As nurses in long-term care settings, you play a pivotal role in the lives of individuals with dementia Alzheimer’s disease. With the growing prevalence of these conditions, it’s essential to deepen our understanding and refine our approach to care.
What is dementia
Dementia is the loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person's daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change.
Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.
Dementia is more common as people grow older—about one-third of all people aged 85 or older may have some form of dementia—but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.
What is Alzheimer’s disease
Alzheimer’s disease is a progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior. It accounts for 60-80% of dementia cases and typically manifests with subtle memory loss that escalates over time. As a long-term care nurse, recognizing the early signs—such as confusion about time or place, difficulty with problem-solving, and changes in mood or personality—is crucial for timely intervention.
What are the signs and symptoms of dementia
Signs and symptoms of dementia result when once-healthy neurons, or nerve cells, in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.
The symptoms of dementia can vary and may include:
Experiencing memory loss, poor judgment, and confusion
Difficulty speaking, understanding and expressing thoughts, or reading and writing
Wandering and getting lost in a familiar neighborhood
Trouble handling money responsibly and paying bills
Repeating questions
Using unusual words to refer to familiar objects
Taking longer to complete normal daily tasks
Losing interest in normal daily activities or events
Hallucinating or experiencing delusions or paranoia
Acting impulsively
Not caring about other people’s feelings
Losing balance and problems with movement
What causes dementia
The causes of Alzheimer’s and related dementias can vary, depending on the types of brain changes that may be taking place. While research has found that some changes in the brain are linked to certain forms of dementia, in most cases, the underlying causes are unknown. Rare genetic mutations may cause dementia in a relatively small number of people.
Although there is no proven prevention, in general, leading a healthy lifestyle may help reduce risk factors that have been associated with these diseases.
What are the different types of dementia
Various disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these diseases.
The five most common forms of dementia are:
Alzheimer’s disease: The most common dementia diagnosis among older adults. It is caused by changes in the brain, including abnormal buildups of proteins, known as amyloid plaques and tau tangles.
Frontotemporal dementia: A rare form of dementia that tends to occur in people younger than 60. It is associated with abnormal amounts or forms of the protein’s tau and TDP-43.
Lewy body dementia: A form of dementia caused by abnormal deposits of the protein alpha-synuclein, called Lewy bodies.
Vascular dementia: A form of dementia caused by conditions that damage blood vessels in the brain or interrupt the flow of blood and oxygen to the brain.
Mixed dementia: A combination of two or more types of dementia.
When communicating with confused patients, several strategies tend to help them understand better.
Ask yes or no questions when possible.
Provide a limited number of choices for questions. Use memory aids such as a daily routine list or calendar to remind them of activities.
Say the patient’s name and make eye contact to get his or her attention.
Make calm, positive, and reassuring statements in a soothing tone.
Ask if they need to use the restroom or want some water at periodic intervals.
Strategies for helping patients with Dementia
Assist with activities of daily life: The patient may not need assistance with activities of daily life (ADL) during the early stages, or they may need cueing during each step of an activity. Check the assignment sheet for the level of care the patient requires. Since energy levels tend to be highest at the beginning of the day, it is most effective to schedule demanding activities, such as a shower or bath, in the morning.
Communicate: When talking with a dementia patient, stay on task and focus on one thing at a time, using simple words, and restating information if necessary.
Cue: Provide verbal or physical cues, or demonstrations, for the next step in an activity. Verbal; cues are concise, simple, and repetitive, using the same wording to avoid confusion. Cueing that involves touching the patient should occur within the patient’s visual range since unexpected contact can be frightening to patients.
Label: Begin the process of labeling doors, dressers, and other objects during the early stages of the disease since memory loss can occur quickly. This helps provide familiarity for the person.
Safety: Check home for safety issues. Remove rugs from walkways, ice on the sidewalk, and other hazards.
Schedule: Assist the patient by developing a daily routine to promote comfort and compliance as the disease progresses. Dementia patients have trouble tolerating unstructured activities, such as family discussions, for extended periods, so keep these to no longer than 30 minutes