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Indicators for Dementia, Depression and Delirium

March 19, 2015 0 Comments

Screen for Dementia, Delirium and DepressionElderly clients are at a higher risk of Depression, Dementia (chronic) and Delirium (acute). To effectively treat these disorders, correct diagnosis is required.

“15-30% of elderly clients will experience delirium upon admission to a medical facility while more than 55% will develop delirium during their stay.”
National Centre for Biotechnology Information

Depression

When evaluating your client for depression, it is important to assess their cognitive status and ability to perform Activities of Daily Living (ADL) well. ADL includes tasks like:

  • bathing,
  • dressing,
  • moving around, and
  • using the bathroom.

Collect as much information as possible from the client’s family, however bear in mind that feedback on your client’s cognitive ability may be misconstrued, and in some cases exaggerated or played down. It is helpful to regularly observe your client’s movements throughout their stay.

“In 2012, more than 50% of permanent aged care client’s showed symptoms of depression.”
Australian Institute for Health and Welfare (AIHW)

Clients who are experiencing memory impairments should be screened for depressive symptoms as well. It’s possible they could be suffering from the disorder, pseudodementia, which is a cognitive disorder caused by depression. Be on the look out for major depressive disorder. This is a disorder which usually affects 1-2% of elderly clients within a facility. Some symptoms would be an inclination to commit suicide and underlying medical problems. Major depressive disorders can affect clients who have gone through critical illnesses such as cancer and coronary strokes.

Dementia

Dementia is an age-associated disorder which becomes more prominent as people age. In elderly people aged 70-80, an estimated 5-10% people are suffering from dementia. For those in their 90’s, around 30-40% are affected with the disorder.

“One in every four people over the age of 85 has dementia.”
FightDementia.Org.Au

The large majority of elderly people suffering from dementia are often unaware of their disorder. As dementia most often begins slowly, family members might notice a few changes in their loved one’s actions, however most signs go unnoticed until the condition is advanced.

Dementia is most often a symptom of a disease such as Alzheimer’s, vascular dementia, lewy body dementia, frontotemporal dementia or a related disorder.

Some symptoms of dementia include:

  • poor hygiene,
  • an inability to find the right words to express themselves,
  • missed appointments,
  • difficulty remembering instructions and,
  • on some occasions, car accidents.

Delirium

“Studies show that 30% to over 65% of individuals with delirium go undetected.”
Age and Ageing

Delirium or an acute confusional state is often understated. It is best to screen clients for Delirium when they have an apathetic or lethargic mood. Research show that 20-30% of elderly clients are affected with Delirium. This can cause longer hospitalisation and high mortality rates.

Delirium is usually a sudden change in a condition. One day, your client is exhibiting behaviour that is normal according to their personality or condition, and then suddenly they are unstable, confused and struggling to perform Activities of Daily Living (ADL).

Most often Delirium is a symptom of a specific illness. Your client could have a condition that you are unaware of, such as a urinary tract infection, or even dehydration. Also be aware that some medications or substances when paired together can cause Delirium. For this reason you need to know exactly what medications, supplements, vitamins, or even alcoholic beverages your client is taking. If a Delirium presents then you can pass this information on to the doctor.

Screening for Depression, Dementia and Delirium

Dementia, Delirium and Depression are factors that will affect elderly clients at some point. Because of this and the rising elderly population, it is required in aged care facilities to properly screen and diagnose clients with these disorders. Knowing if Delirium is present allows the doctor to prescribe appropriate treatment, leading to a faster recovery.

“In 2004, statistics showed a 13% increase in the elderly population. This expected to rise to 20% after 20 years (2024).”
NSW Agency for Clinical Innovation

Identifying if a person with Dementia has Delirium can prove challenging – particularly if the client is new to you. According to a study by Fick and Mion, approximately 22% of older adults in the community with Dementia develop Delirium. And 89% of people who have Dementia and are hospitalized develop Delirium.

When screening clients for Depression, Dementia or Delirium, a sudden mood change is one suggestive indicator of Delirium – perhaps your client suddenly becomes resistive to care. Major over-reactions to situations can also point to Delirium.

Other signs of Delirium can include an inability to speak coherently, increased agitation (hyperactivity) or extreme lethargy and lack of response, an inability to focus and maintain attention, and fluctuations in alertness. Memory is usually less affected in Delirium, but can be present with Dementia.

If Delirium has been ruled out after screening, Depression would be a practical consideration. And, clients with Dementia are less likely to communicate any cognitive changes than those with Depression.

Filed in: Care Tips

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