Caring for clients with delirium or dementia

Definitions & Key takeaways

Clients with delirium or dementia are often more sensitive to their environment and may be more easily startled or frightened. They can present with agitation, wandering, and other challenging behaviors. So, when caring for such clients, ensure the place is calm and that you maintain a daily routine. Also, make sure you speak slowly and calmly and use simple words and phrases that can help to ease confusion and agitation.

Providing patients with plenty of opportunities for rest can also be helpful, as can implementing a routine whenever possible. Consistency is critical for those with delirium or dementia, so creating a predictable daily schedule can help to reduce anxiety and confusion. Finally, it is important to encourage patients to eat and drink regularly, as dehydration can worsen delirium symptoms.

Chapters:

Watch video only

Intro 0:00–0:20

As a nursing assistant, you will be caring for clients that have either delirium or dementia. You need to be familiar with these diseases and what you can do to provide the best care to your clients.
Both delirium and dementia lead to a decline in various mental functions, including memory, thinking, language, behavior, mood, and personality.

Delirium vs Dementia 0:20–0:59

Delirium has a sudden onset, while the onset of dementia is gradual. Delirium occurs as a consequence of an underlying condition, like an infection, medication toxicity, a recent surgery, or serious illness, and signs and symptoms often fluctuate, meaning they come and go.
On the other hand, dementia is caused by structural changes in the brain; it progressively gets worse over time. Delirium can last hours or weeks, and it is reversible when the underlying cause is addressed promptly.
Okay, let’s take a closer look at delirium, which is a medical emergency and must be recognized and treated promptly. As a nursing assistant, you might notice your client isn’t their usual self, which could signal the onset of delirium.You might notice client behaviors, like disorientation, where they don't know where they are or what day it is, or they might have difficulty concentrating.

Delirium0:59–1:43

Their level of activity will often fluctuate between agitated, angry, and aggressive to being drowsy, withdrawn, and depressed.
Their speech may not make sense; they could experience hallucinations, which means they see, hear, or even smell things that are not actually real but are very real to them; or they could experience delusions, where they believe things that are not true.Now, there are some general considerations to keep in mind when caring for a client with delirium.

General Considerations when Caring for Clients with Delirium1:43–2:39

First, it’s really important to keep your client safe. Check the nurse and client’s care plan for interventions, such as creating a calm environment by reducing environmental noise; reorienting the client to person, place, time, and procedures; and ensuring they have their glasses and hearing aids as needed to avoid sensory deprivation.
Restraints should be avoided. Some clients respond to music therapy or other relaxation techniques, such as massage or warm blankets.
When communicating to the client, remember to speak in a clear, calm voice using short, simple sentences. Encouraging family members to visit and bring in familiar objects or photographs can also be helpful.
Finally, you could be asked to assist with client care, such as pain management; maintaining skin integrity; promoting nutrition, hydration, and sleep; and assisting with mobility as tolerated.Okay, let’s switch gears and talk about dementia.

Types of Behaviors in Dementia 2:39–3:30

Τhere are some behaviors commonly exhibited by clients with dementia. These include wandering and getting lost; restlessness, or the constant need to move around or pace back and forth; repetitive speech or actions, rummaging or hiding things; and agitation, where the client becomes excessively upset.
Other common behaviors include catastrophic reactions, meaning that they react excessively to something seemingly trivial; sundowning, meaning that symptoms of confusion or loss of orientation may intensify late in the afternoon or evening; as well as inappropriate sexual behavior.
Also, clients with dementia can have delusions; hallucinations; as well as abnormal motor behavior, like resting tremors, stiff and slow movements, and limited facial expressions.
These behaviors can be triggered by various physical and emotional causes. First of all, the client’s room can be overwhelming due to loud noises and excessive decorations, or it can be too big or too small for the client.

Causes for These Behaviors3:30–4:07

Also, clients can feel uncomfortable and insecure when they’re in a new environment, such as a hospital or a long-term care facility.
A person can also exhibit strange behaviors when they’re asked to perform a new or complicated task. Finally, these behaviors can be the person’s way to communicate a physical need, such as hunger, thirst, and need to use the bathroom, or an emotional need, such as missing their family.
It’s very important to find and address the underlying cause instead of accepting them as normal for a client with dementia.

Addressing the Cause & Gathering Information4:07–4:41

Many times, a change in a client’s behavior may be the first sign of a new medical problem. For instance, a client that develops a new urinary tract infection can become more agitated or seem restless as the only sign.
Observe the client and try to understand the reason behind the behavior they’re exhibiting. Keep track of when and where the behavior occurs and the situation and condition that triggers it.
Remember to report your observations to the nurse and document them. When caring for a client with dementia, there are some common care tips you need to remember.

General Considerations when Caring Clients with Dementia 4:41–6:51

First, it is important to help maintain a safe and comfortable environment in order to avoid overwhelming the client and triggering behaviors, such as wandering.
Also, clients with dementia often have hearing problems, so when entering the client’s room, don’t forget to knock and announce yourself before touching the client to avoid startling them.
Try to speak clearly and use a calm tone of voice. Another important tip is to use simple words and short sentences that a person with dementia can process.
Also, consider holding the person’s arm when interacting with them to show affection and fondness. It can also be helpful to use hand gestures to better communicate an instruction.
Avoid negatively phrased commands such as, “Don’t do that;” instead, use positive instructions, like, “Please do that,” which are easier to follow.
Also, give them time to respond or follow your command. As dementia progresses and the client’s oral skills deteriorate, observe their body language closely to understand them better.
It’s also important to avoid arguing with and upsetting the client. People with dementia also have emotional needs so help them feel safe, appreciated, and show them affection.
People with dementia can show vastly different behavior from day to day, making it difficult to work with them. So, you have to persist and be patient with them.
It’s also essential to allow them to participate in their daily activities and personal care as much as possible because this will boost their self-esteem and well-being.
When providing personal care for a client with dementia, collect all the necessary supplies in advance in order to complete the task quickly and efficiently without rushing the procedure.
It’s also important to encourage them to continue activities that they used to enjoy, provided they can do so safely. Also, help them stay oriented in time and place by using visual cues, such as a calendar or a large clock in the resident’s unit.
Also, try to maintain a regular schedule in order to reduce stress and confusion. At all times, keep an eye on the client and protect them from falling, wandering, or leaving the healthcare facility.
Okay, when caring for a client with dementia, a technique that can be used is validation therapy. With this approach, you accept the client’s reality and divert the conversation by encouraging them to talk about events from the past that they remember better.

Validation Therapy6:51–10:22

For example, you can sit down with the client and ask them to tell you stories about their partner, distracting them from wanting to leave the healthcare facility.
This way, you protect the person’s feelings, understand their needs, and gain their trust.Alright, now, when assisting with personal care procedures or grooming, there are some specific considerations to keep in mind.
Let’s start with bathing, which can be upsetting for a client with dementia. In order to reduce the stress, tell the client, “It’s time to freshen up,” and avoid using the word “bath.” Watch out for a slippery bathtub or bathroom floor; place a non-slip mat and secure it to prevent a fall.
Check the water to make sure the temperature is safe and comfortable for the client. Encourage them to participate as much as possible.
At all times, respect the client’s privacy and modesty by remembering to close the room’s door, all window covers, and ensuring the client is properly covered.
Clients with dementia will also require assistance with dressing and undressing. Some clients will only need minimal assistance, like help selecting clothes, while others will require your assistance for the entire procedure of dressing and undressing.
If the client seems to have trouble choosing clothes, provide limited choices to make the decision easier. If they’re not able to decide on their own, choose clothes that are comfortable and appropriate for the client’s activities and the environment.
Also, choose clothes that are easy to put on and take off. For instance, pick clothes with fasteners instead of zippers or buttons.
When assisting with changing clothes, allow the client to dress or undress themselves as much as possible. Many clients with dementia also need assistance with eating.
They can forget when they need to eat, how to use the eating utensils, or even lose their ability to swallow. Ask the nurse how much help the client will need and then confirm with the client.
Whenever possible, let them eat in the dining room together with others. However, in some cases, it’s best to provide a private place to avoid distractions.
Try to create a friendly atmosphere, keep them company, and help them as much as they need while encouraging them to participate as much as possible.
Try placing your hand over the client’s to remind them how to eat. Also, be sure that the client chews the food before swallowing to prevent choking.
If they’re unable to eat a proper meal, give the person fast meals, such as sandwiches, fruits, and vegetables. Also, make sure that they’re drinking enough fluids to avoid dehydration.
For clients with end-stage dementia that have trouble swallowing, liquid meals can be prepared and given to the client using a syringe to place the food directly at the back of the mouth.
Before you proceed with assisting with the procedure, make sure it’s within your authorized duties and facility policies.
Moving on: Clients with dementia can also have difficulties with urinary or bowel elimination. They can forget how to get to the bathroom or how to use the toilet.
They can also have trouble removing their clothes fast enough, which can lead to accidents. Falls and injuries while trying to get to the bathroom are also common.
Make sure the path to the toilet is lit before the client goes to the bathroom and answer call lights promptly. Also, keep note of their normal elimination habits, so you can recognize any changes and report them to the nurse.
Let the nurse know if the client starts having more frequent accidents because this can be the first clue to serious medical conditions, such as a urinary tract or a gastrointestinal infection.
Alright, now a person with dementia also has emotional needs that should be met. There are several types of approaches that can be used to prevent boredom and reduce problematic behaviors, such as wandering and restlessness.

Types of Therapy to Meet Emotional Needs 10:22–11:39

First is the reminiscence therapy, which is to encourage the client to talk about experiences from their past. These should be focused on positive activities, like hobbies they’ve had or an old job they enjoyed.
This can direct their attention to pleasant memories and can boost their self-esteem. Reminiscence therapy can also be done in groups in order to promote socialization with other clients.
A second approach is activity therapy, which is planning activities to exercise the client’s mind, keep them engaged, prevent boredom, and reduce problematic behaviors.
Some examples of activities include cooking, reading a magazine, looking at a photograph album, attending a picnic, or going for a walk.
These activities are often done in a group setting and are modified based on each client’s abilities and interests. Another approach is music therapy, which can help relax the client, especially when they’re upset or angry.
Finally, there’s pet therapy, which is spending time with animals, such as cats and dogs. Watching a pet or having the pet sit with the client on their lap can reduce anxiety.
It can also remind the client of pets they used to have and encourage them to talk about those pets. Now, when caring for clients with end-stage dementia, there are some additional considerations to keep in mind.

Additional Considerations for End-Stage Dementia11:39–12:03

For clients who become immobile, keep an eye out for signs of pressure ulcers. Support is aimed at ensuring the client is as comfortable and happy as possible until they reach the end of their life.
Finally, in all cases, it’s important to provide support and comfort for the clients’ families that are going through these tough times.
Caring for dementia patients can affect the caregiver, both physically and emotionally. Because clients with dementia are dependent for most everyday life activities, it can be exhausting for the caregiver.

Effects on the Caregiver12:03–12:32

It’s also common for a client with dementia to become agitated, yell, swear, curse, or even slap, scratch, and hit the caregiver.
This requires a lot of patience and endurance. Finally, repetitious behaviors every day can frustrate and exhaust the caregiver.
There are some strategies that can help you support your own well-being when caring for these clients. First, it's important to remember that the person’s behaviors result from the disease and are beyond their control.

Strategies to Maintain the Caregiver’s Well-Being12:32–13:17

Sometimes walking out of the client’s room and taking a deep breath can be helpful when you feel tired or annoyed. You can also ask a co-worker or the nurse to help you with the client.
If you feel that you can no longer take care of a particular client, share your thoughts with the nurse. Asking to be assigned to another client can give you a break.
Be sure to reach out for help before your frustration causes you to harm the client. If you harm the client, you may be charged with abuse, lose your job, and even be punished in a court of law.
Finally, take some time off, take care of yourself, avoid burn-out, and protect your own physical and emotional well-being.
Alright, now as a nursing assistant, you will be in a prime position to recognize and report changes that may suggest a client is experiencing delirium.

Reporting 13:17–13:58

First, inform the nurse if your client exhibits difficult behaviors, such as wandering, restlessness, or if they have hallucinations.
Also, let the nurse know if they seem unusually upset and confused; if your client does not remember a member of their family or a close friend; or the client’s memory seems to deteriorate rapidly, where they don’t remember recent events, such as what they ate a few hours ago.
For clients with dementia, report any accidents or behaviors that could endanger themselves and others and any signs or change in behavior that might suggest the onset of a new medical condition.
All right, as a quick recap… Both delirium and dementia cause a decline in mental function, and caring for clients with these disorders can be challenging.

Recap13:58–15:21

When caring for clients with delirium, it’s important to maintain a calm environment and keep a daily routine. Clients with dementia can exhibit difficult behaviors, such as wandering and agitation, and it’s important to find and address the underlying physical or emotional reason for the behaviors.
Validation therapy is helpful when you’re caring for the client and reminiscence, activity, pet, and music therapy can improve their quality of life and decrease problematic behaviors.
You will sometimes need to assist these clients with bathing, dressing, eating, as well as urinary and bowel eliminations.
As the disease progresses, you might need to provide end-of-life care with the goal of helping them be as comfortable and as happy as possible.
Caring for clients with dementia can have significant physical and emotional effects on the caregiver; however, there are some strategies you can use to maintain your well-being, such as understanding the cause of their behavior is due to a disease, taking a deep breath when you feel overwhelmed, and sharing your thoughts with the nurse.
Finally, as a nursing assistant, it is also your responsibility to recognize and report changes in a client that may suggest a delirium.
For clients with dementia, report any signs or change in behaviors that might be due to a new medical condition and any accidents or behaviors that could