Geriatric Dementia

Course overview

Objectives Describe geriatric dementia and its causes Explain the various causes of altered mental status in geriatrics Describe the differentiating factors between delirium and dementia Content Polypharmacy 1 Multiple chronic diseases mean multiple medications 2 Drug dosages may not have been adjusted for multiple medications 3 Drug interactions may cause problems 4 Consider polypharmacy as a cause of patient problems Psychosocial and Economic Aspects 1 Demographics and graying of America 2 Psychosocial issues Living environments Financial issues Social services Alzheimers Disease 1 Definition Stages Diagnosis Prognosis 2 Epidemiology Population Early onset 3 Pathophysiology Plaques Tangles 4 Signs and Symptoms Memory Learning Judgment Language Tasks 5 Personality Changes Apathy Irritability Depression Agitation Psychosis 6 Normal Day to Day Living Problems associated with management Patient violence Patient verbal abuse Fearful patient 7 Management Communication Slow clear instructions Distraction from agitation Treat symptomatically Consider co illnesses Consider medication reactions 8 Alzheimers Treatment Cholinesterase inhibitors Antipsychotics Antidepressants Dementia 1 Definition 2 Causes of Dementia Alzheimers disease Multi infarct dementia Drug toxicity Emotional disorders Metabolic and endocrine disorders Brain tumor Brain trauma Infections Major depression Parkinsons disease Huntingtons chorea 3 Alzheimers Disease as the Most Common Form of Dementia Pathophysiology Stages Paramedic assessment and interactions 4 Associated Signs and Symptoms Progressive loss of cognitive function including short and long term memory Loss of attention span Loss of communication skills Inability to perform daily routines Easily lost Angers easily Problems Associated With Management of the Dementia Patient Poor historian and impaired judgment Inability to vocalize pain or symptoms Unable to follow commands Anxiety over removal from home or care facility Anxiety and fear regarding medical treatment Delirium Definition A sudden change in behavior consciousness or cognitive processes generally due to a reversible physical cause 1 Mortality rates 2 Evaluation of Pathophysiology History Possible risk factors Current medications Common Causes Intoxication or withdrawal from alcohol Withdrawal from sedatives Vitamin deficiencies Urinary tract infections or bowel obstruction Cardiovascular disease Hyperglycemia or hypoglycemia Psychiatric disorders Malnutrition Dehydration Environmental emergencies Depression Fever Medication effects including anticholinergic drugs 3 Associated Signs and Symptoms Rapid onset minutes hours or days Disorganized thoughts including inattention memory loss and disorientation Hallucinations Delusions Reduced level of consciousness 4 Possible Physical Assessment Changes Changes in peripheral core and neurovascular perfusion Changes in pupil response Changes in motor response Dysrhythmias Adventitious breath sounds 5 Assessment Tools Neurological exam including cranial nerves motor and sensory function Blood pressure assessment Limb lead ECG evaluation Twelve lead ECG interpretation for ischemia injury or anomalies Cardiac auscultation for irregular muffled or extra heart sounds Lung auscultation for adventitious sounds Capnography Blood glucose evaluation 6 Treatment Airway ventilatory and circulatory support Oxygen with adjuncts as appropriate Venous access ECG monitoring Treatment of reversible causes such as hypoglycemia with D50 IV or glucagon and suspected opioid overdose with Narcan Ongoing reassessment of patient response