Confusion - what is confusion?

Residents can become confused for many different reasons and it does not always have to be dementia. Confusion of a more temporary nature is often due to another illness that can be serious. It is not uncommon for people to quickly go from being clear and alert to becoming confused. These are not uncommon in connection with moving in and other things that stress a person. Even for someone who already has dementia but who at the moment seems more confused, other causes may lie behind the confusion state than the dementia itself.

Signs of confusion may be that the resident turns the clock, loses perception of time and space and has difficulty understanding things that the resident normally understands. Other changes may be difficulties remembering, speaking clearly and thinking clearly. Behavior may change, restlessness is common, as well as concentration difficulties. The condition affects emotions and alertness and can vary during the day. It is possible for the resident to see and hear things that are not real. Confusional states are temporary and usually do not cause any problems afterwards.

Causes of confusion can be infection, pain, heart attack, circulatory disorders, blood clots in the brain or other head injuries. Constipation, urinary tract problems, deficiency diseases, liver and kidney failure are other causes that can all lead to confusional states. Medications such as sedatives and antipsychotic medications can cause confusion. It is important to seek the cause of confusional states so that the elderly and their loved ones are not exposed to unnecessary suffering. The confusional state should therefore be investigated.

This is important before making a decision to move to a nursing home. It has happened that people have moved to a nursing home with suspicion of dementia. Once there with good food and a proper medication review, they perk up and are not at all in need of the nursing home's level of care. Once you have given up your regular accommodation, it is not so easy to back down. There must be a proper dementia assessment before moving into a dementia care home.

Confusion - symptoms

Disorientation: The person may be confused about time, place or person. They may not know where they are or what is happening around them.
Memory problems: Forgetfulness and difficulty remembering things are common. It may be difficult to remember important events, names or instructions.
Impaired attention: The person's ability to focus and maintain attention may be impaired. They may be easily distracted or have difficulty concentrating.
Confused thoughts: Thoughts and ideas may be incoherent and difficult to follow. The person may have difficulty expressing themselves clearly.
Worry and anxiety: Confusion can often be anxiety-driven, and the person may feel scared or worried because of their confused thoughts.

b>Difficulty in making decisions: Making decisions can be a challenge, and the person may be hesitant and unsure.
Personality changes: Sometimes confusion can lead to changes in personality and behavior. People may become more irritable, angry, or aggressive.
Changes in sleep patterns: Sleep problems, such as insomnia or increased sleepiness, are common with confusion.

It is important to note that confusion can be a symptom of a variety of underlying medical conditions, including infections, brain injuries, dementia, or medication side effects. If someone is exhibiting symptoms of confusion, it is important to seek medical evaluation to determine the cause and prescribe appropriate treatment. Early detection and proper management of confusion is crucial to a person’s well-being.

Always inform the assessing nurse whether a doctor should be consulted. Anti-hallucination medications may be prescribed if symptoms are bothersome. Check that vision and hearing aids are working properly. Activities, social contacts and a good night's sleep help reduce the risk of confusion.

Dementia

Residents often have dementia that affects their lives. With knowledge about dementia, it is possible to create a good everyday life and reduce the risk of worry and anxiety. The development of the disease and symptoms are related to the type of dementia the resident has. With knowledge, treatment and adapted activities.

If dementia is suspected, a basic dementia investigation is carried out. It is based on medical history, current situation, functional and activity capacity, conversations with loved ones, tests of thinking ability and sampling. If necessary, a computed tomography of the brain is carried out. The examination is done to rule out other medical conditions that can cause cognitive impairment.

If it is still not possible to establish a diagnosis, further investigation is carried out in the form of neuropsychological tests, MRI, lumbar puncture and possibly a functional brain imaging with SPECT.

Alzheimer's disease, frontal lobe dementia, Lewy body dementia and Parkinson's disease with dementia are caused by brain cells atrophying and dying. In Alzheimer's, the parietal and temporal lobes are affected, in frontal lobe dementia the frontal and temporal lobes are affected, in Lewy body dementia and Parkinson's disease with dementia it is the white matter in the brain that atrophies. These diseases usually have an insidious course. Vascular diseases of the brain, on the other hand, usually have a rapid progression. Blood clots and restricted oxygen supply to the brain often occur suddenly after a stroke.

Dementia caused by, for example, syphilis, HIV, alcohol abuse and dementia caused by solvents are called secondary dementias. These are diseases that can, but do not always, progress to a dementia state.

In addition, mixed dementia can be seen in some. Dementias cause great suffering for the individual and their loved ones, but are also associated with large societal costs. Early investigation is important in order to be able to take action quickly.

Different dementias require different approaches. This can affect both the resident in social contacts on the unit, loved ones and co-workers. Causes of behavioral and mental symptoms are investigated. All dementia homes should have employees who are trained to handle BPSD symptoms. Guidance from, for example, a BPSD team can provide perspective for how employees can treat the resident in order to improve care.

Meaningful daily activities and individual physical training in the form of, for example, weights, gait-balance and movement training improve everyday life for people with dementia. If a person is treated with anti-anxiety or antipsychotic medications despite measures, the treatment period should be short. The effect and side effects are evaluated within a couple of weeks.

All care, nursing and welfare for people with dementia is based on a person-centered approach and that the work around people with dementia is conducted in a cross-professional manner. Person-centered nursing means that the person and not the disease is put in focus. Person-centered nursing is expected to lead to a reduction in antipsychotic medications.

A lot is happening in the field of dementia, for example what we can do to slow down the progression. In a few years, there may be a dementia robot that can make a reliable diagnosis early. There is good training when it comes to dementia. One example is Dementia ABC, which is provided by the Dementia Center.

BPSD

The BPSD register can provide support when a resident with dementia experiences symptoms that may be difficult to manage in the facility. There is a checklist, training, assessments and suggestions for measures to reduce the problems that may arise. The method can support the development of treatment plans and other suggestions for treatment interventions.

BPSD-registret är ett kvalitetsregister som utformats för att hitta bakomliggande orsaker till orostillstånd. Registret innehåller förslag på åtgärder för att minska symtomen. Utredning och kartläggning kan visa hur och när över dygnet symtomen visar sig och i vilka situationer de uppstår. Lämpliga åtgärder vidtas som sedan utvärderas.

Man räknar med att cirka 90% av alla med demenssjukdom någon gång drabbas av BPSD-symtom i form av oro, aggressivitet, hallucinationer, sömnstörningar och vanföreställningar. Syftet med BPDS-registret har varit att utreda allvarlighetsgraden och frekvensen av BPSD-symtom hos den enskilde individen. Bakomliggande orsaker till symtom kan exempelvis vara smärta, den omgivande miljön eller personalens bemötande. Personalen arbetar i team för att söka möjliga orsaker till beteendestörningen.
Utbildningar i BPSD har gjort att demensvården förändrats under senare år.

Åtgärder för att motverka BPSD-symtom kan exempelvis vara utevistelse, aktiviteter, musik, massage eller gymnastik. Vidtagna åtgärder ska utvärderas. Symtom på BPSD graderas och om åtgärderna varit effektiva syns det vid den uppföljande registreringen.
BPSD-registreringen har lett till en utveckling av den personcentrerade omvårdnaden och att de nationella riktlinjerna för demenssjukdom och teamarbetet har utvecklats och används   inom demensvården. BPSD-registreringen har vidare lett till verksamhetsutveckling och kvalitetssäkring genom att uppföljningar görs.

Närståendestöd kan exempelvis ges genom deltagande i utbildningsprogram, psykosociala stödprogram och möjlighet till avlösning. Miljön på boendet ska vara trygg, hemlik och utformad så att den boende får en meningsfull vardag. Många verksamheter har idag någon eller några medarbetare som är utbildade Silviasystrar med fördjupade kunskaper i bemötande och omsorg om människor med demenssjukdom.

Halucinationer hos äldre

Hallucinationer hos äldre behöver inte bero på psykossjukdom, depression eller ångest. Det kan finnas helt andra bakomliggande orsaker som behöver utredas.
- Demens: Hallucinationer kan vara ett symptom på olika former av demens, såsom Alzheimers sjukdom eller Lewykroppsdemens.
- Medicinering: Vissa läkemedel som används av äldre människor kan orsaka hallucinationer som en biverkning. Det kan vara läkemedel som används för att behandla Parkinsons sjukdom, epilepsi eller psykiatriska tillstånd.
- Sömnstörningar: Sömnbrist eller oregelbundna sömnmönster kan öka risken för hallucinationer hos äldre.
- Annat såsom infektioner, hjärntumörer, abstinens och nedsatt syn eller hörsel kan också bidra till halucinationer.
Hallucinations in the elderly should always be taken seriously. A medical examination should be performed to determine the cause of the hallucinations and to rule out serious medical conditions.

Visual hallucinations in the elderly

Visual hallucinations, or seeing things that are not really there, is a phenomenon that can affect people of all ages, including older individuals. These illusions can be particularly affecting older people due to their vulnerability and increased risk of various health problems.

What are visual hallucinations?
Visual hallucinations involve a person experiencing visual impressions that do not exist in reality. They may also involve seeing colors, patterns, shapes, people, or objects that are not present. Visual hallucinations can be complex and vivid or simple and abstract.

Prevalence in the elderly
Visual hallucinations in the elderly are not uncommon, but they may be underdiagnosed because older people may not always report such experiences. The incidence increases with age and is more common in people with dementia, such as Alzheimer's disease. They can also occur in older people with vision loss or vision problems.

Possible causes of visual hallucinations in older people
Dementia can contribute to damage to the brain's visual system or changes in brain chemistry. Older people with vision loss, such as cataracts or macular degeneration, may experience visual hallucinations. This form of hallucination is sometimes called Charles Bonnet syndrome. Poor sleep quality or sleep disturbances can increase the risk of hallucinations, including visual hallucinations. Some medications used to treat age-related diseases can cause hallucinations as a side effect. Older people who feel lonely or socially isolated may be more likely to experience visual hallucinations. Infections such as urinary tract infections, poisoning, tumors and alcohol withdrawal can also cause visual hallucinations

Management of visual hallucinations in the elderly
Often, an individual treatment must be found. Always start by consulting a doctor to rule out various underlying medical causes. A thorough medication review should be done to rule out that it is drug side effects that are causing visual hallucinations. Dosage adjustment or changing medications may then help. If there are signs of loneliness, social support can help reduce the problem. A sleep analysis can provide insights into how sleep quality can be improved.

For older people with vision problems, an ophthalmologist can help manage visual hallucinations by correcting vision problems or prescribing vision aids. For those who do not have cognitive impairment, CBT can help the person manage their visual hallucinations.

Reflection - memory impairment
Caregiver:
• What do you do if one of your residents changes and becomes confused?
• Have you completed the dementia center's dementia training?
• What do you find most difficult about caring for people with dementia?
• How do you work to find ways of working that help the resident in the best way?
• Do you have good skills in caring for people with dementia?

Manager, nurse, occupational therapist and physiotherapist:
• Has it happened that you have admitted people to the dementia unit who have not been properly investigated?
• Do you have good team cooperation around residents with dementia?
• In what way can you develop your working methods during the coming year?
• How do you work with residents who show BPSD symptoms?

Residents and relatives:
• Have you experienced that your relative has become confused for a short period?
• Do the employees have a good attitude towards residents with dementia?
• Have you heard of BPSD before?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day