Chapter 10: Nursing Management of Dementia

1. Chapter 10: Nursing Management of Dementia

2. Learning Objectives • Differentiate among dementia, depression, and delirium. • Identify the stages and clinical features of dementia. • Describe procedures for diagnosing dementia. • Recognize and address the common causes of delirium. • Discuss the theoretical foundations of nursing care for persons with dementia. • Contrast pharmacological and nonpharmacological interventions for dementia, delirium, and depression.

3. Learning Objectives (cont’d) • Apply basic principles to provide safe and effective care for persons with dementia. • List specific nursing interventions for behavioral and psychological symptoms of dementia. • Recognize the role of adult day services in the care of persons with dementia. • Identify the role that palliative care/hospice care plays for individuals with dementia and their families.

4. Dementia • Progressive, degenerative brain dysfunction, including deterioration in memory, concentration, language skills, visuospatial skills, and reasoning, that interferes with a person’s daily functioning • Not considered a normal part of aging

5. Dementia (cont’d) • Most common types of dementia in older adults • Alzheimer’s disease (most common) • Vascular dementia (second most common) • Mixed Alzheimer’s/vascular dementia • Parkinson’s dementia • Lewy body dementia (LBD) • Frontotemporal lobe dementia

6. Dementia (cont’d) • Risk factors for dementia • Age • Family history • Genetic factors • apolipoprotein E-e4 (APOE-e4) • History of head trauma • Vascular disease • Certain types of infections

7. Dementia (cont’d) • Alzheimer’s Disease • Medical diagnosis (Box 10-5, P. 382; Box 10-8, p. 385) • Stages (mild, moderate, severe) (Box 10-9, p. 386) • Pharmacological intervention • cholinesterase inhibitors (CEIs): Aricept • N-methyl-D-aspartate (NMDA) receptor antagonists: Namenda • Medications that cause or worsen confustion • Anticholinergic (Box 10-6) • Medications with central nervous system effects

8. Delirium • Acute confusion (dementia-chronic confusion) • Develops over hours or days • Hyperalert (agitated) or hypoactive states (lethargic) • Confusion Assessment Method (CAM) is developed based on 4 features of delirium: • Acute onset or fluctuating course • Inattention • Disorganized thinking • Altered level of consciousness • Common Causes of Delirium (Box 10-12, p. 391)

9. Sundowner Syndrome • A form of delirium and refers to behavior problems that are sometimes seen in the late afternoon or early evening when the sun sets. • Nocturnal confusion • Confusion “as the sun goes down” • Increased with unfamiliar surrounding • Often disturbed sleep patterns • May result from excess sensory stimulation or deprivation

10. Depression • Risk increases in older adults with chronic illnesses or dementia (box 10-13) • Symptoms • can be incorrectly attributed to normal aging • may overlap with dementia • often include anxiety, agitation, and insomnia • Potentially life-threatening • Treatable • Often under recognizing, undertreated

11. Caring for the Person with Dementia • Behavioral and Psychological Symptoms (Box 10-15) • Pharmacological Treatment (Box 10-16) • Nonpharmacological Treatment for Dementia (Box 10-17, 18) • Pain Management and Alzheimer’s Disease (Box 10-19, 20, 21) • Activity Interventions • Communication Interventions (Box 10-22) • Interventions for Particular Behaviors (p. 405-407) • Activities of Daily Living

12. Settings for Care:Focus on Adult Day Services • Recreational therapy/activities • Meals • Social services • Transportation • Personal care: bathing, hair and nail care • Nursing services • Rehabilitation services (less commonly offered) • Medical services (less commonly offered)

13. Hospice/Palliative Care • Palliative care • comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases. (Box 10-32) • Advance directives

14. Legislative Action • National Alzheimer’s Project Act (2011) calls for the expansion and coordination of research and health service delivery across federal agencies for Alzheimer’s disease and related dementias. • The top priorities of the Act are to place significant focus on the dementia people to improve patient outcomes and to reduce disparities.

15. Summary • As population ages, cases of dementia will grow • Reliable assessment tools are available • Interventions for the common behaviors encountered among persons with dementia can help those persons and their caregivers