OT 504 Week 3 LG 2 Flashcards (Major NCD Models & Delirium)

What is Dementia-Friendly (DF) care?

Approaches that include and involve people living with dementia within their communities and wider society.

What is the goal of dementia-friendly care?

Promote inclusion, participation, and quality of life for people living with dementia.

What does COPE stand for?

Care of Older Persons in their Environment

What are the goals of COPE?

Maintain/improve quality of life, help care partners manage daily care challenges, and reduce caregiver distress

What cognitive strategy is included in COPE?

Tailored Activity Program (TAP).

What caregiver support is included in COPE?

Teaching communication skills and strategies to manage behavioral and psychological symptoms.

What environmental intervention is included in COPE?

Home safety strategies and environmental modifications.

What does TAP stand for?

Tailored Activity Program

What is TAP?

A home-based OT intervention designed to reduce behavioral symptoms and caregiver burden

What has research shown about TAP?

It reduces behavioral symptoms and caregiver burden in people with dementia.

Why are environmental modifications used in dementia care?

To improve behavior, safety, orientation, and participation.

Give examples of environmental modifications for dementia.

Monitoring devices, concealed doorknobs, wall murals, improved visual access to amenities, and adaptations for perceptual changes

How can environmental noise regulation help people with dementia?

Reduces distractions and promotes engagement.

What is Snoezelen®?

A multisensory intervention used in dementia care.

Why use ambient music in dementia care?

To support mood, comfort, and engagement

What does CST stand for?

Cognitive Stimulation Therapy.

What is CST?

A structured group or one-on-one program using cognitive exercises and social interaction.

Examples of CST activities?

Sequencing cards, games, life stories, creative activities, and communication exercises.

What does CST aim to improve?

Cognitive challenge, communication, relationships, and engagement.

What is Hogewey in the Netherlands known for?

A dementia village ("Dementiaville").

What are key features of a dementia village?

Independent living, minimal medication use, maintenance of valued ADLs/IADLs, and trained caregivers acting as residents.

What does PACE stand for?

Program of All-Inclusive Care for the Elderly

What is the goal of PACE?

Support independent living for older adults.

Examples of dementia-friendly interventions in the U.S.?

Memory cafés, light therapy, music therapy, art therapy, storytelling, and gardening.

What is one major characteristic of delirium?

Acute, dateable onset.

Is delirium reversible?

Usually treatable and reversible.

Common causes of delirium?

Post-surgical complications, dehydration, lack of nutrients, medication toxicity, and illness

Key cognitive symptom of delirium?

Difficulties with attention and concentration

What does "waxing and waning" mean?

Symptoms fluctuate dramatically over hours.

Other symptoms of delirium?

Changes in alertness, awareness, agitation, and psychotic symptoms.

Which type of delirium is most common?

Hypoactive delirium.

Characteristics of hypoactive delirium?

Appears dazed, withdrawn, or "out of it"; often difficult to diagnose

Characteristics of hyperactive delirium?

Restlessness, agitation, mood swings, and delusions.

Which type of delirium is easiest to recognize?

Hyperactive delirium.

What is mixed delirium?

Alternating hypoactive and hyperactive symptoms.

Four delirium assessment tools discussed in class?

4AT, CAM, CAM-S, and DRS-R-98.

Why aren't MoCA and SLUMS ideal for delirium?

They are often too long for individuals with delirium.

what does 4AT stand for?

4 A's Test

What does the 4AT screen for?

Delirium.

How many questions are in the 4AT?

Four.

What four areas does the 4AT assess?

Alertness, AMT4, attention, and acute change/fluctuating course.

What is the scoring range for the 4AT?

0–12 points.

What does a 4AT score of 0 indicate?

Delirium and severe cognitive impairment are unlikely.

What does a 4AT score of 1–3 indicate?

Possible cognitive impairment. This may suggest dementia or another chronic cognitive condition, although delirium is not completely ruled out.

What does a 4AT score of 4 or more indicate?

Delirium is strongly suggested and requires further assessment, investigation, and management.

What does CAM stand for?

Confusion Assessment Method.

Purpose of CAM?

Allows clinicians to identify delirium quickly and accurately.

Can CAM be used by non healthcare workers?

Yes, CAM can be used by trained non-healthcare workers to identify signs of delirium.

What does CAM-S measure?

Severity of delirium symptoms.

which is shorter CAM-S or CAM?

CAM-S is shorter than CAM.

Can CAM-S diagnose delirium?

No, it must be used with CAM.

How long does the CAM-S short form take?

Less than 5–10 minutes.

What does DRS-R-98 stand for?

Delirium Rating Scale-Revised-98

Purpose of DRS-R-98?

Initial assessment and repeated measurement of delirium severity.

How many severity items are included in DRS-R-98?

13 severity items.

What information sources are used in DRS-R-98 scoring?

Patient examination, nurses, family members, and chart review

What is the score range for the Severity Scale?

0–39 points

What is the score range for the Total Scale?

0–46 points.

What are the 13 severity items on the DRS-R-98

• Sleep-wake cycle disturbance

• Perceptual disturbances/hallucinations

• Delusions

• Lability of affect

• Language

• Thought process abnormalities

• Motor agitation

• Motor retardation

• Orientation

• Attention

• Short-term memory

• Long-term memory

• Visuospatial ability

How are hallucinations scored on the DRS-R-98?

Hallucinations receive the highest score (3 points).

What is the difference between illusions and hallucinations?

Illusions are misinterpretations of real stimuli; hallucinations occur without an external stimulus.

What score indicates delusional thinking?

3 points

What language problems may be seen in severe delirium?

Word salad, muteness, nonsensical speech, or severely reduced comprehension.

What thought-process abnormality receives a score of 1?

Tangential or circumstantial thinking.

What thought-process abnormality receives a score of 3?

Loosely connected associations most of the time

What is motor agitation?

excessive motor activity such as pacing, fidgeting, pulling IV lines, or combativeness

What is motor retardation?

Slowed voluntary movement and decreased spontaneity of movement.

How is orientation scored on the DRS-R-98?

• 0 = Oriented to person, place, and time

• 1 = Disoriented to time OR place

• 2 = Disoriented to both time and place

• 3 = Disoriented to person

What is a hallmark cognitive deficit in delirium measured by the DRS-R-98?

Impaired attention

What score indicates severe attention impairment?

Inability to sustain attention, many incorrect responses, inability to follow instructions, or extreme distractibility (3 points)

How is short-term memory assessed?

Recall of information after a 2–3 minute delay.

How is long-term memory assessed?

Recall of personal history, general knowledge, or information after a delay of at least 5 minutes

How can visuospatial ability be tested?

Drawing, copying designs, arranging puzzle pieces, map drawing, or observing navigation abilities.

What are the 3 optional diagnostic items?

• Temporal onset of symptoms

• Fluctuation of symptom severity

• Physical disorder causing symptoms

What score indicates an abrupt change in behavior occurring over hours to one day?

3 points

Why is temporal onset important for delirium diagnosis?

Delirium typically develops acutely over hours to days.

What feature is characteristic of delirium and measured by Item 15?

Fluctuation of symptom severity throughout the day

What score indicates symptom severity fluctuates over minutes?

2 points.

Why is the physical disorder item included?

To determine whether a medical condition, infection, medication, metabolic disorder, or CNS lesion is causing the symptoms.

What is the key difference between the 4AT and DRS-R-98?

• 4AT: Rapid screening tool for delirium.

• DRS-R-98: Comprehensive clinician-rated assessment used to diagnose delirium and track symptom severity over time

What are the three major treatment targets in delirium?

Precipitating factors, impaired connection to context, and misinterpretations/distress.

what are Precipitating factors?

Factors that contribute to the onset of delirium, such as infections, medications, or environmental changes.

Can delirium continue after the cause is treated?

Yes, it can persist for weeks.

How can OT support reorientation?

Orient the client to time, date, location, and situation.

What are cognitive anchors?

Familiar cues that help clients reconnect to their community and feel secure.

What does the letter "F" stand for in delirium intervention?

Familiar and Favorite.

Examples of "Familiar and Favorite"?

Family, friends, familiar surroundings, favorite foods, smells, and TV shows.

What routines should OT help re-establish?

Physical activity, meals, hydration, ADLs, and sleep-wake cycles

What should OT do for hypoactive delirium?

Increase alertness

Why is positioning important?

Prevent edema and pressure injuries

What is polysensory stimulation?

Intense external stimulation to increase alertness

Examples of cognitive stimulation interventions?

Sequencing cards, dominoes, memory games, and visuospatial activities.

How can OT address sensory deficits?

Encourage use of glasses and hearing aids.

Additional OT interventions for delirium?

ADL training and caregiver education

What should you do during a treatment session?

Build rapport, adapt communication, explain at the patient's level, maintain flow, and close effectively

Environmental management responsibilities?

Proper setup, adaptation to space, and ensuring patient safety.

What demonstrates good clinical reasoning?

Activities are appropriately challenging and graded as needed.

What makes a treatment client-centered?

Activities reflect the client's needs, desires, and occupations.

Evidence-based interventions for major NCD?

Multi-modal interventions, social engagement, exercise, sleep interventions, and activity modification.

Three common activity modification strategies?

Task simplification, prompting, and errorless learning