Cognitive Assessment and Delirium in Older Adults

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Questions and Answers

Which of the following is NOT a component of cognitive assessment?

Attention and concentration

Patient's physical health evaluation (correct)

Clock Drawing Test

Memory assessment

What is a common etiology of delirium?

Severe allergic reactions

Exposure to high altitudes

Disturbances in neurotransmitters (correct)

Chronic stress conditions

Which tool is specifically used to assess depression in older adults?

Clock Drawing Test

Mini-Cognition

Mini-Mental State Exam

Geriatric Depression Scale (correct)

What percentage of older adults in the ICU may experience delirium?

90% Signup and view all the answers

Which of the following best describes delirium?

A rapid onset with fluctuating symptoms Signup and view all the answers

Which of the following factors can influence access to dementia services?

Language barriers Signup and view all the answers

Which of the following medications is classified as a cholinesterase inhibitor?

Galantamine (Reminyl) Signup and view all the answers

Which demographic group is more commonly associated with vascular dementia?

People from Africa and South Asia Signup and view all the answers

What is true about Lewy Body Dementia (LBD)?

It can include dementia with Lewy bodies and Parkinson’s disease dementia. Signup and view all the answers

What is a common treatment for Lewy Body Dementia that can offer symptomatic benefits?

Cholinesterase inhibitors Signup and view all the answers

What is one of the major predisposing factors for delirium in older adults?

Age 65 years or older Signup and view all the answers

Which of the following is NOT a precipitating factor for delirium?

Weekly exercise regime Signup and view all the answers

Which clinical subtype of delirium is characterized by reduced responsiveness?

Hypoactive delirium Signup and view all the answers

What consequence of delirium might increase the length of hospital stay?

Functional decline Signup and view all the answers

Which of the following factors is associated with medications that can precipitate delirium?

Multiple psychoactive medications Signup and view all the answers

What negative consequence can occur as a result of delirium, aside from cognitive decline?

Increased postoperative complications Signup and view all the answers

Which factor contributes to a lack of recognition of delirium in healthcare settings?

Inadequate education about delirium Signup and view all the answers

Which of the following describes a demographic characteristic that is a risk factor for delirium?

Age 65 years or older Signup and view all the answers

What is the first step when approaching a person who is wandering?

Gently touch their arm or shoulder Signup and view all the answers

What should you avoid doing when a person is expressing their wandering agenda?

Belittling their concerns Signup and view all the answers

If verbal redirection fails, what is the recommended action?

Continue walking and allow control Signup and view all the answers

Why are caregivers of individuals with dementia often at a higher risk for health problems?

They experience higher levels of stress Signup and view all the answers

What could be a beneficial environmental modification for individuals with dementia?

Special care units in institutional settings Signup and view all the answers

What is the significance of registering a person with dementia in a program like Safely Home®?

To have a plan in case they become lost Signup and view all the answers

What characterizes delirium in older adults?

Rapid onset usually over hours or days Signup and view all the answers

What is typically true for most Canadians living with dementia?

They reside in community settings Signup and view all the answers

Which of the following statements about dementia is accurate?

It has a gradual onset with a steady pattern of cognitive decline. Signup and view all the answers

Which of the following is a common response to environmental alterations for dementia care?

Fewer distractions to enhance focus Signup and view all the answers

What is a common concern when caring for persons with dementia?

Nursing assessments can be intrusive and intimidating. Signup and view all the answers

Which nursing model is appropriate for managing cognitive impairment?

A personalized care plan tailored to the cognitive abilities of the patient. Signup and view all the answers

How should nurses approach cognitive assessment in older adults?

Nurses need to have skills to minimize patient stress during assessment. Signup and view all the answers

What is one of the primary benefits of engaging in therapeutic activities for older persons?

Cognitive stimulation and social interaction Signup and view all the answers

What is one of the identified primary emotional challenges for family carers in the early stage of memory loss?

Accepting the prognosis Signup and view all the answers

Which intervention is recommended for providing care related to activities of daily living (ADLs)?

Encouraging self-care and making bathing areas comfortable Signup and view all the answers

What should caregivers prioritize when assessing pain in older persons?

Conduct a comprehensive pain assessment Signup and view all the answers

How can caregivers predict wandering behaviors in older persons?

Through careful observation of the person's patterns Signup and view all the answers

What is NOT recommended when providing care for bathing to older persons?

Making bathing areas unsafe to promote compliance Signup and view all the answers

What is a key factor that contributes to preventing excess disability among older persons?

Engaging in regular exercise Signup and view all the answers

What should caregivers do when a person refuses participated care?

Explain all actions and respect their choice Signup and view all the answers

Study Notes

Ebersole and Hess' Gerontological Nursing & Healthy Aging in Canada (3rd Edition) - Chapter 21: Cognitive Impairment

Learning Objectives (1 of 2): Differentiate between dementia, delirium, and depression; Discuss different types of dementia and appropriate diagnoses; Describe nursing models of care for people with dementia and cognitive impairment.
Learning Objectives (2 of 2): Discuss common concerns in caring for people with dementia; Develop a nursing care plan for a person with delirium; Develop a nursing care plan for a person with dementia.

Overview of Cognitive Impairment

Cognitive Assessment: Older adults with changes in cognitive function need thorough assessments to identify potential pathological conditions. Nurses must possess skills to recognize and monitor cognitive impairment.
Considerations: Cognitive impairment can be a stressful experience for older adults, sometimes perceived as intrusive, intimidating, fatiguing, and offensive. Timing of assessments and interventions is crucial.

The Three Ds

Delirium, Dementia, and Depression: Not normal consequences of aging. Can be difficult to diagnose. Delirium has a rapid onset (hours to days), while dementia involves a gradual decline.

Screening for Cognitive Impairment

Components of a Cognitive Assessment: Includes level of consciousness (LOC), orientation (person, place, time), memory (various types), attention/concentration, abstract reasoning, and problem-solving.
Assessment Tools: Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), Clock Drawing Test (CDT), Mini-Cog, Confusion Assessment Method (CAM and CAM-ICU).

Delirium

Characteristics: Characterized by a rapid onset and fluctuating course. Symptoms include disturbances in consciousness and attention, and changes in cognition.
Etiology: Thought to be related to disturbances in brain neurotransmitters, poor cerebral blood flow, or a complication of a medical illness, medication or substance use, or surgical procedures (especially with general anesthesia).

Delirium: Incidence, Prevalence and Recognition

Prevalence: Delirium affects up to 20% of older adults in emergency departments (EDs), more than 50% in hospitals and up to 90% in intensive care units (ICUs).
Recognition: Often, delirium goes unrecognized by healthcare providers. Contributing factors include inadequate education about delirium, the lack of formal assessment methods, and ageist attitudes.

Risk Factors for Delirium (1 of 2)

Predisposing Factors: Demographic characteristics (age 65+, male sex), cognitive status (dementia, cognitive impairment, history of delirium, depression), functional status (dependence, immobility, low activity), sensory impairments (visual or hearing), decreased oral intake leading to dehydration/malnutrition, medications (especially multiple psychoactive meds), and co-existing medical conditions.

Risk Factors for Delirium (2 of 2)

Precipitating Factors: Medications (sedative hypnotics, narcotics, anticholinergics, multiple medications, alcohol withdrawal), primary neurological diseases (stroke, intracranial bleeding, meningitis), intercurrent illnesses, surgery, environmental factors (ICU admission, physical restraints, bladder catheter), pain, and prolonged sleep deprivation.

Clinical Subtypes and Consequences of Delirium

Clinical Subtypes: Hypoactive, hyperactive, mixed.
Consequences: Significant distress for everyone involved (including the patient), high morbidity and mortality, functional decline, increased postoperative complications, increased length of hospital stay, increased hospital readmissions, long-term cognitive decline, and high rates of institutionalization.

Implications for Gerontological Nursing and Healthy Aging

Assessment: Assess the person's usual mental status, conduct a formal assessment for possible delirium upon admission to a hospital, and routinely complete the Confusion Assessment Method (CAM).
Intervention: Interventions should be tailored to individual risk factors. Nonpharmacological interventions (e.g., Hospital Elder Life Program (HELP)) are often effective.

Overview of Dementia

Definition: An irreversible state that progresses over years.
Prevalence: Alzheimer's type is the most common type. About 1% of Canadians between 65 and 69 years have dementia, and the prevalence reaches 25% for those over 85. Prevalence increases with age. Projected figures of over 912,000 cases of Alzheimer's in 2030.
Clinical Features: Aphasia, apraxia, agnosia, and disturbances in executive functioning (planning, organizing, sequencing, abstracting).

Types of Dementia

Primary: Progressive disorders caused by pathological conditions of the brain.
Secondary: Produce pathological brain conditions as a result of other conditions.
Mixed: Combination of conditions like Alzheimer's disease, vascular brain changes, or prior alcoholism.

Alzheimer's Disease

Characteristics: A cerebral degenerative brain disorder of unknown origin, destroys nerve cell proteins, characterized by neurofibrillary tangles and plaques in the brain, causing shrinkage to roughly one-third of normal brain weight.
Diagnosis: Only confirmed through brain biopsy or autopsy. Probable diagnosis is based on clinical presentation, onset pattern, and exclusion of other possible causes of cognitive deficits; symptoms typically present for several years before diagnosis
Cultural Differences: Research shows some ethnic minorities are under-represented in seeking and receiving dementia services.
Medication Treatment: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and N-methyl-D-aspartate (NMDA) antagonists (memantine) are used.

Vascular Dementia

Characteristics: Heterogeneous disorders caused by cerebrovascular insufficiency or damage (ischemic or hemorrhagic). More common in people of African and South Asian descent. Associated with aging, male gender, and stroke; often co-exists with Alzheimer's.

Lewy Body Dementia

Characteristics: Most common form of degenerative dementia, highly underdiagnosed, varying disorders spectrum including Dementia with Lewy Bodies (DLB) or Parkinson's Disease Dementia (PDD).
Treatment: No specific medications are approved; but Cholinesterase inhibitors may provide symptomatic benefits.
Symptoms: Cognitive fluctuations, unpredictable changes in concentration & attention, hallucinations, Parkinsonian symptoms, REM sleep behavior disorder, and severe sensitivity to neuroleptics.

Frontotemporal Dementia

Characteristics: A clinical syndrome associated with shrinking of the anterior frontal and temporal lobes of the brain. Typically affects people between 52-56 years; often found in other family members.
Symptoms: Changes in personality and inappropriate/bizarre social behavior
Treatment: Aimed at managing behavioral symptoms, compensating for functional decline, and supporting family caregivers.

Implications for Gerontological Nursing & Healthy Aging (continued)

Person-Centered Care: Focus should be on the individual and relationship with the family caregiver, addressing their needs, and enhancing their well-being & quality of life.

Interventions for Mild Cognitive Impairment & Early Memory Loss

Early Interventions: Earlier diagnoses enable beginning pharmacological and psychosocial interventions. Three primary emotional challenges for family caregivers include accepting the diagnosis, accepting the prognosis, and relinquishing the former relationship with the patient.
Care Concerns: Care concerns often include nutrition, ADLs, maintaining health & function, safety, communication, and caregiver needs

Providing Care for Activities of Daily Living (ADLs)

Bathing: Assess and respect lifetime preferences, and provide care only when the person is receptive; encourage self-care where possible; make bathrooms/shower areas safe, comfortable, and warm; alternative methods may need consideration, such as towel baths.

Wandering (1 of 3)

Behaviors: Wandering may lead to falls, elopement, eating/care routine issues, and interference with others' privacy.
Observation: Behaviors can often be predicted with careful observation.
Interventions: Approach the person, make direct eye contact (unless the person sees it as threatening), gently touch, use their name, and actively listen to their concerns.

Wandering (2 of 3)

Emotional Needs: Identify underlying emotional needs, the plan of action, and their agenda.
Respond to Feelings: Calmly respond to expressed emotions and needs.
Reassurance: Repeat words/phrases if needed for distraction or reassurance. Avoid arguing or correcting if it escalates distress. Direct them to more positive/familiar, non-threatening areas

Wandering (3 of 3)

Interventions (continued): Attempt to reorient the person if possible but acknowledge the need for safety; involve backup carers or staff; recognize the time-limited nature of the behavior; and consider programs like Safely Home® for lost persons.

Environmental Alterations & Family Caregiving

Environmental Modifications: Modify both home and institutional settings to support people with dementia.
Special Care Units: Facilities often have established special care units (SCUs) to meet the needs of people with dementia.
Caregiver Burden: Caregivers of people with dementia experience more adverse consequences than care givers of people with other chronic illnesses with increased rates of depression and health problems.

Family Caregiving for Persons with Dementia

Community-Based Care: Most Canadians with dementia live in the community and commonly rely on family or friends for care.
Caregiver Burden: Caregivers spend approximately 26 hours per week and on average, $4,600 a year for out-of-pocket expenses supporting their loved ones.
Effective Interventions: Caregiver intervention programs that include bundled interventions are effective strategies.

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Description

Test your knowledge on cognitive assessment components, the etiology of delirium, and the specific tools used to evaluate mental health in older adults. This quiz covers topics such as delirium symptoms, risk factors, and common treatments for various types of dementia. Perfect for students or professionals in geriatric care.