29

SE C T I O N T H R E E - C O N F USI O N A ND D E M E N T I AS IN SE NI O RS

Cognitive Powers As people age, changes in the brain cause some decline in short-term memory and a slowing down in learning ability. This section deals with changes in the older person:s Brain, which affect their cognitive powers including:

memory; thinking; reasoning; judgment; and, behavior.

By being knowledgeable about what is normal and what some of the more common neurological conditions, which inflict the elderly are, Home Care Assistants will better understand the reasons for their clients: thoughts and actions. They will Become familiar with confusion and dementia and recogniPe the impact these conditions have and they will understand that delirium, dementia and severe memory loss are not part of the normal aging process but are, instead, indicative of degenerative brain disorders, such as AlPheimer:s Disease. Home Care Assistants will also learn that confusion can be attributed to other causes such as infections and fluctuations in glucose levels. This is important, as often people are too easily Iand wronglyN categoriPed as Being “senile”. Nervous System Changes Due to Aging The aging process causes a number of changes in the nervous system:

confusion; memory shortfalls; forgetfulness; dizziness; slower reflexes; loss of brain cells; decreased hearing and vision; decreased blood supply to brain; decreased sense of taste and smell; slower nerve conduction; slower response and reaction times; and reduced sensitivity to pain.

Confusion

30

Confusion is a state of unstable awareness, which results in disrupted thoughts and affects decision making. Often orientation is affected in terms of person, place and time. Confusion is not a diagnosis in itself, but rather it is a symptom, which is the reason that assistance or intervention is sought in the first place. Confusion can be divided into two categories:

Acute Confusion (Delirium) Chronic Confusion (Dementia)

Acute Confusion (Delir ium) Delirium is characterized by being:

temporary; has a fast onset; and, may be recognizable by a combination of inappropriate behaviors.

Causes Symptoms T reatment

hospitalization emotional & social

disruptions loss of hearing loss of sight diseases infections medication reactions physical conditions such

as: o nutrition o cardiovascular

conditions o changes in urinary

functions o changes is body

temperature

disoriented regarding person, place or time

inaccurate perceptions delusions poor judgment forgetfulness difficulty communicating angry withdrawn uncooperative restless hyperactive or lethargic

control or reverse the cause of the symptoms

make environment pleasant, comfortable & safe

stopping or changing medications

treat physical ailments which are contributing to confusion

provide glasses &/or hearing aid as required

advise of realities frequently

31

Chronic Confusion (Dementia)

Dementia is characterized as being:

long-term; progressive; and, possibly degenerative.

Dementia is a slow, progressive decline in mental function in which memory, thinking, judgment, and the ability to learn are impaired. Dementia is a much more serious decline in mental ability than confusion is. With time, it becomes worse. Seniors who are aging normally may become forgetful or misplace objects, but those with dementia, may forget entire events. Individuals with dementia have problems conducting regular tasks such as driving, cooking, and handling finances. Dementia progresses at different rates, depending on the cause. Generally it takes from two to ten years before death occurs, which is often attributed to an infection, such as pneumonia.

Causes Symptoms T reatment

AlPheimer:s Disease Strokes Parkinson:s Disease Infections such as AIDS Drug or alcohol abuse Head injuries Cardiac arrest Huntington:s Disease Multiple Sclerosis Brain tumors Syphilis Conditions that worsen

dementia are: o diabetes o emphysema o heart failure

forgetfulness inability to recognize people places

& objects difficulty finding & using the right

word difficulty working with numbers fast and severe range in emotions changes in personality worriers become more worried failure to perform routine tasks withdrawn less control over behavior unable to follow conversations inability to speak becoming bed ridden difficulty swallowing food

No treatment can restore mental functions.

Sometimes treating a disorder that is worsening the dementia will slow the progression down.

How Home Care Assistants Can Care for Confused Seniors

Do one thing at a time i.e. Have the senior complete one task before starting another. Keep instructions simple and try to ensure senior understands what is wanted. Tell the senior everything that will happen before it happens, regardless of his/her state of alertness. Avoid startling the senior. Pay attention to complaints of hunger, thirst or pain. If a senior seems agitated, distract him/her by asking a question.

32

If the senior resists any care, don:t continue trying to provide that care. Protect the senior from injury and other problems. Communicate with the senior. Be relaxed in your interactions. Support the senior:s family. Ensure the senior has privacy. Remind them of special occasions and events. Tell the senior what the day and date is. Encourage the senior to wear glasses and a hearing aid, if needed. Discuss current events with the senior. Maintain a calm, safe and peaceful environment. Veep the senior:s same routine. Be consistent. Encourage senior to help in self care. Mark reminders down on a calendar. Provide stimuli such as newspapers, TV and radio. Read to the senior.

)284eimer0s 7isease AlPheimer:s Disease is the commonest form of dementia. It is a progressive and relentless loss of mental function revolving around memory, language and thought.

Causes Symptoms T reatment The cause is not known but theories are:

chemical deficiencies genetic factors body attacks its own

immunity system virus defective blood vessels

in the brain

problems remembering conversations forgetting where objects have been

placed routine tasks, which require thought,

become more difficult difficulty responding to simple

problems becoming lost in familiar

surroundings difficulty finding the appropriate

words problems paying attention less responsive

There is no cure but it can be managed by:

medications to: o delay the onset o slow the rate of progression o improve memory, language,

attention span & orientation healthy diet regular exercise intellectual stimulation social interactions stimulating environment support groups

33

/$ages of )284eimer0s 7isease AlPheimer:s Disease has three stages. Signs and symptoms Become more severe with each stage and eventually death occurs.

Stage 1

Individuals in Stage 1 can generally manage their daily activities themselves, but they may require some assistance with organization. Traits common to Stage 1 are: o loss of memory; o problems finding the right words; o problems exercising good judgment; o problems making good decisions; o becoming lost in familiar places; o problems carrying out multi-task activities; o feeling sad, depressed, & anxious; o avoiding social interactions; o problems remembering appointments, names or recent events; and. o misplacing items.

Stage 2

Individuals in Stage 2 may have more problems taking care of themselves, but they can still be involved in their daily care and follow a routine. Traits common to Stage 2 are: o some assistance needed with their activities of daily living ; o becoming restless, especially during the evening hours; o loss of memory increases O they may not know family or friends; o failure to recognize dangers and differentiate between hot and cold; o becoming angry or easily upset; o need to be reminded to eat; o having trouble expressing self and understanding others; o some bowel and bladder incontinence; and, o loss of impulse control (e.g. uses foul language, poor table manners, sexually aggressive)

34

Stage 3 Individuals in Stage 3 usually require complete assistance with daily care.

Traits common to Stage 3 are: o unable to communicate O may grunt or scream; o does not recognize self or family members; o touching or patting things continuously; o sleeping more often; o disoriented to person, place and time; o cannot sit or walk O becomes confined to bed; o total bowel and urinary incontinence; o unable to swallow; o may have seizures; o coma; and, o death.

:e4a;iora2 5a$$erns !o<nd in )284eimer0s 7isease

Behavior Descr iption How to Handle the Behavior

Recurring Behaviors

Recurring behavior is doing the same act over and over ( e.g. folding a towel).

allow the individual to continue the repetitive behavior

take individual for walk

Abnormal Sexual

Behavior

Sexual behavior may involve the wrong person, at the wrong time, in the wrong place. Or, it may involve an inappropriate action (e.g. exposing themselves or masturbating in front of others).

encourage affection with individual:s sexual partner

when masturbating, lead individual to a private area

Screaming Screaming occurs in an attempt to communicate. It can involve screaming a name, a word or simply making yelling sounds.

provide a calm & quiet environment determine if there are vision or hearing

problems

Aggression Aggression & combativeness often occur because of restlessness or agitation (e.g. hitting, punching, biting).

do not argue with the individual remain calm & collected protect yourself

Agitation An agitated individual may walk back & forth, hit or yell.

determine why the individual is agitated (e.g. Hungry? In pain? Insufficient sleep?)

maintain a calm & quiet environment

Disastrous Responses

Disastrous responses are extreme responses, with the individual reacting as if a major disaster has occurred.

avoid having too many stimuli present at one time (e.g .asking questions when the TV is on)

maintain a calm & quiet environment

Delusions

Delusions area false beliefs, even when facts say differently. (e.g. An individual may think he/she is going to be murdered.)

reassure individuals that you will protect them & they are safe

use touch to cam them distract the individual with some type

of activity

35

Behavior Descr iption How to Handle the Behavior

Hallucinations A hallucination is hearing, seeing smelling or feeling things that are not there. (e.g. Individuals may think snakes are in bed with them.)

reassure individuals that you will protect them from harm

don:t argue with them, as they do not understand what you are saying

Sundowning Sundowning is the appearance of confusion, agitation, and other severely disruptive behavior coupled with inability to remain asleep. It occurs in the late afternoon & evening hours.

make sure their basic needs are looked after (e.g. hunger, toileting, warmth)

provide a clam setting at the end of the day

keep a light on, as many individuals with AlPheimer:s Disease may Be afraid of the dark.

Wandering Since AlPheimer:s Disease causes the individual to be disoriented in respect to person, place or time, they may become lost or use poor judgment, which compromises their safety.

ensure individuals are not able to wander off by securing safety locks at tops or bottoms of doors & windows

keep their environment free from hazards.

Caring for /eniors ?i$4 )284eimer0s 7isease and @$4er 7emen$ias

create a supportive environment by: o providing extra security measures such as posting notes to serve as reminders (e.g. turn stove off); o keeping the environment familiar e.g. don:t move furniture aroundC o establish and maintain a regular daily routine; and, o keeping the client oriented. (e.g clock, calendar, radio, night light);

evaluate home for safety and take corrective actions by: o removing scatter rugs; o storing household cleaners and harmful substances in a safe place; o removing sharp & breakable objects from the environment; and, o using plastic eating and drinking utensils;

provide structure and routine; schedule low stress activities; speak slowly and clearly to facilitate their understanding of what is being said; provide simple explanations on everything said; research community resources which will benefit the client; encourage them to share their memories, as long as they can recall them; plan physical activities, as they will offset disruptive behavior; encourage mental activities (e.g. reading, crafts, keeping abreast with current events); and, provide the client:s Basic needs.

36

Summary As people grow older, changes in the brain cause some decline in short-term memory and a slowing down in learning ability. There is a general decrease in cognitive powers, which affect the individual:s memory, thinking, reasoning, judgment and behavior. These changes, which occur throughout the nervous system, often cause an individual to become confused. There are two main types of confusion -- acute confusion, also known as “delirium”, and chronic confusion, also known as “dementia”. They each have distinct characteristics which affect cognitive abilities and behavioral patterns. The most common form of dementia is “AlPheimer:s Disease”, for which there is no cure. It is a progressive disease and has three main stages. Hhile it can:t Be cured, it can Be managed. There are various ways a Home Care Assistant can support seniors with AlPheimer:s Disease or other dementias. This would include such measures as maintaining a safe and calm environment, making the senior feel secure and providing ongoing and increasing support with their activities of daily living.