The 3 D’s: Delirium, Dementia, and

DepressionSusan E. DeRosa, MS RN GCNS-BC

November 27, 2012

Genesee Valley Nurses Association

Objectives

• Define Delirium, Dementia, and Depression

• Describe the signs and symptoms of the 3 D’s in the older adult

• Identify the nurse’s role in identifying risk and interventions

It seems so basic…

• Individualized care

• Knowing the baseline

• Listening

• Consistency

Impact from any one of the 3 D’s

• Health care economics

• The older adult

• The family

• The primary care provider and staff

Delirium is a medical emergency!

S & S of Delirium

• Acute onset

• Inattention

• Disorganized thinking

• Altered state of consciousness

Risk Factors for Delirium

• 75 years or older

• Dementia

• Infection

• Polypharmacy

• Poor sleep

• Relocation

• Electrolyte imbalance

• Surgery

Confusion Assessment Method (CAM)

acute onset & inattention

plus either or both…

disorganized thinking

altered level of consciousness

Delirium Interventions

• Review of meds

• Pain management

• Sleep quality

• Fluids/nutrition

• Sensory aids

• Physical and mental activity

• Family involvement

• NO restraints

What could you do instead of this phone call?

Expected Outcomes

• Absence of delirium

• Cognitive status returned to baseline

• Functional status returned to baseline

• Discharged to same destination at pre-hospitalization

Alzheimer’s Dementia

• Slow onset-over years

• Stable symptoms

• Persistent memory changes

• Alert and stable level of consciousness

• Sleep fragmented

Alzheimer’s DementiaProposed Stages

• Preclinical

• Mild cognitive impairment

• Dementia-includes the current stages of mild, moderate, and severe

Risk Factors for Dementia

• Advancing age, but not normal aging

• First degree relative

• Apolipoprotein e4 (APOE-e4) gene

• Mild cognitive impairment with memory problems

• Cardiovascular disease risk factors

• Social engagement and diet

• Head trauma and traumatic brain injury

Mini-Cog Assessment

• Composed of 3 item recall and Clock Drawing Test

Intervention for Alzheimer’s Dementia

• Individualized

• Pre-planning

• Change of intervention with disease progression

• Appropriate use of tx options

• Good management of coexisting conditions

• Coordinated care with related communication

Expected Outcomes

• Older adult independent & functional in environment of choice for as long as possible

• Co-morbid conditions well managed

• Distressing symptoms minimized & controlled

Depression

• Syndrome with multiple causes with symptoms of affective, cognitive, somatic and/or physical manifestations

S & S of Depression

• Mood change

• Loss of interest

• Weight gain or loss

• Sleep disturbance

• Fatigue and loss of energy

• Diminished concentration

• Suicidal thoughts

Risk factors for Depression

• Alcohol/substance abuse

• Co-morbid conditions

• Functional disabilities

• Social isolation

• Loss

• Side effect of medications

Interventions for Depression

• Monitor & promote nutrition, elimination, sleep/rest patterns, pain management

• Promote physical function

• Social support

• Maximize self efficacy

• Structure of daily activities

• Safety precautions as necessary

Expected Outcomes

• Safety maintained

• Reduction in symptoms

• Daily function improves

Barriers to Implementing the Care Plan

Resources

www.consultgerirn.org geriatric protocols.

On this site you will find the “Try This” series:

– Confusion Assessment Method

– Geriatric Depression Screen

– Assessing and Managing Delirium in Persons with Dementia

– Mental Status Assessment of Older Adults: the Mini-Cog