Hospice Palliative Care Waterloo Wellington Tip of the Month – February 2013 HPC Consultation Services Recognizing & Treating Delirium – Part One: Recognizing Delirium Delirium, dementia and depression are frequently unrecognized in our elderly for a variety of reasons. Left undiagnosed and untreated, these conditions severely impact the quality of one’s life and death. In Part One of this two-part series highlighting Delirium we hope to underscore the differences between these 3 conditions to aid in early recognition, screening and treatment. Recognizing Delirium, Depression and Dementia (3D’s) Note: Residents may have more than one “D” present at the same time and symptoms may overlap. Delirium Depression Dementia Delirium is a medical emergency with an Depression is a term used when a cluster of Dementia is a gradual and progressive acute and fluctuating onset of confusion, depressive symptoms is present on most days, for decline in mental processing ability that disturbances in attention, disorganized most of the time, for at least 2 weeks and of such affects short-term memory, communication, Definition thinking and/or decline in level of intensity that they are out of the ordinary for that language, judgment, reasoning and abstract consciousness. Delirium cannot be accounted individual. Depression is a biologically based illness thinking. It is a terminal condition. for by a preexisting Dementia; however, can that affects a person’s thoughts, feelings, behavior, co-exist with Dementia. and even physical health. Recent unexplained changes in mood that persist Onset Sudden onset: hours to days Gradual deterioration over months to years for at least 2 weeks -can be reversible with treatment -usually reversible with treatment Course -often fluctuates over a 24 hr. period – often -slow, chronic progression and is irreversible -often worse in the morning worse at night Cognitive decline with problems in Fluctuations in alertness, cognition, Reduced memory, concentration and thinking, Thinking memory plus problems with speech or perception and thinking Low self esteem motor control or self care Psychotic Misperceptions and illusions Delusions of poverty, guilt, somatic symptoms Signs may include delusions of Feature theft/persecution and/or hallucinations Sleep/ Disturbed but with no set pattern Disturbed wake May be disturbed most nights Differs night to night Early morning awakening or hypersomnia cycles Depressed mood especially in early Depressed mood Dementia. May persist in dementia; Fluctuations in emotions – outbursts, Diminished interest or pleasure Mood however, apathy anger, crying, fearful Changes in appetite (over or under eating) is more common and may Possible suicidal ideation/plan; hopelessness be confused with depression Geriatric Depression Scale (GDS) Mini Mental Status Exam (Folstein) Screening Confusion Assessment Method Cornell Scale for Depression Clock Drawing Test (CDT) (CAM) Tools Assessment of Suicide Risk in the Older Adult Mini-Cog Dementia Screen

SSource: Toronto Region Best Practice in LTC Initiative. (2007). Recognizing Delirium, Depression and Dementia (3D’s). Retrieved from: http://www.opadd.on.ca/Local%20Projects/documents/LocalProjects-Educ.Training-3Dscomparisonchart.pdf