Dementia is a progressive condition with changes over time. If you notice sudden changes in a person’s cognition or sudden increased confusion, then always seek your General Practitioners (GP) support in the first instance. The person may be experiencing a medical condition called ‘delirium’ and this requires medical attention.
As always, it is important to remember that every person is unique and so these suggestions may not work for everyone and what works this week may not work next week. However, we hope the knowledge of confusion will help you understand what could be happening and ways you may be able to assist the person with dementia who may appear ‘confused’ at times.
What is Confusion?
Confusion is defined as ‘a disturbed mental state in which a person has impaired orientation with respect to time/place/person’. For people who have a dementia diagnosis, increased confusion is often one of the earliest symptoms that the person may have another illness.
Signs of confusion can include:
- Difficulties with short term memory
- Difficulty carrying out familiar tasks
- Reduced attention span
- Increased speech difficulties
- Increased difficulty following instructions.
Confusion always needs to be discussed with the GP. Other medical conditions can also cause the person to appear confused: e.g., Diabetes, stroke, low blood sugar, metabolic disorders.
Delirium is confusion that comes on very suddenly, sometimes in just a few hours, as a result of some sort of physical problem. A person experiencing a delirium may also see and hear things that are not really there (hallucinations). There can be more than one cause of a delirium. These causes may include:
- Drug or alcohol withdrawal
- Medical illness
- Medical procedure such as surgery
- Severe pain
- Prolonged lack of sleep
- Infection such as a urinary tract or chest infection.
If you suspect that the confusion is being caused by a delirium, then seek medical support from your General Practitioner (GP). They can test for infections or see if the medications need to be changed.
Stress can affect a person’s memory and concentration. Stress can also exacerbate pre-existing medical conditions such as dementia. Just because a person has a diagnosis of dementia, does not mean they cannot still experience stress.
Dementia causes brain damage which means that the brain’s ability to cope with stressors is a lot less than if it were healthy. If you notice a change in the person’s symptoms, have a think about what has been going on in their lives that could cause stress. Examples may be the death of a family member or friend, a significant change in routine, stressful family dynamics or moving home.
If stress is a possible cause of the confusion, then you may wish to:
- Seek medical support if needed
- Try and remove the person with dementia from the person/situation causing the stress
- Create a calm environment
- Talk to and reassure the person with dementia
- Seek counselling for the person with dementia where appropriate
Fatigue for people with dementia may be caused by poor night time sleep, an erratic routine, traveling long distances or situations requiring prolonged concentration such as socialising or GP/specialists appointments.
Fatigue can affect a person’s ability to concentrate, affect their memory, or make word finding more difficult.
If fatigue is causing the change in symptoms, you may wish to:
- Seek medical support if needed.
- Have a good routine. Routine uses habits and so requires less concentration and uses less mental energy.
- Plan – if there is an event that requires extended concentration (family event or specialist appointment), be prepared for the person with dementia to have worse symptoms. Try and make the following day quiet and uneventful to allow recovery time.
- Break up long travel time by using regular break stops or travelling over 2 or more days.
- Plan your week where possible. Try and get an idea of how much energy the person with dementia has over a week. Then plan your week to ensure that activities are spread out to reduce the risk of fatigue
- Try and practice good sleep hygiene – reduce evening caffeine/alcohol, switch off evening TV/phone screens, have a regular bed and awake time.
People living with dementia may be susceptible to things that can cause pain, such as falls, accidents and injuries as well as a range of medical conditions. Depending on the type or stage of dementia or level of acute confusion the person may be unable to tell you that they are in pain. A person experiencing pain may present with a range of different symptoms, including confusion.
If you suspect that the confusion is being caused by pain, then seek medical support from your General Practitioner (GP).
Some people with dementia may be at a higher risk of developing constipation due their lifestyle, or treatment for other medical conditions. The dementia itself may also lead a person to become constipated as their awareness of needing the toilet reduces.
Symptoms of constipation can include:
- Reduced appetite
- General inability to function normally
- Incontinence of urine
Ways we can ensure a person’s bowels are healthy include:
- Eat foods high in fibre
- Drink lots of fluids to keep the stools moist
- Increase physical activity as this helps to increase bowel activity. This can be done from a seated position if there is a risk of falls
- Know the persons bowel habits –Timing your bowel care or toileting after a meal may make it more effective
- Sit on the toilet properly. Sit up straight; you may need to use a footstool
- Seek support from the GP. Sometimes changes in medications or the addition of medication can help with bowel movement
Environment and Routine
As dementia progresses the person may become more reliant on their surroundings and routine to stay orientated. The environment and routine provide the person with dementia cues as to what is happening, what time of the day it is and where they are.
If the environment or routine is changed then this may cause the person to become confused, anxious or frustrated.
This can often be seen in a hospital setting where the family of a person may have thought they were coping fine, but the person with dementia becomes very confused in the hospital. This may have been because the person was able to function only within their routine and home environment which provided a façade of coping.
Sometimes family may want to take the person with dementia home with them (such as during the COVID-19 restrictions) but find that person becomes confused and agitated when staying at the family members home. Try and plan for increased confusion, or if possible, go and stay with the person with dementia rather than bringing them to your home.
A person living with dementia may walk or drive along the same route every day and is therefore able to navigate the route through habit. The problem with navigation through habit is that the person can lack the skills to problem solve should there be a disruption in the routine. Examples of how this may occur include a footpath being closed for maintenance or due to a road traffic accident, the addition or removal of road crossings, a distraction by a person, object or animal. Once distracted or diverted away from the usual route it can be very easy for a person living with dementia to become confused, disorientated and lost.
Possible other environmental reasons why a person with a dementia type diagnosis may appear to be confused:
- Too much noise e.g.: radio, TV, too many people all talking at the same time.
- The room may appear to be large/overwhelming.
- Too much clutter may cause the person with dementia to feel overwhelmed and confused.
- Changes in floor surfaces, changes in lighting, mirrors can all cause the person to misinterpret what they are seeing.
Other factors that may cause confusion:
- Prescribed medications – some prescribed drugs may cause confusion. Always inform the GP of any concerns re confusion.
- Impaired vision/hearing can affect a person’s ability to understand what is being said and what is happening around them. Routinely check to ensure hearing aids are in good working order, and prescription glasses are clean and worn as prescribed.
- Dehydration – many people with dementia do not drink enough, as they may not recognize the sensation of thirst, or they may forget to drink. Symptoms of dehydration may include confusion.
- The task the person is doing may be too hard/challenging for them.
- Being asked to do a new/unfamiliar task may cause a person to experience confusion.
How to respond when the person you are supporting appears to be confused
‘You have to figure out what’s going to make the person feel the safest’ (Mariotto)
Stay calm. Respond with a brief, simple explanation. Use clear photos/pictures to help give a tangible explanation. These may assist as memory prompts.
Offer reassurance. Focus on the person’s feelings, e.g., ‘you seem worried’? “You are safe with me’. ’We are going to the bathroom’.
Redirect: e.g. Go into another room, have a hot drink, walk around garden.
If the person is confused and speaks re their wish to go home – rather than trying to rationalize with the person that they ‘have lived here for 5 years’- try and focus on and validate on what the word ‘home’ may mean to them.
Offer respectful correction, framed as a ‘suggestion’. e.g., ‘I think he is your Grandson Paul’.
When asking the person who has a dementia diagnosis a question: consider framing your questions in a way that only require a ‘yes’ or ‘no’ response.
Always try and see the situation from the person with dementia’s perspective. Try not to take it personally. Treat them with respect/kindness and be patient.
- Try and minimize clutter. Simplify room layout and ensure clear pathways for person to move inside their home. Create a calm environment: e.g., pleasant smells, flowers etc.
- Ensure good lighting-to help reduce shadows and reduce falls risks.
- Reduce noise and distractions where possible.
- Encourage the person to engage in purposeful activities and participate in regular physical exercise
Finally, Be Kind to Yourself
You are human. None of us are perfect – especially during these times at home.
Take care of yourself, as well as your family member who has dementia.
Feel free to contact us at Dementia Waikato if you need to talk about any issues you are having with the person you are caring for. Dementia Waikato staff are all working from home and can speak with you on the phone 07 929 4042 or via email firstname.lastname@example.org