What’s the difference, and strategies to help
the patient and caregiver
Definition
 Delirium
 Disturbance of consciousness with reduced ability to focus,
sustain, or shift attention
 A change in cognition, a perceptual disturbance not
accounted for by preexisting, established or evolving
dementia
 Occurs over a short time period and fluctuates during the day
 Has a causal component
 Dementia
 Chronic acquired decline in memory and at least on other
cognitive function
 Decline usually evident over longer periods with mild to
severe cognitive decline, hallucinations, and delusions
Delirium vs. Dementia
Delirium
 Acute
 Reversible
 Consciousness: fluctuating
 Decreased awareness of self
 Perceptions: illusions,






hallucinations common
Speech: slow, incoherent
Disorientation: time, others
Cognitive dysfunction
Illness, med. toxicity: often
Diurnal disruptions
Outcome: excellent if
corrected early
Dementia











Gradual
Irreversible
Consciousness: rarely alters
Decreased awareness of self
Perceptions: Hallucinations
not common
Speech: repetitive difficulty
finding words
Disorientation: time, person,
place
Memory impairment
Illness, med. toxicity: rarely
Diurnal disruptions
Outcome: poor
Delirium
 A medical emergency
 Triggered by
 Oxygen deprivation
 Drug use/poisons, meds
 Infections, recent surgery, or trauma
 Severe chronic illness
 Electrolyte imbalances
 Pre-morbid brain conditions, and functional status
 Preexisting cognitive impairment
 Old age/ sensory losses
Prevention
Risk factors
Intervention
 Cognitive impairment
 Routine mental status
 Dehydration/electrolyte
imbalance
 Sensory deprivation/ sleep
disturbances
 Pharmacy
assessment, staff education
 I&O, skin assessment, early
recognition
 Non pharmacologic sleep
aids, decreased noise and
light at night, frequent rest
periods, daytime activities
 Staff education of medication
side effects, pharmacy liaison,
start low go slow
Dementia
C
Comes on over time, short term memory
loss
loss becomes evident

May progress slowly or quickly
 May affect younger persons as well as elderly
 Different kinds of dementia
 Treatment generally depends on the stage/ severity of
the disease
 Becoming old doesn’t mean you will develop dementia
 Is terrifying while the client is still able to realize that
they are not thinking properly
Communication
 Is often what relationships are built on
 When communication
becomes faulty our
relationships crumble
 Our communication
strategies can help an
older adult with advancing
dementia feel safe, less
anxious, and less likely to
become upset or aggressive
Getting their attention
 Gain the persons attention
 Turn off extraneous noise
 Stand in front of the person and
maintain eye contact
 Go slow, direct and redirect their
attention
Be aware of your tone of voice
 Do not shout!
 Do not speak in a condescending
tone
 Speak slowly
Take care with your use of language
 Use adult language
 Concrete simple language, short phrases
 Be positive and reassuring
 Don’t talk about the person as if they
weren’t there
Try yes or no questions
 Use 2 choice questions like do you
want juice or soda?
 Are you hungry?
 Are you tired?
 Can I read to you?
Repeat rephrase and repair:
 This is a difficult strategy but is helpful to maintain
conversation and helps fill in the missing information
the person with dementia may omit
 Repeating-helps fill in speech Ex: I want a cup of…. If
you repeat this the elder may add the word coffee, water
or juice
 Rephrasing- helps the person hear the corrected
response if they say juice you might point to a juice
container and say I want a glass of juice
 Repairing-uses both tactics to fix or fill in missing
information for example a person points at a pantry
cabinet and says, “look there.”, you might say, “your
Hungry?”
Orient and reorient frequently
 Use visual aids
 Make sure they have hearing aids or
glasses if they need them
 Calendars and message boards
 Keep them up to date, make sure they are
easy to locate
 Orient the person with your language
Use touch
 Touch makes us human and is
reassuring
 Helps maintain attention during
conversation
 Can be calming
Learn to be a good listener
 Listen and watch/ wait for the response
 Do not interrupt
 Be willing to talk about old times then
redirect
Lastly-DON’T ARGUE
 You won’t win
 The person with dementia is not trying to be disagreeable
they are usually unaware that they are making mistakes
 If the person is in immediate danger then correcting the
thought or behavior might be appropriate. If not DON”T ARGUE you will only cause
frustration, fear and anger so what’s the
point?
References
 Bell, L. (November, 2011). AACN practice alert:
Delirium assessment and management. American
Association of Critical Care Nurses.
 Cason-McNeeley, D. (2004). Delirium the Mistaken
Confusion. PESI Healthcare, Eau Claire,
Wisconsin
 Galik, E. M., Sparks, M., Spurlock, W. (2008).
Effective communication and behavior
management strategies in the care and treatment
of Alzheimer’s disease. Counseling Points, 1(2).
 Kohler, S. (2004). How to Communicate with
Alzheimer’s. Granny’s Rocker Publishing, Venice,
CA.