Lesson 3 - Delirium and challenging behaviours

HLTENN045 - Implement and Monitor Care of the Older Person

Overview

• Focuses on the need for specialized care of the aging population at Swinburne University of Technology.

• Importance of understanding the unique health care needs of older individuals, especially those with cognitive impairments.

Key Statistics

• By age 85, individuals have a 24% chance of experiencing some form of cognitive impairment.

• Advancements in modern medicine have increased life expectancy, resulting in a population with a higher prevalence of dementia.

• The aging population in Australia necessitates additional health and community care services.

• A growing number of older individuals will require care, particularly as dementia prevalence increases.

Understanding Dementia

• Main Abilities Affected:

  • Judgement

  • Orientation

  • Emotions

  • Memory

  • Thinking

• Individuals with dementia may exhibit different behaviors due to varying degrees of brain damage.

• Each impact of dementia is unique to the individual, causing different behavioral reactions.

Delirium

• Definition: A serious cognitive condition characterized by disturbances in attention, perception, awareness, and cognition.

• May result from various factors such as medical conditions, medications, or intoxicating substances.

• Types of Delirium:

  • Hyperactive Delirium: Involves increased activity, agitation, aggressiveness, hallucinations.

  • Hypoactive Delirium: Characterized by decreased activity and may often go unnoticed.

  • Mixed Delirium: Combines features of both hyperactive and hypoactive delirium.

Impact of Delirium

• Higher rates of delirium are observed in older adults in surgical, palliative, and intensive care settings.

• Patients may exhibit persistently delirious symptoms even post-discharge, and about 30-40% of delirium cases may be preventable.

• Consequences of delirium include increased risk of cognitive decline, elevations in hospital stay lengths, and higher mortality rates.

Challenges in Recognition

• Delirium is often unrecognized by healthcare providers.

• Inaccurate labeling can lead to a misdiagnosis of patients with dementia or delirium as merely ‘demented.’

• Common factors for missed delirium diagnoses include inadequate cognitive testing upon admission and fluctuating symptoms.

Management of Delirium

• Must be treated as a medical emergency with prompt recognition.

• Involves investigating and addressing medical causes, utilizing pharmacological and behavioral management strategies, and providing reassurance for the patient and family.

Understanding Behavioral and Psychological Symptoms of Dementia (BPSD)

• BPSD affects 70-90% of individuals with dementia, causing stress for healthcare providers and families.

• Symptoms include apathy, aggression, agitation, depression, anxiety, and psychosis.

Aggression in Dementia

• Causes may be linked to the individual's health history, environmental factors, task-related issues, and communication barriers.

• The ABC model can assist in understanding behaviors:

  • A: Activating Event

  • B: Behavior

  • C: Consequence

Communication Strategies

• Effective communication with dementia patients includes maintaining a respectful tone, ensuring visual clarity, minimizing distractions, and adopting appropriate body language.

• Use simple language, avoid baby talk, and confirm understanding through paraphrasing.

• Non-verbal cues are crucial; individuals may sense body language and tone more than words.

Stress Responses in Staff

• It’s essential for staff to manage their own reactions during aggressive episodes. Inner calm and focusing on the situation are vital.

• Training in stress management and team dynamics can help prepare staff for high-pressure interactions and maintain safety.

Addressing Aggression

• Proper posture, personal space maintenance, and environment control are key in handling aggression in dementia patients. Aggressiveness requires careful management that prioritizes safety for all involved.

Conclusion

• Understanding the complexities of dementia, delirium, and BPSD is vital for providing quality care to older adults. Empowering care staff with education on these conditions can improve patient outcomes and enhance the quality of care delivered.