updated24-25 NUR 303 Lecture 3 -common health problems of older people(5-6)

Created by JK

p.46

What are the common causes and complications associated with delirium in older adults?

Click to see answer

p.46

Delirium is a frequent cause and a serious complication of hospitalization in older adults.

Click to see question

1 / 120
p.46
Delirium in Older Adults

What are the common causes and complications associated with delirium in older adults?

Delirium is a frequent cause and a serious complication of hospitalization in older adults.

p.46
Delirium in Older Adults

What are the barriers to effective treatment of delirium in older adults?

Major barriers to effective treatment of delirium include under-recognition of the syndrome and poor understanding of the underlying pathophysiology.

p.46
Delirium in Older Adults

What are the primary management strategies for delirium in older adults?

Management strategies for delirium focus on prevention and symptom management.

p.47
Delirium in Older Adults

What are the key components of a thorough assessment for delirium?

The key components of a thorough assessment for delirium include:

  1. Thorough medical history: This involves understanding the patient's usual mental state, any recent operations, and potential infections.

  2. Assessment tools:

    • General cognitive assessment tools: Examples include MMSE (Mini-Mental State Examination) and MoCA (Montreal Cognitive Assessment).
    • Delirium-specific assessment tools: An example is the Confusion Assessment Method (CAM).
  3. Self-reports or caregiver reports: Gathering information on any changes in cognitive function from the patient or their caregivers.

p.48
Delirium in Older Adults

What are the key features required for the diagnosis of delirium according to the Confusion Assessment Method (CAM)?

The diagnosis of delirium by CAM requires the presence of:

  1. Feature 1: Acute Onset of Changes or Fluctuations in the Course of Mental Status
  2. Feature 2: Inattention
  3. Either Feature 3: Disorganized Thinking or Feature 4: Altered Level of Consciousness
p.49
Delirium in Older Adults

What are the modifiable risk factors for delirium in older adults?

The modifiable risk factors for delirium include:

  1. Acute neurological diseases
  2. Infections
  3. Fracture
  4. Surgery
  5. Dehydration
  6. Poor nutritional status
  7. Emotional distress
  8. Polypharmacy
  9. Immobilization
  10. Change of environment
p.49
Delirium in Older Adults

What are the two main pathways leading to delirium as described in the flow chart?

The two main pathways leading to delirium are:

  1. Pathway 1:

    • Hypoxemia, metabolic derangements
    • Global impairment of cerebral metabolism
    • Decreased synthesis and release of neurotransmitters
    • Result: Delirium
  2. Pathway 2:

    • Drugs
    • Neurotransmitter imbalance, disruption of synaptic communication
    • Result: Delirium
p.49
Delirium in Older Adults

How does systemic inflammation contribute to the development of delirium?

Systemic inflammation contributes to delirium through the following pathway:

  1. Activation of primed microglia
  2. Increased cytokine levels in the brain
  3. Neurotransmitter imbalance, disruption of synaptic communication
  4. Result: Delirium
p.50
Delirium in Older Adults

What are the key descriptive features that differentiate delirium from Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
Key Descriptive FeatureConfusion, inattentionMemory loss
p.50
Delirium in Older Adults

How does the onset of delirium compare to that of Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
OnsetAcuteInsidious
p.50
Delirium in Older Adults

What is the typical course of delirium compared to Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
CourseFluctuating, often worse at nightChronic and progressive, stable daily
p.50
Delirium in Older Adults

What is the duration of delirium compared to Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
DurationHours to monthsMonths to years
p.50
Delirium in Older Adults

How does consciousness differ between delirium and Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
ConsciousnessAlteredNormal
p.1
Common health conditions in older adults

What are some common health conditions in older adults?

Condition
Dementia
Delirium
Depression
Parkinson's Disease
CVA (Cerebrovascular Accident)
Dysphagia
Skin conditions
p.3
Understanding Dementia

What is dementia and how does it relate to aging?

Dementia is NOT a normal part of aging; it is a collective name for many progressive brain syndromes characterized by drastic degeneration and death of brain cells, leading to an abnormal decline in cognitive functions.

p.4
Prevalence of Dementia in Hong Kong

What is the approximate percentage of adults aged 70 or above affected by dementia in Hong Kong?

Approximately 9.3% of adults aged 70 or above are affected by dementia.

p.4
Prevalence of Dementia in Hong Kong

What is the projected number of elderly individuals aged over 60 who will be suffering from dementia in Hong Kong by 2039?

By 2039, more than 300,000 elderly individuals aged over 60 will be suffering from dementia in Hong Kong.

p.4
Prevalence of Dementia in Hong Kong

How does the prevalence of dementia change with age in Hong Kong?

The prevalence of dementia increases as people age in Hong Kong.

p.5
Understanding Dementia

What is dementia and how does it differ from mental illness?

Dementia is an irreversible, progressive impairment in cognitive function that affects various abilities such as memory, orientation, judgement, reasoning, attention, language, and problem solving. It is an umbrella term for several neurological conditions characterized by a decline in brain function due to physical changes in the brain, and it is not the same as mental illness.

p.6
Types of Dementia

What are the four common types of dementia and their prevalence rates?

Type of DementiaPrevalence Rate
Alzheimer's Disease (AD)50-75%
Vascular Dementia (VaD)20-30%
Lewy Body Dementia (LBD)10-25%
Frontotemporal Dementia (FTD)10-15%
p.6
Alzheimer's Disease Overview

What are the key characteristics of Alzheimer's Disease?

  • Most common form of dementia
  • Involves neurofibrillary tangles, amyloid plaque, and brain atrophy
  • Slow onset of symptoms and steady decline in activities of daily living (ADLs)
p.6
Vascular Dementia Characteristics

What are the main risk factors associated with Vascular Dementia?

  • Previously called multi-infarct dementia
  • Associated with cardiovascular risk factors such as:
    • Hypertension (HT)
    • Diabetes Mellitus (DM)
    • High blood cholesterol and lipid levels
    • Arrhythmia
    • Smoking
  • Many subtypes depending on the location of vascular damage in the brain
p.6
Types of Dementia

What symptoms are associated with Lewy Body Dementia?

  • Caused by a buildup of Lewy's body proteins in the brain
  • Rapid shifts in mood and behaviors
  • Symptoms include:
    • Visual hallucinations
    • Tremor and rigidity
    • Paranoia and delusions
p.6
Frontotemporal Dementia Characteristics

What are the characteristics of Frontotemporal Dementia?

  • Originally called Pick's Disease
  • Affects individuals in their mid-50s
  • Associated with frontal and temporal anterior lobe atrophy
  • Behavioral changes and language problems are more obvious, while visuospatial and memory skills remain intact
p.7
Cardinal Signs of Dementia

What is a common early sign of dementia related to memory?

A common early sign of dementia is a decline in short-term memory, which may manifest as forgetting names or appointments but later remembering them.

p.7
Cardinal Signs of Dementia

How does dementia affect a person's ability to communicate?

Dementia can lead to difficulty with speech, writing, or comprehension, creating a communication barrier for the individual.

p.7
Cardinal Signs of Dementia

What are some signs of disorientation in individuals with dementia?

Signs of disorientation in individuals with dementia include confusion about time or place.

p.7
Cardinal Signs of Dementia

What changes in daily functioning might indicate dementia?

Individuals with dementia may experience difficulty completing everyday tasks and a decline in planning and problem-solving abilities.

p.7
Cardinal Signs of Dementia

How might dementia affect a person's social interactions?

Dementia can lead to withdrawal from work or social activities, impacting social interactions.

p.7
Cardinal Signs of Dementia

What mood changes might be observed in someone with dementia?

Individuals with dementia may exhibit changes in mood and personality, which can be noticeable to family and friends.

p.7
Cardinal Signs of Dementia

What visual difficulties can be associated with dementia?

Dementia can cause trouble understanding visual information, such as objects, people, and spatial relationships, which may be compounded by age-related vision changes like cataracts.

p.8
Assessment and Investigation of Dementia

What are the key components of clinical judgment in dementia assessment?

The key components of clinical judgment in dementia assessment include:

  1. History Taking (from the client and caregivers)
  2. Physical Examination
  3. Cognitive Status Assessment (using tools like MMSE, MOCA, ADAS-Cog)
  4. Functional Assessment (including ADL & IADL, gait, and balance)
  5. Radio-diagnostic Imaging (CT scan, MRI, PET scan)
  6. Laboratory Tests (CBP, biochemistry, vitamin B12, thyroid function)
  7. Determine Underlying Etiology
  8. Identify Treatable Conditions
  9. Decide on Treatment Modality
  10. Assess Levels of Care
p.8
Assessment and Investigation of Dementia

What cognitive status assessment tools are commonly used in dementia evaluation?

Common cognitive status assessment tools used in dementia evaluation include:

  • Mini-mental Status Examination (MMSE)
  • Montreal Cognitive Assessment (MOCA)
  • Alzheimer's Disease Assessment Scale (ADAS-Cog)
p.8
Assessment and Investigation of Dementia

What types of radio-diagnostic imaging are utilized in the assessment of dementia?

The types of radio-diagnostic imaging utilized in the assessment of dementia include:

  • Computerized Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI)
  • Positron Emission Tomography (PET) scan
p.8
Assessment and Investigation of Dementia

What laboratory tests are important in the assessment of dementia?

Important laboratory tests in the assessment of dementia include:

  • Complete Blood Picture (CBP)
  • Biochemistry tests (RFT, LFT, lipid profile, +/- genetic studies)
  • Vitamin B12 levels
  • Thyroid function tests
p.8
Assessment and Investigation of Dementia

What is the purpose of determining underlying etiology in dementia assessment?

The purpose of determining underlying etiology in dementia assessment is to identify any treatable conditions and to guide the appropriate treatment modality and levels of care required for the patient.

p.9
Alzheimer's Disease Overview

What are the key pathological features of Alzheimer's Disease?

The key pathological features of Alzheimer's Disease include:

  1. Tangling of Tau-protein in neurofibrils
  2. Deposit of β-amyloid protein plaques in neurons
  3. Shrinkage of the cerebral cortex
  4. Shrinkage of the hippocampus
  5. Enlarged ventricles
p.10
Alzheimer's Disease Overview

What are the four stages of Alzheimer's Disease and their corresponding durations?

StageDuration
Mild Cognitive Impairment7 years
Mild Alzheimer's2 years
Moderate Alzheimer's2 years
Severe Alzheimer's3 years
p.10
Alzheimer's Disease Overview

What are the symptoms associated with Mild Alzheimer's Disease?

Symptoms include:

  • Reading problems
  • Poor object recognition
  • Poor direction sense
p.10
Alzheimer's Disease Overview

How does the disease progress in terms of brain regions affected in Moderate Alzheimer's?

In Moderate Alzheimer's, the disease spreads to the frontal lobe of the brain, affecting functions such as judgment and attention.

p.10
Alzheimer's Disease Overview

What is the primary symptom of Mild Cognitive Impairment in Alzheimer's Disease?

The primary symptom of Mild Cognitive Impairment is short-term memory loss.

p.10
Alzheimer's Disease Overview

What symptoms are associated with Severe Alzheimer's Disease?

Symptoms include visual problems as the disease spreads to the occipital lobe.

p.11
Alzheimer's Disease Overview

What are some common signs and symptoms of Alzheimer's disease in the mild stage?

  • Trouble remembering recent events.
  • Difficulty managing finances.
  • Difficulty completing familiar tasks.
  • Losing track of dates and the passage of time.
  • Difficulty with vision and spatial relations, leading to getting lost.
  • Problems with speaking and writing words.
  • Forgetfulness and misplacing things.
  • Social withdrawal from family and friends.
  • Changes in mood or personality (confusion, depression, suspiciousness, anxiety).
  • Often repeating questions and statements.
  • Trouble with driving, confusing pedals and traffic signals.
p.11
Alzheimer's Disease Overview

What are the behavioral symptoms associated with moderate Alzheimer's disease?

  • Behavioral problems such as anger, paranoia, anxiety, and suspiciousness.
  • Wandering and getting lost.
  • Repetitive behaviors, often repeating things.
  • Anxiety, particularly in the late afternoon and early evening (sun-downing).
  • Eating problems, including loss of table manners.
  • Needs assistance with bathing, dressing, and personal care.
  • Incontinence.
  • Hoarding behaviors.
  • Inappropriate behavior.
  • Violent behavior.
  • Increased difficulty with speech and recall.
  • Loss of coordination, leading to shuffling and more falls.
  • Stops recognizing family and friends.
p.11
Alzheimer's Disease Overview

What are the severe symptoms of Alzheimer's disease?

  • Loses ability to communicate.
  • Loses ability to smile.
  • Inability to recognize people, places, and things.
  • Requires full assistance with dressing, bathing, and personal care.
  • Loses ability to chew and swallow.
  • Eventually loses ability to walk.
  • Sleeps a lot.
  • May experience seizures.
  • May have strokes.
  • Incontinence and bowel problems.
  • Weight loss.
p.12
Alzheimer's Disease Overview

What are the genetic risk factors associated with Alzheimer's Disease?

The genetic risk factors for Alzheimer's Disease include the APOE-4 gene and a family history of the disease.

p.12
Alzheimer's Disease Overview

How does gender influence the risk of developing Alzheimer's Disease?

Approximately 2/3 of individuals diagnosed with Alzheimer's Disease are women, indicating a significant gender influence on risk.

p.12
Alzheimer's Disease Overview

What environmental factors are considered risk factors for Alzheimer's Disease?

Environmental risk factors for Alzheimer's Disease include air pollution, city combustion waste, and water impurities such as aluminum toxicity.

p.12
Alzheimer's Disease Overview

What lifestyle factors contribute to the risk of Alzheimer's Disease?

Lifestyle factors that contribute to the risk of Alzheimer's Disease include smoking, alcohol consumption, poor sleep, unhealthy diet, lack of exercise, and stress.

p.12
Alzheimer's Disease Overview

How does age affect the risk of developing Alzheimer's Disease?

The risk of developing Alzheimer's Disease increases with age, with a 3% risk for those aged 65-75 and a 32% risk for those over 85.

p.12
Alzheimer's Disease Overview

What chronic diseases are associated with an increased risk of Alzheimer's Disease?

Chronic diseases associated with an increased risk of Alzheimer's Disease include diabetes mellitus (DM), hypertension (HT), obesity, hypercholesterolemia, and dyslipidemia.

p.12
Alzheimer's Disease Overview

What cognitive factors are considered risk factors for Alzheimer's Disease?

Cognitive factors that are risk factors for Alzheimer's Disease include a low education level and less cognitive reserve.

p.12
Alzheimer's Disease Overview

What types of brain injuries are considered risk factors for Alzheimer's Disease?

Head injuries are considered a risk factor for Alzheimer's Disease, as they can lead to brain cell damage.

p.13
Vascular Dementia Characteristics

What is the second most common form of dementia and what are its key characteristics?

Vascular Dementia (VaD) is the second most common form of dementia characterized by:

  • Clinical evidence of local brain damage
  • Abrupt onset and stepwise deterioration
  • Evidence of stroke, hypertension, and other cardiovascular disease risk factors.
p.13
Vascular Dementia Characteristics

What are the subtypes of Vascular Dementia?

The subtypes of Vascular Dementia include:

SubtypeDescription
Multi-infarct dementiaLarge infarct or cortical infarct
Subcortical vascular dementiaSubcortical or lacunar infarct
Hypoperfusion dementiaLow cardiac output
Hemorrhagic dementiaPressure effect
Strategic-infarct dementiaEmboli or hypertension
Mixed dementiaCombination of different types
Hereditary vascular dementiaGenetic factors involved
p.14
Vascular Dementia Characteristics

What are the main risk factors for Vascular Dementia compared to Alzheimer's Disease?

ConditionRisk Factors
Vascular DementiaHypertension, diabetes, dyslipidemia, atheromatosis
Alzheimer's DiseaseAPOE, diabetes
p.14
Vascular Dementia Characteristics

How does the clinical evolution of Vascular Dementia differ from that of Alzheimer's Disease?

ConditionClinical Evolution
Vascular DementiaStepwise
Alzheimer's DiseaseProgressive
p.14
Vascular Dementia Characteristics

What are the key differences in the neuropsychological profiles of Vascular Dementia and Alzheimer's Disease?

ConditionNeuropsychological Profile
Vascular DementiaExecutive/frontal and semantic dysfunction
Alzheimer's DiseaseMemory impairment (encoding)
p.14
Vascular Dementia Characteristics

What neuroimaging findings are associated with Vascular Dementia compared to Alzheimer's Disease?

ConditionNeuroimaging Findings
Vascular DementiaWhite matter lesions, lacunae, leukoaraiosis
Alzheimer's DiseaseMedial temporal lobe atrophy, amyloid PET positivity, FDG hypometabolism in parieto-temporal regions
p.14
Vascular Dementia Characteristics

Can Vascular Dementia and Alzheimer's Disease occur in the same person, and how are their symptoms related?

Yes, symptoms can be similar in both conditions, and it is possible for an individual to have both Vascular Dementia and Alzheimer's Disease simultaneously.

p.15
Vascular Dementia Characteristics

What are the common symptoms of vascular dementia?

The common symptoms of vascular dementia include:

  • Inappropriate Behavior
  • Personality Change
  • Memory Loss
  • Hallucination
  • Poor Judgement
  • Misplacing Things
  • Difficulty in Organizing
  • Reduced Language Skills
p.16
Types of Dementia

What are the primary signs and symptoms of Lewy Body Dementia (LBD)?

The primary signs and symptoms of Lewy Body Dementia include:

  • Fluctuating cognition
  • Change in personality and mood
  • Visual hallucinations
  • Paranoia or delusions (which can change day by day)
  • Sleep disorders

Additionally, symptoms related to Parkinsonism include:

  • Postural tremor and unsteady gait
  • Rigidity and mobility impairment
p.16
Understanding Dementia

What causes the symptoms of Lewy Body Dementia?

The symptoms of Lewy Body Dementia are caused by the deposition of abnormal proteins (alpha-synucleins) in the neurons, leading to apoptosis (cell death). This affects different parts of the brain, resulting in both dementia-related symptoms and Parkinsonism symptoms.

p.17
Types of Dementia

What is Frontotemporal Dementia (FTD) and what causes it?

Frontotemporal Dementia (FTD) is a group of disorders caused by the progressive loss of nerve cells in the frontal and temporal lobes of the brain. The exact etiology is unknown, but it may involve genetic mutations.

p.17
Cardinal Signs of Dementia

What are the early signs and symptoms of Frontotemporal Dementia (FTD)?

In the early stages of Frontotemporal Dementia (FTD), short-term memory is often not affected. However, symptoms can include:

  • Change in personality
  • Impulsive behaviors
  • Poor insight and judgement
  • Difficulty in concentration and thinking
  • Language disturbances, such as progressive non-fluent aphasia
  • Poor mobility coordination
p.18
Types of Dementia

What are the key characteristics of Alzheimer's disease?

  • Early, insidious short-term memory loss
  • Language deficits & spatial disorientation
  • Later personality changes
p.18
Types of Dementia

What are the defining features of Vascular dementia?

  • Stepwise decline
  • Early executive dysfunction
  • Cerebral infarction &/or deep white matter changes on neuroimaging
p.18
Types of Dementia

What symptoms are associated with Frontotemporal dementia?

  • Early personality changes
  • Apathy, disinhibition & compulsive behavior
  • Frontotemporal atrophy on neuroimaging
p.18
Types of Dementia

What are the main characteristics of Dementia with Lewy bodies?

  • Visual hallucinations
  • Spontaneous parkinsonism
  • Fluctuating cognition
p.19
Assessment and Investigation of Dementia

What are the types of blood tests commonly conducted in dementia investigations?

Common blood tests include:

  • Drug and alcohol tests (toxicology screen)
  • HIV tests
  • Syphilis tests
p.19
Assessment and Investigation of Dementia

What is the purpose of a lumbar puncture in dementia investigations?

A lumbar puncture is performed to:

  • Obtain cerebrospinal fluid
  • Analyze the fluid for Alzheimer's disease proteins or to check for certain infections and inflammatory conditions
p.20
Assessment and Investigation of Dementia

What is the primary use of Computed Tomography (CT) in brain scans?

CT is primarily used to identify signs of stroke or a brain tumor.

p.20
Assessment and Investigation of Dementia

What are the key functions of Magnetic Resonance Imaging (MRI) in diagnosing dementia?

MRI is used to confirm the type of disease causing dementia, including:

  1. Assessing if blood vessels are damaged, which is relevant in vascular dementia.
  2. Showing which parts of the brain are shrinking.
p.20
Assessment and Investigation of Dementia

What condition can Positron Emission Tomography (PET) help identify?

PET can help identify the presence of a brain tumor.

p.21
Alzheimer's Disease Overview

What is the current status of curative treatment for Alzheimer's disease?

There is no curative treatment for Alzheimer's disease.

p.21
Alzheimer's Disease Overview

What is the role of drugs in the treatment of Alzheimer's disease?

Drugs are used to temporarily slow down the progression of symptoms of Alzheimer's disease and to manage behavioral symptoms.

p.22
Understanding Dementia

What are the medications commonly used for memory loss?

The medications commonly used for memory loss include:

  1. Donepezil (Aricept)
  2. Rivastigmine (Exelon)
  3. Memantine (Ebixa)
  4. Galantamine (Reminyl)
p.23
Dementia Care Issues and Support Strategies

What are some examples of non-pharmacological interventions for dementia?

Examples of non-pharmacological interventions include:

  1. Reality Orientation: Helps individuals with dementia to stay connected to their environment and reality.
  2. Reminiscence Therapy: Involves discussing past experiences to enhance memory and emotional well-being.
  3. Multisensory Stimulation: Engages multiple senses to improve cognitive function and emotional response.
  4. Alternative Therapies: Such as music therapy and aromatherapy, which can provide comfort and improve mood.
  5. Cognitive Training: Focuses on enhancing attention, eye-hand coordination, and daily living skills.
p.24
Dementia Care Issues and Support Strategies

What types of medications are commonly used to manage behavioral symptoms in patients?

The commonly used medications for managing behavioral symptoms include:

  1. Antidepressant medications
  2. Antipsychotic medications
  3. Anti-anxiety drugs
p.25
Dementia Care Issues and Support Strategies

What is the purpose of a Comprehensive Geriatric Assessment in dementia care?

The purpose of a Comprehensive Geriatric Assessment in dementia care is to:

  1. Determine the client's levels of dependency.
  2. Identify the client's care needs.
  3. Assess the progression of dementia based on the 7 stages.
p.25
Types of Dementia

What are the characteristics of Stage 1 in the seven stages of dementia?

StageCharacteristics
1Appears normal; can cover up lapses in memory or cognitive function
p.25
Types of Dementia

What symptoms are associated with Stage 4 of dementia?

StageSymptoms
4Reduced ability to count; difficulty in travel; inability to manage one's own affairs
p.25
Types of Dementia

What are the key features of Stage 6 in the progression of dementia?

StageKey Features
6Needs help eating; requires assistance using the toilet; may experience incontinence; disorientation to time and place; possible forgetfulness of personal identity
p.25
Types of Dementia

What are the main symptoms of Stage 7 in the seven stages of dementia?

StageMain Symptoms
7Severe speech loss; motor stiffness; incontinence; need for feeding assistance; total disorientation
p.26
Assessment and Investigation of Dementia

What are the common assessment tools used for cognitive and neurological assessments?

Common assessment tools include:

  1. Abbreviated Mental Test (AMT)
  2. Mini-Mental State Examination (MMSE)
  3. MoCA (Montreal Cognitive Assessment)

These tools assess memory, problem solving, language skills, math skills, sensory response, and reflexes.

p.27
Dementia Care Issues and Support Strategies

What are some strategies to assist clients in coping with memory loss?

  • Stay in regular routine
  • Use visual prompts/cues (e.g., clock, watch, calendar)
  • Utilize memory aids (e.g., drawing board, notepads, lists)
  • Focus on one task at a time
  • Break down tasks into small steps
  • Simplify the home environment with labeling/pictures
  • Keep items in the same place
  • Build repetitive skills and drills
  • Engage in reminiscence with old-time pictures, photos, movies, music
  • Provide cognitive stimulation (e.g., chess, mahjong, sudoku)
  • Implement reality orientation
p.28
Dementia Care Issues and Support Strategies

What are the key principles of assistance in supporting Activities of Daily Living (ADLs)?

The key principles of assistance in supporting ADLs include:

  1. Respect & Dignity: Treating clients with respect and maintaining their dignity.
  2. Safety: Ensuring a safe environment for the client.
  3. Engaging Client: Actively involving the client in their care.
  4. Use Assistive Devices: Utilizing tools that aid in daily activities.
  5. Incremental & Step by Step: Providing assistance in a gradual manner.
  6. Motivation: Encouraging and motivating the client to participate in activities.
p.29
Dementia Care Issues and Support Strategies

What are some key strategies for providing psychological support to individuals with dementia?

  1. Empathy: Understand their world from their perspective.

  2. Initial Assessment: Identify the individual's status and needs.

  3. Reminiscence Therapy: Journal about joyful past experiences.

  4. Self-Actualization Activities: Provide opportunities for activities like craftwork, painting, and calligraphy.

  5. Sense of Fulfillment: Elicit feelings of fulfillment from past achievements and roles.

  6. Integration Activities: Enhance channels for integrating the inner self with the outer world through music therapy, reflective writing, and art therapy.

  7. Sensory Stimulation: Create sensory experiences with pet therapy, tactile exercises, and aromatherapy.

  8. Social Interaction: Promote interaction with family, peers, and young people.

  9. Drug Therapy: Administer prescribed medications as needed.

p.30
Dementia Care Issues and Support Strategies

What are some essential training and support strategies for family and caregivers of individuals with dementia?

  • Continuous support is essential: you're not alone
  • Advice on home-safety design
  • Use of assistive devices to support more independent living
  • Assess and identify available and appropriate caregivers
  • Train caregivers in areas of the client's mobility, transfer, nutrition, communication, and orientation.
  • Establish a support group for caregivers to talk and relieve stress
  • Arrange respite care or day care to give caregivers a break and avoid burnout
  • Discuss any need for financial support and assist with applications
p.31
Dementia Care Issues and Support Strategies

What are some protective factors that can help prevent dementia?

  • Quit Smoking
  • Weight Management
  • BP Control / DM Control
  • No Alcohol
  • Healthy Diet
  • Enjoy social activity
  • Physical Exercise
  • Brain Games
p.31
Dementia Care Issues and Support Strategies

What lifestyle factors can increase the risk of dementia?

  • Hearing Loss
  • Hypertension
  • Obesity
  • Smoking
  • Depression
  • Diabetes
p.31
Dementia Care Issues and Support Strategies

What lifestyle factors can decrease the risk of dementia?

  • Education
  • Physical Activity
  • Social Contact
p.31
Dementia Care Issues and Support Strategies

According to the Lancet Commission, what percentage of dementia cases could potentially be prevented by addressing lifestyle factors?

1 in 3 cases of dementia could be prevented by addressing these lifestyle factors.

p.32
Dementia Care Issues and Support Strategies

What is the primary goal of care for clients with Behavioral and Psychological Symptoms of Dementia (BPSD)?

The primary goal is to maximize functional abilities by supporting all losses in a prosthetic manner.

p.32
Dementia Care Issues and Support Strategies

How can caregivers effectively support clients with BPSD?

Caregivers can support clients by:

  1. Establishing a caring relationship.
  2. Teaching caregivers to observe and evaluate verbal and nonverbal responses.
  3. Identifying triggers related to discomfort or stress reactions.
  4. Modifying the environment to support losses and promote safe function.
  5. Evaluating care routines and responses to plan care effectively.
p.32
Dementia Care Issues and Support Strategies

What strategies should be employed to encourage self-care in clients with BPSD?

To encourage self-care, caregivers should:

  1. Offer choices to the client.
  2. Explain all actions taken.
  3. Avoid rushing or forcing the person to do something.
p.32
Dementia Care Issues and Support Strategies

What ongoing support should be provided to caregivers of clients with BPSD?

Caregivers should receive ongoing education, support, care, and problem-solving assistance to effectively manage the needs of clients with BPSD.

p.33
Dementia Care Issues and Support Strategies

What are some common triggers of behavioral symptoms in older adults?

Common triggers include:

  1. Hunger, thirst, toileting needs
  2. Feeling too hot/too cold
  3. Boredom
  4. Pain or discomfort
  5. Sleep disturbances
  6. Environmental overstimulation or understimulation
  7. Changes in environment or person
  8. Certain people
  9. Certain activities (meals, baths)
  10. Loss of control; being forced to do something
  11. Restraint
p.34
Dementia Care Issues and Support Strategies

What are some strategies to manage agitation and aggression in individuals?

  1. Avoid provoking situations
  2. Intervene early before escalation
  3. Remain calm; speak in a soft voice
  4. Approach slowly from the front
  5. Avoid touching initially; wait until the person is calmer
  6. Stay at eye level with the person
  7. Distract the person
  8. Avoid rational arguments
  9. Avoid physical restraint if at all possible
  10. Identify and address unmet needs (food, fluid, toileting)
p.35
Dementia Care Issues and Support Strategies

What are some effective interventions for addressing resistance to bathing in individuals with dementia?

  1. Remain calm during the process.
  2. Use a soft voice to communicate.
  3. Choose a time when the person is most rested and least confused.
  4. Consider the person's lifelong preferences regarding bathing:
    • Shower vs. bath
    • Morning vs. evening
  5. Maintain a leisurely pace and avoid rushing.
  6. Premedicate with analgesics if there is pain with movement.
  7. Allow the person to wear underwear or a gown if desired.
  8. Avoid spraying water directly on the head or face.
  9. Use distraction techniques such as conversation, snacks, or music.
  10. After bathing, give praise for their clean appearance.
p.36
Dementia Care Issues and Support Strategies

What are some interventions for managing delusions or paranoia in individuals?

  1. Assist the person to keep track of personal items.

  2. Avoid defensiveness if accused.

  3. Do not argue with the person.

  4. Maintain a simple, noncluttered environment.

  5. Avoid whispering in front of the person.

p.37
Dementia Care Issues and Support Strategies

What are the classifications of Inappropriate Sexual Behaviour (ISB)?

The classifications of ISB include:

  1. Sex talk: Foul language not consistent with premorbid personality.
  2. Sexual acts: Such as masturbation or exposing oneself in private or public places.
  3. Implied sexual acts: Requesting unnecessary genital care.
p.37
Dementia Care Issues and Support Strategies

What interventions should be taken if a person is disrobed due to Inappropriate Sexual Behaviour (ISB)?

If a person is disrobed, the intervention is to offer clothing to them.

p.37
Dementia Care Issues and Support Strategies

What steps should be taken if a person is found masturbating as a result of Inappropriate Sexual Behaviour (ISB)?

If a person is masturbating, the following steps should be taken:

  1. Avoid laughing, scolding, or confrontation.
  2. Guide the person to a private place.
  3. Distract the person.
p.38
Dementia Care Issues and Support Strategies

What is wandering in the context of dementia?

Wandering is a behavioral problem associated with dementia, particularly prevalent in the middle or later stages of the disease. It can occur during the day or at night and is characterized by aimless or purposeful motor activity, such as pacing up and down. This behavior often leads to social issues, including getting lost, leaving safe environments, or intruding into inappropriate places.

p.38
Dementia Care Issues and Support Strategies

What are some common characteristics of wandering in dementia patients?

Common characteristics of wandering in dementia patients include:

  1. Increased motor activity: Patients may pace up and down.
  2. Aimless or purposeful movement: The activity may not have a clear purpose.
  3. Low social interaction: Wandering can be associated with reduced engagement with others.
  4. Occurrence at any time: Wandering can happen during the day or at night.
  5. Management challenges: It poses significant challenges in both home and institutional settings.
p.38
Dementia Care Issues and Support Strategies

What are the social problems caused by wandering in dementia patients?

Wandering in dementia patients can lead to several social problems, including:

  • Getting lost: Patients may wander away from familiar areas.
  • Leaving safe environments: They may exit secure settings, increasing the risk of harm.
  • Intruding into inappropriate places: Wandering can result in entering areas where the patient does not belong, causing disturbances or safety concerns.
p.39
Dementia Care Issues and Support Strategies

What are some risk factors for wandering in older adults?

  • Visuospatial impairments
  • Anxiety and depression
  • Poor sleep patterns
  • Unmet needs
  • A more socially active and outgoing premorbid lifestyle
p.40
Dementia Care Issues and Support Strategies

What are some strategies to prevent wandering in individuals with dementia?

  1. Assess for unmet needs
  2. Reassure the person that he or she is in the right place
  3. Use identification bracelets (in case he or she gets lost)
  4. Place alarms on the person and/or doors to detect elopement
  5. Provide a safe wandering 'path'
  6. Provide alternative activities
  7. Minimise medication use (to reduce risk for falls)
  8. Visually disguise exits
  9. Provide daily exercise
  10. Provide simple snack foods to be eaten 'on the run'
p.41
Dementia Care Issues and Support Strategies

What are the steps to take when addressing wandering or exit behavior in older adults?

  1. Face the older adult and make direct eye contact.

  2. Gently touch the older adult, e.g., on the shoulder.

  3. Call him or her by name.

  4. Listen to what the older adult is communicating and the feelings expressed.

  5. Identify the agenda, plan of action, and emotional needs that emerged from the agenda.

  6. Respond to the expressed feeling.

  7. Repeat specific words or phrases; state the need or emotion.

  8. Distract the older adult, e.g., by talking.

  9. Orientate or redirect the older adult.

  10. Call for help if redirection fails.

p.42
Dementia Care Issues and Support Strategies

What are some strategies to visually disguise exits for clients who may wander?

Strategies to visually disguise exits include:

  1. Creative Murals: Painting murals that depict scenes like houses or gardens can distract from the exit door.

  2. Tape Barriers: Using tape barriers can create a physical and visual obstruction to exits.

  3. Signage: Implementing signs that indicate 'No Exit' can help deter wandering.

  4. Decorative Elements: Incorporating decorative elements around exits to blend them into the environment can reduce their visibility.

p.43
Dementia Care Issues and Support Strategies

What are some local community resources available for dementia care support?

Local community resources for dementia care support include:

  1. Alzheimer's Disease International - Provides information and support for individuals affected by dementia. Visit here

  2. Care Resources Connect - Offers community support specifically for dementia care. Visit here

  3. Hong Kong Alzheimer's Disease Association - Focuses on providing assistance and resources for Alzheimer's patients and their families. Visit here

  4. Jockey Club Centre for Positive Ageing - Aims to promote positive ageing and support for older adults, including those with dementia. Visit here

p.46
Delirium in Older Adults

What is delirium and how does it typically present in older adults?

Delirium is a serious disturbance in mental abilities characterized by confused thinking and reduced awareness of the environment. It usually has an acute and rapid onset, occurring within hours or a few days.

p.50
Delirium in Older Adults

What are the differences in attention between delirium and Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
AttentionImpairedNormal (except in late stages)
p.50
Delirium in Older Adults

How does orientation vary in delirium compared to Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
OrientationFluctuatesPoor
p.50
Delirium in Older Adults

What are the speech characteristics in delirium versus Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
SpeechIncoherentMild errors
p.50
Delirium in Older Adults

How do thought processes differ between delirium and Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
Thought ProcessDisorganizedImpoverished
p.50
Delirium in Older Adults

What is the prevalence of illusions and hallucinations in delirium compared to Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
Illusions/HallucinationsCommon, often visualRare (except in late stages)
p.50
Delirium in Older Adults

How do perceptions differ in delirium and Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
PerceptionAlteredAltered or normal
p.50
Delirium in Older Adults

What are the psychomotor changes observed in delirium compared to Alzheimer's disease?

FeatureDeliriumAlzheimer's Disease
Psychomotor ChangePresentAbsent
Study Smarter, Not Harder
Study Smarter, Not Harder