Confusion is fairly common in elderly patients, especially in those who have dementia or delirium. Because the older population is expected to increase in the coming years, as more baby boomers retire, nursing assistants have to be more efficient in meeting the care needs of older patients. This is especially true during times they become confused because of their illness.
To understand confusion in older patients, it is important for nursing assistants to know the difference between dementia and delirium.
Dementia is a slow but progressive worsening of thinking, judgment, and problem-solving abilities. People with dementia easily forget people, places, and how to do things because of brain changes. Their confusion worsens slowly over time.
Delirium, on the other hand, is confusion that develops suddenly, usually as a result of infection or surgery. It is common in hospitalized older people.
Why is it important to recognize the signs and symptoms of confusion in elderly patients?
Nursing assistants must be especially vigilant for signs and symptoms of confusion in older patients because it is a sign of overwhelming stress (delirium) or worsening condition (dementia). Also, it can lead to falls that can cause patient injury and even death.
If you are a CNA and unsure how to spot a confused patient, here are some common verbal and non-verbal responses to watch out for:
1. "Who are you? Where am I?"
A patient who is confused often becomes disoriented regarding time, place, and people. They do not remember where they are or why they are in a hospital, for example. They do not even recognize family members. They also tend to forget recent events, such as being taken to the emergency room.
2. “I want to go home!”
Confused patients with dementia often ask to go home even when they are home. This response is a sign that the patient has unmet needs, like comfort and the need to do a task.
3. “I just want to go to the bathroom . . .” but they were found wandering the neighborhood.
Confused patients with dementia may aimlessly walk around, forgetting where they are going or why, so they get lost on the way.
4. "What is this for?" referring to the pen in their hand.
Confused patients may not remember what ordinary items are for and how to use them.
5. Blank stares.
Confused patients with delirium may show signs of inattention, such as blank stares or quiet withdrawal. They may also be drowsy and have difficulty making sense of what is being said to them.
6. Picking at something in the air.
They may show odd, bizarre, or embarrassing behaviors. They may appear to talk to someone or perform a task, undress in inappropriate places, or be sexually expressive.
If you see these signs and symptoms of confusion in elderly patients, here are some helpful tips to save your day (and your patient’s!):
1. Be patient and understanding.
Keep in mind that the patient's behavior is a result of their illness, and as such, they cannot be expected to understand what's proper and what's not. Continue to provide care without passing judgment and keep them safe at all times.
2. If you note sudden signs of confusion in a hospitalized patient, report it to the supervisor or nurse immediately.
Delirium in confined patients is a sign of physical distress and is associated with poor outcomes. Your immediate reporting is crucial, as the patient may need further examination and treatment.
3. Orient to time, place, and person.
Confusion may result in further stress to the patient, so when they are not aware of their surroundings or their situation, remind them of the date and time, tell them where they are, and introduce them to their loved ones.
4. Ensure that the patient is using their eyeglasses and hearing aids.
This strategy prevents the patient from misinterpreting the things they see and hear because of impaired eyesight and hearing.
5. Ask short and simple questions, one at a time, allowing ample time to answer.
When patients are confused, they cannot make sense of their environment, not even what you’re telling them. To interact with the patient, call them by their name and use short and direct sentences. Repeat or rephrase what you tell them if necessary.
6. Meet the patient’s basic needs.
Provide adequate nutrition and hydration. Confusion can be caused by many things, two of which are lack of proper food and liquid intake. CNAs must check their trays for any leftovers and monitor the amount of liquid the patient drinks in a day. If it less than what is needed, report your observation to the supervisor.
7. Provide comfort.
Providing comfort is perhaps one of the simplest and yet most effective ways nursing assistants can prevent or lessen confusion in elderly patients. Be sensitive to their need for warmth. Remember, older people have difficulty adjusting to extremes in temperature.
Ensure the patient’s cleanliness. Change their incontinence pads as soon as they are soiled. Help them bathe and perform mouth care. Promote good circulation and relaxation through gentle massage or back rubs. Play the patient’s favorite music.
8. If your patient insists on going home, provide a distraction.
Sometimes, orienting confused patients to reality would be more distressing than helpful. If you tell a patient with dementia that they cannot go home because they are home, this will likely be rejected violently, because they do not recognize their present place of residence. Provide a meaningful distraction and keep the patient safe.
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