Compare and contrast delirium and dementia: Answer the questions about the case scenarios.Beth is an 81 year old woman, accompanied by her daughter, to the preadmission clinic for a scheduled total hip replacement. Beth had been active, playing darts and taking daily walks, until about 6 months ago when her hip began hurting so much as to limit her activity. She states she had experienced sporadic pain for years, but the hip started “giving out” on occasion, resulting in several falls. Beth is in otherwise good health, though her daughter reports that she has noticed that Beth has been having some difficulty with her short-term memory recently. She is able to compensate for this loss by keeping an appointment calendar next to her phone and using post-it notes to help her remember messages and daily tasks. Beth has a history of depression, which is treated with citalopram and hypertension, which is treated with metoprolol.
The preadmission clinic nurse completed a cognitive screen test using the Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Beth scored 1 on the depression scale showing her depression is well managed with her current medication regime. However, she struggled with 2 elements of the MMSE – item recall and time identification.
Questions for scenario 1
1. What is delirium? What are the signs and symptoms of delirium?
2. How common is delirium in hospitalized, older adults and what national strategy is currently being introduced to target this?
3. Is Beth at high risk to develop postoperative delirium? Explain why and include in your answer any risk factors she may have?
4. Is delirium always reversible? Explain your answer.
5. What negative consequence can develop as a result of undiagnosed delirium?
6. How can Beth's risk for developing delirium during this hospitalization be reduced? Include nursing intervention and assessments.
Betty, age 78, lives with her husband of 59 years in the home where they raised their four children. Her husband had been noticing for the past year (but kept to himself) that Betty increasingly asks him questions about things she previously had no trouble remembering and that she keeps misplacing things with greater frequency. The couple's children, who live in neighbouring areas and only see her on weekends, began to notice these same things, and Betty has even starting to acknowledge her memory loss with comments like, “you know I have a memory problem” when she can’t remember something.
At a family meal one weekend, Betty was very slow in getting the meal prepared even with the usual help she received from her daughters. Everyone in the family noted that Betty was having an unusual amount of difficulty organising the meal and getting it ready to serve. She required recipes to follow for dishes she had made from memory for decades, and could not remember how to set the table. The family suspected that Betty might have early Alzheimer's disease.
Questions for scenario 2
1. What are the signs and symptoms of dementia? What stage of cognitive decline is Betty experiencing at this point? Give a rationale for the chosen stage.
2. Discuss the definition of dementia and the most common types?
3. What are the warning signs (behaviours) for Alzheimer's disease?
4. What services or organisations are available to help Betty and her husband with living and caring for someone with Alzheimer’s disease?
Scenario 2 continued
Betty moved to a residential independent living community about 5 years ago with her husband after declining cognitive health resulted in her care being too difficult for the husband in the family home. She continued to decline cognitively, but her husband refused to move her to a higher level of care away from him, insisting he could handle her cares. A few months ago she fell in their unit, sustaining an ankle fracture that required surgery. Due to the level of care she needed after the fall, she was moved to a high level care facility. Since the move to high level care Betty’s cognitive state has continued to slowly decline.
In the last month, Betty has continued to decline, remaining in bed most days in a sleep like state with bouts of aggression when cares are attempted. Her family reports great distress seeing her in this debilitated state. The family insists that she be dressed each day and gotten out of bed for all meals. Betty is sometimes incontinent of urine and becomes very distressed when attempts are made to ambulate.
Questions for scenario 2 continued
5. Identify two ways to best communicate with Betty at this late stage of her illness. Provide a rational for your answer.
6. What strategies can you implement for Betty’s urinary incontinence whilst promoting independence? Provide a rationale for your answer.
7. List three strategies to help Betty eat and drink safely. Provide a rationale for your answers.
8. Discuss three actions for keeping Betty’s skin healthy and free of skin breakdown. Provide a rationale for your answers
9. The family asks, “Is Betty in pain?” What are some signs of pain in a person with Alzheimer's disease?
10. What recommendations can you make to ensure Betty and her husband, maintain their loving relationship?