Dementia

  • Dementia Definition

    Dementia is a gradual and progressive development of multiple mental problems.

    Dementia Characteristics
    Dementia involves both memory problems and a disturbance in at least one other area of mental faculty. Signs of dementia include behavior that poses a threat to the patient or those around him – such as refusal to eat or bathe, or outright aggression.

  • Dementia Assessment

    Executive Dysfunction
    Hospitalization of the older adult may uncover mental changes that had gone unnoticed. Executive function is a set of abilities that includes flexible thinking, idea formation and self-monitoring. Assessing executive function can help determine a patient’s ability to handle healthcare decisions and discharge planning. When there are problems with executive function, the older adult may have trouble with normal activities (for example, shopping, driving and medication management) even though memory problems are mild.

    Screening for executive dysfunction is intended for older adults who may not be exhibiting mental problems and where other tools may not pick up mental changes. Screening for executive dysfunction consists of three tests:

    Royall’s CLOX Clock Drawing: Patients must draw a clock set at 1:45 and copy a clock with all the numbers in place set at 1:45. Mistakes with the clock may indicate mental impairment. Individuals with only executive dysfunction make mistakes with the first clock only; mistakes with both clocks indicate wider problems.

    Controlled Oral Word Association Test: The older adult must fill in categories with words of at least three letters beginning with F, A and S. Patients with no metal problems can fill in at least ten words in one minute.

    Trail Making Test – The Oral Version: Individuals must count from 1 to 25 and recite the alphabet. The patient is then asked to pair the number with the corresponding letter from the alphabet, for example: “1-A, 2-B, 3-C.” More than two errors out of 13 indicate metal problems.

  • Mini Cog

    The Mini Cog is a quick test used by doctors and nurses to assess someone who seems to have the signs and symptoms of dementia. The Mini Cog only takes a few minutes to administer and can show that further tests are needed. The test consists of a three-item recall and a clock drawing test:
    1. The patient is asked to repeat three words.
    2. The patient is then asked to draw a clock.
    3. The patient is then asked to recall the three words.

    If the patient is unable to recall any of the three words then they are categorized as “probably demented.”

    If the patient draws a clock that is in any way wrong they are considered as “probably demented.” If the clock is normal then they are considered “probably not demented.”

    Emergency Department Dementia
    Behaviors that lead to Emergency Department admissions (for example, behavior that poses a threat to the patient or those around him – such as refusal to eat or bathe, or outright aggression) can be caused by dementia. It is important that testing be performed to understand the problems and the cause(s).

    Tests commonly used in the Emergency Department to test for dementia include the Clock Drawing Test, the Mini Cog and others.

  • Elopement

    Elopement “is when a patient wanders away, walks away, runs away, escapes or otherwise leaves a caregiving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge” (National Institute for Elopement Prevention and Resolution).

    The following are possible causes of elopement in older adult patients (GilbertGuide.org):
    • Memory loss
    • Physical needs (e.g. toileting)
    • Social needs
    • Insomnia
    • Side effects from medication
    • Confusion

  • Mittens

    Mittens

    Mittens may be considered restraints, depending on their use. Mittens are a type of soft restraint designed to restrict hand movement without damaging the skin. Mittens are sometimes used to prevent the confused, disoriented or combative patient from injuring himself/herself or others, or from removing equipment such as IV lines, catheters and tubes. They are considered to be less restrictive than other methods of restraint.

    Restraints, including hand mitts, should be used only as a last resort. Restraints cannot substitute for adequate nurse staffing or monitoring.

  • Dementia Therapeutic Activity Kits

    Links to things, people and events can help older adult patients with dementia. Activity Kits provide this link through the use of items that involve touch, hearing and vision. The kits can also help the patient connect with his or her caregivers.

    The activity kit may include:
    • Games
    • Audiotapes
    • Art supplies
    • Textured fabric
    • Cloth to fold
    • Tools
    • Key and lock boards

Links:

Dementia Link:

NICHE Dementia Need to Knows

Elopement Links:

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