Care of elderly and confused

Pepper The Cat, BSN, RN · Oct 19, 2008

Use simple sentances. One instruction at a time. For example, don't say sit, put on your slippers and stand up. Say sit up - wait for action.

Put on slippers - wait for that. Stand up - wait for that.

Repeat things as necessary.

Keep area well lit - shadows cause hallucinations.

Speak to pt in person - don't get on the intercom and ask pt questions - would you answer a voice coming out of the wall?

Ask family what works, what doesn't work.

Large calendar with date on it. Large clock that they can see, or visible ways to orient to time - open curtains, etc. Keep stimulation to a minimum.

Keep narcotic use to a minimum - narcs and confused people can be a deadly mixture! Also watch out for Ativan - can work much differently in the elderly!!

Remember - the confused need longer to process information, do not adapt well to change and can't process multiple things at one time - ie don't ask questions while doing vital signs.

Above all - be patient. As irritating as it is to repeat things over and over, they are not doing this on purpose.

TopazLover, BSN, RN · Oct 19, 2008

I am sure you are very knowledgeable about losses due to stroke, especially one sided neglect and huge blind spots in vision.

If elders are confused due to neuro events it is different than if it is caused by Alz. or other diseases whose predominant feature is dementia, Parkinson's, Pick's, etc.

If dementia, reality orientation is frustrating for pt. and nurse. They probably can't remember. If confused then RO is important. White boards are great for both. Consistent caregivers, working slowly, and speaking to the person - telling them what will happen are important.

Being elderly is different than being either confused or having dementia. Too many times it is assumed that all elders are one or both. Many times elders get confused with new surroundings, so reassurance and RO are important. Lots of times you will see elders with delirium due to disease. UTI is probably the most common. Clear the infection, clear the mind.

There are great resources for care. All have one thing in common: Treat the person with kindness and a smile. Anticipate the possibility of other losses like hearing or sight, but don't assume them.

Love them as many have so little love shown, especially if their behavior is less than pleasant. Keep in mind, you will care for them for a short time, full time caregivers never get a break (in many cases) and may be glad they are hospitalized, crazy as it seems to you as an outsider.

Ask full time caregivers how to approach and what works. NH and ALF staff will know these things and will gladly share.

SuesquatchRN, BSN, RN · Oct 19, 2008

And crouch, so that you are eye level.

I suggest that you look into the Geriatrics/LTC formula. There are entire threads devoted to handling dementia patients, etc.

nursealanarae · Oct 19, 2008

thanks so much for your responses! These are great suggestions :wink2:

laketrash · Oct 19, 2008

All the these are great ideas and will certainly help; just know that as you take care of these people more, you will become more comfortable. Also, one thing that works for me is treating them like they are my grandmother etc.

suanna · Oct 19, 2008

AT my hospital we just promote them to upper level management:wink2:

Honestly, the only thing I have ever found that works is to bring family in to help reorient/calm them. Even with family they settle down less than 1/3 of the time. There have been some studies using Celexa for ICU psychosis but most often we hust use Haldol 5mg IVP with a repeat Q2 hrs an/or ativan IV .5 to 1mg. Nursing interventions: distraction and redirection works better than reorientation. Its hard to be combative when you are bragging about your grandchildren. Sleep for 3-4 straight hrs is required. Don't forget to evaluate your electrolytes and review thier meds- many seemingly benign meds can make the elderly NUTS.

morte, LPN, LVN · Oct 19, 2008

first, to me, DON T assume it is their baseline.....if it is not, and they are post op, anesth is a potential issue.....takes a great deal of time to clear in the younger person, longer in the elderly.....hydration unless otherwise contraindicated.....always consider sensory deficits, ie hearing of vision, as was previously stated....

a little story about assuming....about 20 years ago, when patients were in hosp much longer,lol....had a gentleman who would be up with us until about 4-430 in the morning and then would go back to his room.....mentioned to another nurse...she said "sundowning" i said to myeslf sundowning my orifice......he was alert and oriented.....when next worked asked him what shift he had worked (had been retired les than 2 years) he gave a big sigh and said 3rd shift for 40 years....! as it turned out, he knew that our work pace picked up about 430 or so , so he was getting out of our way..........good luck, and thanks for caring

SuesquatchRN, BSN, RN · Oct 19, 2008

AT my hospital we just promote them to upper level management:wink2:

:yeah:

CoffeeRTC, BSN, RN · Oct 19, 2008

Don't argue with them. If they think it is 1945, then it should be 1945. If they "need to get dinner ready" ...tell them dinner is being made by our cook tonite.....this only works with some pts.

Trying to orientate them could cause more agitation.

Try to meet the basic needs...wet, need to use the bathroom, hungry, pain...etc. Yes. Simple, but sometimes we forget about the basics.