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Integrated Care > Carers, Delirium and Dementia > Flashcards

Carers, Delirium and Dementia Flashcards

1
Q

What is a carer?

A

Person of any age who provides unpaid support to a partner, child, relative or friend who wouldn’t manage to live independently or whose health or wellbeing would deteriorate without this help

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2
Q

What may lead to a person needing a carer?

A 
Frailty
Disability
Serious health condition
Mental ill health
Substance misuse
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3
Q

What sort of roles may a carer have to take on?

A 
Organisation of persons life
Understand medical background of patient
Food prep
Stress management
Own job?
Help move around house
Take to appointments etc.
Finances
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4
Q

What is delirium?

A

Delirium is a state of mental confusion that can happen if you become medically unwell. It starts suddenly and resolves once the cause has been managed

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5
Q

What are the core features of delirium?

A

Cognitive impairment
Rapid onset
Fluctuating severity

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6
Q

How common is delirium?

A

10% of patients presenting to ED that are >65yo

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7
Q

What are the types of delirium?

A

Hyperactive - detected, fall risk, agitated, incoherent speech, disorganised thoughts, delusions

Hypoactive - often mistaken for depression, missed, sluggish and drowsy, look withdrawn

Mixed

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8
Q

What can predispose a patient to delirium?

A 
Advanced age
Dementia
Polypharmacy
Functional impairment
Sensory impairment
Malnutrition
Co-morbidities
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9
Q

What can precipitate delirium?

A

Acute illness - esp UTI, pneumonia, constipation

Drugs - opiates, anticholinergics, sedatives

Metabolic disturbance

Alcohol

Dehydration

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10
Q

How is delirium assessed?

A

Confusion Assessment Method

Suspect if feature 1, 2 and either 3/4

1 - Acute onset and fluctuating course
2 - Inattention
3 - Disorganized thinking
4 - Altered consciousness

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11
Q

How would you assess each part of the confusion assessment method?

A

Alertness - asleep, normal etc.
AMT4 - age, DOB, current location, current year
Attention - months of year backwards
Acute change/fluctuating course

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12
Q

What investigations would you request for delirium?

A

CXR
Bloods - FBC, U&E, LFT, CRP etc.
Urine dip

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13
Q

How is delirium prevented and treated?

A 
Minimise environmental disruption
Good nursing care
Medication review
Orientation clock
Lighting/side room
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14
Q

What should be done if a patient with delirium is having behavioural disturbances?

A 
Non pharma first 
Consider DOLS (deprivation of liberty safeguard)
Not physical restraint
Lorazepam and haloperidol - low dose
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15
Q

What is the prognosis for delirium?

A

Increased mortality at 6 months
Increased hospital stay
Accelerated cognitive decline in dementia

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16
Q

What is the ICD10 definition of dementia?

A

Syndrome due to disease of the brain, usually chronic or progressive in nature.

Disturbance of multiple higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement

Consciousness is not clouded.

Impairment of cognitive function accompanied by deterioration in emotional control, social behaviour or motivation

17
Q

What is mild cognitive impairment?

A

Evidence of objective cognitive impairment but not severe enough to be classified as dementia

10-15% conversion to dementia per year

18
Q

What are the main cognitive functions affected by dementia?

A

Complex attention
Executive ability - planning, decision making etc.
Learning and memory
Language
Visuoconstuctional and perceptual motor ability
Social cognition

19
Q

What are the common causes of dementia?

A

Alzheimer’s
Vascular
Lewy body
Frontotemporal (pick’s disease)

Others - Alcohol, Huntington’s, HIV associated. MSA, PSP, Prion disease, MS etc.

20
Q

What are the main risk factors for dementia?

A

Female > Male
Education, occupation, socioeconomic status
Genetics - APOE e4 allele
Smoking, alcohol, obesity, cholesterol, HTN, DM, cerebrovascular disease
Psychosocial factors, physical activity, depression

21
Q

What is assessed in a history for dementia?

A 
Timeline
Collateral history important
Symptoms - memory, executive function, language, insight, hallucinations etc.
Driving? 
Support?
Recent changes/bereavement?
Risks?
Comorbidities?
Self care?
22
Q

What is in the clinical cognitive assessment for dementia?

A

Orientation and attention - alertness and cooperation, time, place, who, serial 7’s, WORLD backwards, digit span, months of year backwards

Memory - episodic, semantic, working

Language - Name objects, comprehension, repetition, reading, writing, acalculia

Exec function - Letter and category fluency, impulsivity, personality change, reflexes

Apraxia - meaningless gestures, miming tasks

Visiospatial ability - Topographic disorientation, neglect, copying wire cube clock face and pentagons, prosopagnosia

23
Q

What cognitive assessment scales are used for dementia?

A 
MMSE
AMT
6-CIT 
GP-COG
MoCA
ACEiii
Formal neuropsychological assessment
24
Q

What investigations are carried out for dementia?

A

Physical exam - look for cause/focal neurology
Bloods - FBC, U&E, B12 and folate, TFT, infections
ECG, CXR, EEG, MSU, LP, CT/MRI head
SPECT, FDG-PET, Amyloid PET

25
Q

What are the general principles for the management of dementia?

A

MDT approach - psychiatrist, GP, OT, Social worker, CPN, voluntary sector etc.

Medications - AChEi, Memantine
Post diagnostic care - Alzheimers soc/age UK, psychological intervention
Comorbidities
Risk assessment
Good communication and future planning
Social work involvement
Legal frameworks
26
Q

What support is available for carers?

A

Carers centre CLASP - Leicestershire and Rutland

Carers assessment - questions used by social care to determine impact of caring on a persons life so they can determine what support to offer

27
Q

What physical demands are placed on a carer?

A

Diet - often too busy
Weight - poor diet, no time to exercise
Sleep disturbance - stress, night time care giving

28
Q

What financial considerations impact carers?

A

Need to understand benefits system - application forms and entitlements

Needs - transport, equipment, formal support

29
Q

What emotional considerations must be considered for carers?

A

Feel invisible - no-one ask how they are

Anxiety - health of loved one

Guilt - why them? doing a good job?

Anger - at situation and at feeling annoyed

30
Q

What social considerations are important in carers?

A

Isolation:

  • friends uncomfortable around patient
  • no time
  • change of priorities
31
Q

What are the main barriers to carers accessing support

A

Lack of awareness
Not feeling worthy
Cost
Physical access

32
Q

What support is available for children and families?

A

Healthcare teams and NHS trusts

Social care and council - Leicestershire Safeguarding Children’s Board

Voluntary - Barnardos and childline

Education providers - SENCE, school counsellor

Police - legal responsibility

33
Q

What healthcare teams and NHS trusts can support children and families?

A

Community pads
Dianna community children’s service
Learning disability services
Health play specialist

34
Q

What key things are important in keeping children and families safe?

A

Communication
Situation awareness
Ability to speak out
Leadership

Integrated Care (9 decks)

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