques and Neurofibrillary Tangles in Alzheimer’s Disease vs. Normal Aging

AlzheimerAlzheimer’’ss NormalNormal

TanglesTangles

PlaquesPlaques

Courtesy of Harry Courtesy of Harry VintersVinters, MD., MD.

Assessment of DeliriumAssessment of Delirium

History and PhysicalHistory and Physical

Current medicationCurrent medication

Tests: chemistries, EKG, CXR, ABGs, oxygen Tests: chemistries, EKG, CXR, ABGs, oxygen saturation, u/a, thyroid function tests, cultures, saturation, u/a, thyroid function tests, cultures, drug levels, folate levels, pulse oximetry, drug levels, folate levels, pulse oximetry, EEG, lumbar puncture, serum B12EEG, lumbar puncture, serum B12

Treatment of DeliriumTreatment of DeliriumFailure to treat delays recovery and can worsen the older person’s health and function.

Psychiatric Management: identify and treat underlying etiology, intervene immediately for urgent medical conditions; ongoing monitoring of psychiatric status

Environmental and supportive interventions: all environmental factors that exacerbate delirium; make environment more familiar; reorient; reassure, and inform to fear or demoralization

Somatic Interventions: antipsychotic; benzodiazepines

Assessment of DementiaAssessment of Dementia

Folstein MiniFolstein Mini--Mental Status Examination (MMSE)Mental Status Examination (MMSE)

77--minute screen: cued recall, category fluency, minute screen: cued recall, category fluency, Benton Temporal Orientation Test, Clock Drawing Benton Temporal Orientation Test, Clock Drawing TestTest

MiniCogMiniCog: 3 object recall and Clock Drawing Test: 3 object recall and Clock Drawing Test

Min

i-Men

tal S

tate

E

xam

(MM

SE

)

Source: Folstein, 1975

Minicog Dementia Screen

1) Name 3 unrelated objects (e.g. “apple, house, book” or “pony, qua rter, orange”)2) Draw a large circle and ask the individual to put the numbers on the face of the clockand then to put the hands of the clock to indicated the time 11:203) Ask for the individual to repeat the names of the 3 objects

__ No or very mild Cognitive Impairment/No Dementia___Score =1 or 2 (one or 2 objects recalled ) and normal clock drawing test)___Score =3 (regardless of clock drawing test)

__ Significant Cognitive Impairment/Dementia___Score= 0 (none of the 3 objects recalled)___Score= 1 or 2 (one or 2 objects recalled) and abnormal clock drawing test)

Treatment of DementiaTreatment of Dementia

Treat cognitive symptoms: cholinesterase inhibitors; Treat cognitive symptoms: cholinesterase inhibitors; Vitamin E; Gingko Biloba; stroke preventionVitamin E; Gingko Biloba; stroke prevention

Treatment of Behavioral Disturbances: antipsychotics; Treatment of Behavioral Disturbances: antipsychotics; benzodiazepines; selected tricyclicsbenzodiazepines; selected tricyclics

Educational interventions: family caregivers and staffEducational interventions: family caregivers and staff

Treatment of DementiaTreatment of DementiaImprove functional performance: low lighting level, music, Improve functional performance: low lighting level, music, behavior modificationbehavior modification

Nonpharmacologic Interventions for Problem Behaviors: Nonpharmacologic Interventions for Problem Behaviors: cognitive remediation, massage, pet therapy, occupational cognitive remediation, massage, pet therapy, occupational and physical therapy, validation therapyand physical therapy, validation therapy

Care Environment Alterations: homelike setting, special Care Environment Alterations: homelike setting, special care unitcare unit

Interventions for Caregivers: assess for caregiver Interventions for Caregivers: assess for caregiver depressiondepression

Alzheimer CareAlzheimer Care

Use personal history, life experiences, and habitsUse personal history, life experiences, and habitsMaintain a familiar and comfortable routineMaintain a familiar and comfortable routineSlow down, speak clearly, make eye contact, in field of Slow down, speak clearly, make eye contact, in field of visionvisionCue the person to do as much for him or herself as Cue the person to do as much for him or herself as possiblepossibleModify physical environment Modify physical environment –– reduce misinterpretationreduce misinterpretationMonitor for symptoms of personal distressMonitor for symptoms of personal distress

Ms. D is a 98-year-old female in a skilled nursing facility with a diagnosis of Alzheimer’s disease. Ms. D comes to the nursing station and appears very upset. She tells you that she is looking for her mother and asks you to help her. You start walking with Ms. D.

Ms. D is a 98Ms. D is a 98--yearyear--old female in a old female in a skilled nursing facility with a skilled nursing facility with a diagnosis of Alzheimerdiagnosis of Alzheimer’’s disease. s disease. Ms. D comes to the nursing station Ms. D comes to the nursing station and appears very upset. She tells and appears very upset. She tells you that she is looking for her you that she is looking for her mother and asks you to help her. mother and asks you to help her. You start walking with Ms. D. You start walking with Ms. D.

Case Study: DementiaCase Study: Dementia

Which strategies would be helpful in assisting Ms. D.?Which strategies would be helpful in assisting Ms. D.?

1.1. Using reality orientation in the hope of reversing Using reality orientation in the hope of reversing her cognitive lossher cognitive loss

2.2. Telling her that her mother died a long time agoTelling her that her mother died a long time ago

3.3. Attempt to distract / redirect her into a pleasurable Attempt to distract / redirect her into a pleasurable activity, such as eating or singingactivity, such as eating or singing

4.4. Ask her to help you with a small task and that Ask her to help you with a small task and that later you will look for her mother together.later you will look for her mother together.

Resources: Try This Dementia Seriesat www.hartfordign.org

Resources: Try This Dementia Seriesat www.hartfordign.org

Developed by The Hartford Institute for Geriatric Nursing in Developed by The Hartford Institute for Geriatric Nursing in collaboration with The National Alzheimercollaboration with The National Alzheimer’’s Associations AssociationAssessment tool that can be administered in 20 minutes or less Assessment tool that can be administered in 20 minutes or less Topics include:Topics include:

Brief Evaluation of Executive DysfunctionBrief Evaluation of Executive DysfunctionRecognition of Dementia in Hospitalized Older AdultsRecognition of Dementia in Hospitalized Older AdultsAssessing Pain in Persons with Dementia Assessing Pain in Persons with Dementia Assessing and Managing Delirium in Persons with DementiaAssessing and Managing Delirium in Persons with Dementia

Brief Evaluation of Executive Dysfunction: An Essential Brief Evaluation of Executive Dysfunction: An Essential Refinement in the Assessment of Cognitive ImpairmentRefinement in the Assessment of Cognitive Impairment

SummarySummary

Prevalence, symptoms and treatment strategies Prevalence, symptoms and treatment strategies for depression, delirium, and dementia.for depression, delirium, and dementia.

Assessment toolsAssessment tools

Interventions for behavior problemsInterventions for behavior problems

Case Studies to reinforce knowledgeCase Studies to reinforce knowledge