Increasing confusion in elderly clients can be puzzling, not only for them, but also for you as a caregiver. Establishing if their change in condition is permanent or an acute episode will help you to decide on the right approach and plan of action.

Knowing your client will give you some indication of their basic memory ability and general day to day functioning. This can be obtained from the client, their family and friends, and from other healthcare professionals providing them with care.

Types of Confusion

There are a number of things that could be causing the memory loss and confusion. Typical causes include dementia, acute illness and delirium.

Dementia can affect people differently, but generally it impacts a person’s ability to carry out activities of daily living. There can also be changes in their memory, personality and behaviour. Symptoms of this may include asking the same question repeatedly, getting lost in familiar places, being unable to follow directions and neglecting hygiene or nutrition.

Some acute illnesses have symptoms that may include confusion and memory problems. Conditions that may cause these symptoms include a high fever, urinary tract infections, dehydration or a reaction to medications. Confusion generally comes on suddenly in cases like this and is reversible once the underlying conditions is treated.

Delirium is a serious medical condition. Changes in perception, mood and activity is generally how it presents. Mostly delirium is reversible, but sometimes it can cause long-term irreversible damage. Although it is often associated with post-operative events, delirium can also be the result of a brain event such as stroke or unrecognised bleeding from a brain injury, sudden withdrawal from medication, or withdrawal after prolonged heavy alcohol and nicotine usage.

Immediate Steps

Having a baseline indication of the health and functional status of your client is essential. If you are concerned that your patient is becoming increasingly confused or displaying increased memory problems, ask yourself the following questions:

• Has the confusion come on suddenly or has it been building up over a longer period of time?
• Has your client had a recent illness or fall, been complaining about feeling unwell or have they had a marked decrease in fluid and nutrition intake?
• Does your client have an underlying chronic condition such as diabetes or high blood pressure?
• Has there been any recent changes to your clients medications?

If you suspect at any time that your client’s confusion and memory problems are the result of an acute medical episode consult the their doctor immediately.

Long Term Management

Amyloid plaques between neurons in the brain as seen in Alzheimer’s Disease.

If your client has been diagnosed with dementia increased confusion is a natural progression of this disease. They may also experience ‘sundowning’ (increased confusion in the evening). In managing patients with dementia and those with cases of acute confusion, there are techniques that you may be able to incorporate into their routine that might help with these episodes:

• Use clear concise instructions.
• Keep the patient’s home adequately lit during early evenings and use low-level lighting at night.
• Sensory impairments, like vision or hearing loss, should be aided with appropriate equipment such as hearing aids or spectacles.
• Limit the amount of noise, activities, visits and sensory input in the early evening hours.
• Familiar surroundings and objects such as treasured pictures can give reassurance.
• Do not restrain the client if they are restless, allow them to pace around the room under supervision.
• If they are able, a quiet walk outside may help with restlessness.

Memory loss and confusion were once considered a normal part of ageing. However, this is no longer the case with scientists finding that, although it may take little longer for people to remember things, older people can remain alert and capable as they age. When confusion and memory problems do set in, it is important to establish whether it is part of a deteriorating condition or the result of an acute illness.

Not all episodes of increased confusion and decreased memory will be reversible. In elderly clients, these symptoms may be part of an ongoing medical condition such as dementia. If there are ongoing repercussions from these episodes, then it is important that the clients healthcare plan is updated and adjusted accordingly. Make sure the client, as well as their support network, are informed appropriately so that your patient can receive the best care available.

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References

• Tamara G Fong, Samir R Tulebaev and Sharon k. Inouye, “Delirium in elderly adults: diagnosis, prevention and treatment” Nature Review Neurology Vol 5 April 2009
• Alzheimer’s Association America: Memory Loss and Confusion http://www.alz.org/care/dementia-memory-loss-problems-confusion.asp

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