Screening for Delirium, Dementia and Depression in Older Adults
Delirium Dementia and Depression spr 2011-1
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Transcript of Delirium Dementia and Depression spr 2011-1
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Delirium, Dementia andDepression
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DementiaMultiple cognitive deficits including: 1. Memory impairment 2. At least one of the following:
AphasiaApraxia
AgnosiaDisturbance in executive functioning
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Dementia contOnset: insidious
Duration: months to yearsUsually alertAffect: labile
Orientation: may get near miss answers
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DSM-IV criteria DementiaCriteria A 1. Memory impairment ( Asseen on MMSE)Criteria B 2. A,A,A, Impairment ExecutivefunctioningCriteriaC: Both memory impairment and
cognitive disturbances must be significantenough to cause a serious impairment insocial, or occupational functioning
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Types of Dementia
Senile dementia/ Alzheimers T ype (SDA T ) A. NF T are characteristic B. Dx confirmed post mortum C. Progressive slow decline D. 3X as many women than men
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Multi Infarct Dementia: Vascular Dementia A. Muliplt mini strokes B. Atherosclerotic plaques in bv, Diabetic
deterioration of bl vessels C. Stepwise progressive decline
D. Affects twice as many men as women
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Dementia secondary to other medicalconditions: PD can lead to irreversible dementia secondary
to dopamine insufficiency Huntingtons disease
B1 vitamin deficiencies usually secondary toET OH
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Differentiating Acute Deliriumfrom Chronic Dementia
Feature Delirium Dementia
Onset Acute InsidiousDuration Brief Chronic, unless
reversibleConsciousness fluctuates static
Orientation Abnormal Normal in mildcases
Memory Recent defective Recent/later lossInitial S T loss
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Delirium vs dementia contAttention Always
impairedMay be intact
Perception Freq. Disturbed Flat empty talk T hinking Disorganized,
contents richImpaired,contents empty
Judgement Poor poor Insight Present in lucid
intervalsMay be absent
Sleep Alwaysdisturbed
Variable
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Assessment toolsMMSE: Further eval if score < 25/30
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Assessment toolsPfeiffer Short Portable Mental StatusQuestionnaire: Further evaluation necessary if score is
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Assessment contFAST Functional Assessment Staging of Alzheimers Disease Identifies other causes of regression
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More AssessmentFunctional Rating Scale for Sx of Dementia T his questionnaire predicts clients appropriate
for NH placement. 83% of those appropriate have:
Incontinence of B&B Inability to speak coherently Inability to bathe and groom self
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Some stats1.5-2.3 million persons have mild to moddementiaCognitive impairment affects > 5% of thoseover 65 years., ~20% of those over 75Approximately 50% of nursing home
residents have irreversible dementia~70% of primary medical pt.s presentingwith cognitive deficits may have SDA T
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Intervention with confused pt.sValidation techniques should be employedBeliefs and values of validation: People are unique T here are reasons for disruptive behaviors Behavior reflects physical,social and psych
changes across the lifespan not just anatomicchanges
Behaviors can be changed only if a personwants to change
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Validation cont People must be accepted non-judgmentally When more recent memory fails, elders try to
restore balance to their lives by retrievingearlier memories
When a trusted listener acknowledges pain, pain diminishes
Empathy builds trust, reduces anxiety andrestores dignity
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DepressionDef: Alteration or disturbance of mood.Onset: recentDuration variableAlertness: diminished ability tocommunicateOrientation: Dont know answersAffect: Flat
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Depressive Disorders common inthe elderly
Major Depressive Disorder Dysthymic Disorder Mood disorder Due to General MedicalConditionAdjustment disorder with Depressive Mood
Depressive Disorder Not OtherwiseSpecified
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Differentiating Dementia fromDepression
Feature OrganicDementia
Depression
Onset Slow Rapid
Course Slow, worse atnight
Rapid anduneven same at
nightMemory Greater loss
recentApathetic Idont know
Orientation Approximate, perserverant
Apathetic asabove
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Affect Inappropriate Constricted
Neurovegetative signs
None Possiblesleep,appetite,
bowel or bladder, sex dys
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Factors leading to depression1. Grief/ bereavement2. Change in support network 3. Change in physical function
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Medical disorders causingdepressed mood
Occult malignancyInfectious processHypothyroidismApathetichyperthyroidism
Cushings syndromeAddisons disease
PanhypothyroidismParkinsonsDementing illnessCHFCRF
COPD
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Meds Asc. With depressed moodAntihypertensivesReserpineMethyldopaBeta blockersHydralazine
Histamine type IIReceptors/BlockersDigoxin
Oral hypoglycemicsCNS depressantsBarbituatesNeurolepticsOpiates
AlcoholSteroidsCytotoxics
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Depression Assessment toolsBeck- Long form cut off score of 10indicates depression. Short form is just asgood and takes just 5 minutes.Zung- self report. T he greater the score thegreater the depression. Not the best for
elderly since it was validated on collegestudents. 80 is the highest score and mostindicative of depression.
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Depression assessment toolscont
Geriatric Depression scale: a score of >8 is90%sensitive,80%specific for depression.A score of over 5 may indicate depression.Of the 30 items, one point is awarded for each response that matches the yes or no at
the end of the question.
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Holmes and Rahe SocialAdjustment Scale
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Why is the identification of depression so important?
Hip fracture outcomes, have been shown todepend on the absence or presence of depression.
~13-18% of the community dwelling elderly havedepressionElderly medical pts. ~ 20% are depressed!Suicide rates are disproportionately high among
the elderlyReport your potential findings to the team so thatthis disorder can be treated.