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Underline/highlight any signs/symptoms of dementia, delirium, and/or depression

  • As you read through this case study, underline/highlight any signs/symptoms of dementia, delirium, and/or depression you see.
  • What are risk factors for delirium?
  • What are the signs and symptoms of dementia?
  • What are ways you treat a patient with delirium differently than a patient with dementia?
  • What are signs and symptoms of depression?
  • How do these signs and symptoms overlap with one another and with signs and symptoms of other disease pathologies in the older adult population?

Appendix A Case Study –

Mr. Y’s Story Mr. Y is a 78 year old man who was born in Korea and moved to Canada with his wife 50 years ago. Together, the couple opened a floral shop and ran the business for 40 years. Mrs. Y enjoyed watching her husband’s talent and love of nature come out in his flower arrangements.

When Mr. Y was in his late 60’s, he starting having difficulty making his favourite flower arrangements. Their son also noticed Mr. Y misplacing tools, losing paper orders, and forgetting important pick-up times. At home, Mrs. Y noticed her husband having problems remembering recent events, and waking up at odd hours in the night thinking it was time to open the shop. Mr. Y was becoming irritable at home and at the shop.

When Mr. Y was 70 years old, the family decided to sell the business. Their health-care providers confirmed that Mr. Y was presenting with early stage Alzheimer’s disease. The family then decided that Mrs. Y would be appointed as her husband’s Power of Attorney for personal care and property. She continued to care for her husband at home.

When Mr. Y turned 75 years old, he was having increased difficulty remembering where things were in the house. He often woke his wife at odd hours of the night thinking it was time to get up and ready. When Mrs. Y reoriented her husband that it was still night-time, he would get confused and easily upset. Mr. Y was also becoming more physically weak, but did not perceive his limitations. He was having frequent falls at home. A few times, Mr. Y had become lost outside of their home, forgetting where he had to go and which house was his.

Their son recognized that his mother was not as happy as she used to be. She was constantly worrying about her husband’s increasing care needs, and could not enjoy activities she used to do. She was stressed and was not sleeping properly. With support from their health-care providers, the family decided that a long-term care setting would benefit Mr. Y and Mrs. Y’s well-being.

Admission to long-term care

 At the admission conference, the long term care home’s social worker and charge nurse met Mr. Y and his family, and learned more about his history and preferences. His medical diagnosis includes moderate Alzheimer’s disease and osteoarthritis, with a history of urinary tract infections. Mr. Y also requires reminders to use his walker properly. Mrs. Y always prompted her husband for toileting, as well as when to eat and take medications. Mr. Y requires limited assistance from his wife during activities of daily living, such as dressing or transfers.

As for his preferences, Mr. Y loves homemade Korean food, pastries, and warm drinks. He had always enjoyed baths in the evenings.

Mr. Y’s first week: During the first week in LTC, the staff noticed Mr. Y pacing the hallways, pushing on locked doors, entering other residents’ rooms. When approached by the nursing staff, he had repetitive questions: “Who are you?”, “What do I do?”, “Where do I go?” Mr. Y required frequent reminders that this was his new home.

During meals, Mr. Y ate little despite encouragement and staff offering assistance. During personal care such as changing, toileting and showering, Mr. Y kicked, scratched, grabbed and screamed at the PSWs. Two staff were required during these care activities. Socially, Mr. Y actively participated in group craft activities and exercise classes when the therapists and staff coached him. During the times with no scheduled activities, Mr. Y paced the hallways and asked staff: “What do I do?”, “Where do I go?”

Mr. Y’s second week: At the end of the second week in LTC, Mr. Y was no longer pacing the halls. He was often found napping in his room during the days. One afternoon, a PSW went into Mr. Y’s room and found him sleeping. She tried to gently wake Mr. Y, but he was not easy to arouse. She tried a second time and asked very loudly, “Mr. Y, it’s lunch time, are you ready to go?” Mr. Y slowly opened his eyes. The PSW repeated her question, and Mr. Y replied slowly, “Oh, I ate last week.” The PSW then asked, “I know you had breakfast this morning, now it’s lunch time. Are you hungry?” Mr. Y paused and closed his eyes. The PSW gently woke him again by rubbing his arm and repeated her question. Mr. Y slowly replied, “Yes, my wife is cooking, I will eat”. Together, they walked slowly to the dining room.

In the dining room, Mr. Y stared out the window and did not answer the PSWs when they asked him for his lunch preference. When approached a third time, Mr. Y rambled slowly in English and in Korean to the PSWs. He continued to speak Korean to the PSWs as they tried to assist him with his lunch, but he was unfocused and inattentive. He was unable to finish his meal because of his behavior. The staff were worried that he was not eating or drinking enough since admission.

 When there were group activities, the therapists found it harder to encourage Mr. Y to attend and participate like he had been doing before. It took a lot of encouragement and assistance to have him attend. During the activity, he did not participate or sometimes fell asleep in the middle of the exercise or social program.

A few nights in a row, he was found wandering outside his bedroom without his walker. One time, he told the PSW, “Someone is looking for me.” The PSW reassured him that he is safe, and tried to direct him back to his room. But Mr. Y walked past the PSW and said, “I have to go to the bus stop.” After a few attempts, the PSW was able to direct Mr. Y to his room to sleep, and reoriented him to the use of the call bell. This behaviour continued with increasing disorientation. The sleep disturbances resulted in Mr. Y being too drowsy in the mornings, and not able to eat any breakfast.

Although Mrs. Y was kept informed of her husband’s condition since admission to long-term care, it was not until her first visit during Mr. Y’s third week in long-term care when she realized how much her husband had changed. She was alarmed and asked the staff, “What is happening? What will be done for him? How can I help?”

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