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Dementia, delirium and cognitive impairment


Dementia

Dementia is a common condition that affects about 800,000 people in the UK. Your risk of developing dementia increases as you get older, and the condition usually occurs in people over the age of 65. Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of the brain and its abilities.  

Everyone experiences dementia in their own way. Different types of dementia can also affect how people experience the condition. Some common symptoms associated with dementia are listed below:

  • memory loss – including problems recalling recent events, repeating questions or accounts of particular experiences
  • difficulty thinking things through to plan, organise and make decisions to complete complex tasks or to solve a problem
  • problems communicating – including difficulties finding the right word, following and making sense of conversation
  • experiencing disorientation - confusion about the time, date or season, or being unsure about the current environment, even in a place that may be well known
  • sight and visual difficulties – such as difficulty judging distances, misinterpreting patterns
  • mood changes or difficulties controlling emotions – for example, becoming unusually sad, frightened, angry or upset, losing interest in things or becoming withdrawn.

Dementia is generally a progressive condition, which means that symptoms will become more difficult over time. How dementia progresses varies from person to person. Some people with dementia maintain their independence for many years but in time may need support with daily activities such as cooking or personal care, or help with decision making. 

Source: www.nhs.uk and www.alzheimers.org.uk/


Types of dementia

There are many different types of dementia. Some are far more common than others. These include:

  • Alzheimer’s disease

  • Vascular dementia

  • Dementia with Lewy bodies

  • Fronto-temporal dementia

The Alzheimer’s Society website has a fact sheet on each of these types of dementia plus other rarer types of dementia on their page: Types of Dementia


Delirium

Delirium is a state of confusion that can happen if you become medically unwell.  It is also known as an 'acute confusional state'. About two in ten patients that are admitted to hospital experience a period of delirium.

Symptoms of delirium include:

  • disorientated thoughts and speech
  • memory difficulties
  • illusions or hallucinations
  • changes to sleep patterns

The above symptoms can come and go or increase and decrease in severity over a 24 hour period. 

Medical problems, surgery, infection, dehydration, constipation and medications can all cause delirium. It often starts suddenly and usually lifts when the condition causing it gets better. It can be frightening – not only for the person who is unwell, but also for those around the patient.

How is delirium treated:

If someone suddenly becomes confused, they need to see a doctor urgently. To treat delirium you need to treat the cause. For example, an infection may be treated with antibiotics.

The person with delirium may be too confused to describe what has happened to them, so it's important that the doctor can talk to someone who knows the patient well. Regular contact with familiar people may also help to reassure, calm and orientate the person with delirium.  If the person with delirium is feeling very distressed, agitated or has psychotic symptoms (e.g. feeling scared, paranoid or experiencing hallucinations) a limited trial of an antipsychotic medication and/or a sedative may be considered. 

Source: www.rcpsych.ac.uk


Cognitive Impairment

Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life.  People who have received a diagnosis of dementia will have some cognitive impairment.  Other physical health problems, developmental problems and some mental health problems can also cause people to experience cognitive impairment.

Source: www.cdc.gov/

Mild Cognitive Impairment

Mild Cognitive Impairment (MCI) is a condition in which someone has minor problems with one or more aspects of thinking and/or memory.

In MCI, these difficulties are worse than would be expected for a healthy person.  They may cause minor problems and assistance may be required for more demanding tasks e.g. paying bills, managing medication, driving.  However, symptoms of MCI are not severe enough to interfere significantly with daily life, and are therefore not defined or diagnosed as dementia.

It is estimated that between 5 and 20 per cent of people aged over 65 have MCI. Research in memory clinics suggests that around 10 to 15 per cent of people who experience MCI with gradual memory loss go on to develop dementia each year.

Source: www.alzheimers.org.uk

Trust Confusion Care Pathway

The Confusion Care Pathway has been developed to guide our staff in using best practice in caring for people with dementia, cognitive impairment and/or delirium.  This pathway helps our staff to:

  • identify people with dementia, cognitive impairment and/or delirium
  • assess and treat causes of cognitive impairment and confusion
  • communicate effectively with carers/relatives
  • consider any legal obligations
  • consider future needs of the patient (e.g. advanced directives)
  • determine whether specialist assistance is needed from other health and care professionals.
  • plan the discharge from hospital

A copy of the Confusion Care Pathway will be kept at the front of the patient’s medical file for our staff to reference. 

The Confusion Care Pathway identifier

The ward staff will put a symbol in the patient’s medical notes and above their bed to indicate that the patient would benefit from support provided in line with the Trust Confusion Care Pathway. The medical and therapy teams will recognise this symbol and it will also prompt them to use either the “This is Me” or the “Important Things About Me” leaflet.

The symbol looks like this:


Pathway symbol

According to the Health Foundation , the four main principles of person centred are:

  • affording dignity, compassion and respect
  • offering coordinated care
  • offering personalised care
  • being enabling

The process of delivering person centred care is said to be through communication and focus on the relationship with the person that is being cared for. For people with dementia, cognitive impairment and/or delirium this may involve:

  • recognising the person’s life history and using it to inform conversation
  • asking the person, or their family, about the individual’s preferences, desires and needs
  • supporting the person to do what they want to do
  • expressing and understanding the feelings of the person

It is with these principles in mind that the following documents were created:

"Important Things About Me" and "This is Me" leaflets

Carers/relatives of patients with a diagnosis of dementia, cognitive impairment and/or delirium will be asked if they would like to complete an “Important Things About Me” or a “This Is Me” leaflet.

In this leaflet, the carer/relative will write information about their relative’s background, interests, likes and dislikes to help the team get to know the patient better. This information will help our staff to provide care that is tailored to the patient’s individual needs and preferences.

The leaflets can be downloaded here:

National guidelines

Please see below a list of links to charities, societies and organisations that support patients with dementia, delirium and cognitive impairment:

Admiral Nursing Direct

Admiral Nursing Direct provides specialist Nursing advice, information and support for carers and people with dementia for issues ranging from pre-diagnosis to advance care planning and end of life care.

Telephone - 0800 888 6678 (phone line is staffed from 9:15am to 4:45pm Monday to Friday and also from 6pm to 9pm on Wednesday and Thursday evenings) 

Age UK

Provides information and support for older people

Telephone: 0800 169 2081

Alzheimer’s Society

Alzheimer’s Society works to improve the quality of life of people affected by all forms of dementia, and the lives of their carers and families. There are local services in Harrow, Hillingdon and Brent which include Dementia cafés, Support Services, Day Support and Singing for the Brain.

For information and support with all aspects of living with dementia please call the local office for further details on 01923 823 999 or email harrowandhillingdon@alzheimers.org.uk or brent@alzheimers.org.uk. 

AT Dementia

Provides information on assistive technology that can help people with dementia live more independently.

Telephone: 0116 257 5017

Email: info@trentdsdc.org.uk

Brent Carers Centre

Brent Carers Centre offer carers living in, or caring for a person living in, Brent an extensive range of information and advice services on all aspects of their caring responsibilities, via the operation of the Brent Carers Services Hub and other local initiatives. 

Telephone: 020 3802 7070

Brent Social Services

Provides advice, information, support and services to people aged 18 years and over to vulnerable groups such as older people who are living with a disability, people who are deaf, hard of hearing or have a visual impairment, or people who are caring for someone who has a disability.

Telephone: 020 8937 4300

Email: customer.services@brent.gov.uk

Carers UK

Provide information, advice and support for carers

Telephone: 0808 808 7777

Email: advice@carersuk.org

Culture Dementia

A charity which support carers and people with a diagnosis of dementia, among the Black Minority Ethnic (BME) communities.

Ealing Carers' Centre

The Carers’ Centre is a resource and support centre for all unpaid carers, of any age, in the borough of Ealing. The Carers’ Centre is managed by Carers Connect, a consortium of four well established organisations in the borough.

  • Ealing Centre for Independent Living

  • Ealing Mencap

  • Crossroads Care West London

  • Dementia Concern Ealing (formerly Alzheimer’s Concern)

Telephone:020 8840 1566

Email: carers@ecil.org .

Ealing Social Services (social care)

A range of advice and services are provided for children, adults and the people who care for them.

Telephone: 020 8825 8000

Email: Sscallcentre@ealing.gov.uk

Harrow Carers

Harrow Carers provides information and advice on carers support services and social care and welfare benefits advice.

Telephone: 020 8868 5224

Email admin@harrowcarers.org .

Harrow Social Services (adults)

Provides advice and support for vulnerable people age 18 years and over who are in need of social care services and/or are at risk of losing their independence. Where services cannot be provided directly, advice and information are given on alternative services in the community.

Telephone: 020 8901 2680

Email: AHadults@harrow.gov.uk

Hillingdon Social Services

Information and signposting regarding assessing of needs, access to care and support, as well as support for carers.

Telephone: 01895 556633

Email: socialcaredirect@hillingdon.gov.uk

Carers Johns Campaign

John's Campaign

LNWH NHS Trust is proud to sign up to John's Campaign by welcoming and proactively working with family members of people using our hospital and community services.

Our commitment will begin by developing a "Working with Families" policy in order for all staff to be aware of how our services may be enhanced by using the knowledge of family members to provide person centred care.

We will continue to develop specific projects to ensure families of people using hospital and community services are aware of how the Trust aims to support them including: a dedicated area on the Trust website, use of carers/relatives knowledge to improve care of people with dementia, delirium and cognitive impairment and our close links with local services designed to support carers and relatives.

We will ensure that the rights of carers/relatives continue to be regarded as a central part of the care we provide to people using our hospital and community services by reporting our actions in relation to John's Campaign to the Trust Patient and Staff Committee, which in turn reports to the Trust Executive Board.

For further information about John's Campaign, please see the following web page: http://johnscampaign.org.uk/

Carers information pack

This booklet should be given to carers/relatives of inpatients who have a diagnosis of dementia, suspected dementia, cognitive impairment and/or delirium.

Download the information pack        

Carers passport

This passport is for close relatives/friends who would usually be actively involved in supporting the person who is currently an inpatient.This passport will help to identify those who might require flexible visiting to the ward.

Download the passport    

Carers Agreement 

This agreement will help outline the role that staff and carers/relatives will play in supporting the patient while they are in hospital. 
Download the agreement.

Communications log

Carers/relatives may find it useful to keep a log of communications with our staff. 

Download the log

Delirium information leaflet for patients, relatives and carers

This leaflet will give you information about delirium, such as the causes and treatments and where you can find more information and support. This document is available here.

Alzheimer’s Society publications

The Alzheimer’s Society produce a wide range of publications designed to support and inform anyone affected by dementia . The website contains information about all aspects of dementia, including the different types and causes and aspects of treatment , living with dementia or caring for someone with dementia .

Visit the   Alzheimer’s Society publications section of their website.

Some useful fact sheets: