Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Health Education Fact Sheet

Many older adults are affected by delirium, dementia and/or depression. These are different conditions and are not part of normal aging. However, it is hard to recognize the differences in the older adult because many of the symptoms and behaviours can occur together. It is important to realize that you can seek help in recognizing the differences and find suggestions for care.

Are you or a loved one experiencing the following?
Delirium (acute confusion) is a change in your ability to think clearly, to plan your usual day, to pay attention or to remember a few days or hours ago. It usually happens quite quickly over a short period of time (several hours or days) and is temporary, lasting for a few hours or several weeks. Delirium has many different causes and these may include: severe infections; high fever; lack of fluids; diseases of the kidney or liver; lack of certain vitamins; seizures; lack of oxygen; head injury; reaction to certain medications or alcohol. It can also occur after surgery or sometimes after a fall. A delirious person may be confused about where they are or what time of day or year it is. Things may be seen or heard that are not there. Older people with delirium may have mood swings that can be frightening.

Dementia is the gradual loss in memory (ability to think, reason, remember and plan) and the ability to carry out one’s daily activities. It usually starts slower than delirium, over many months and may appear as a loss in thinking and doing your normal activities. It is different for each person. Aging itself does not cause dementia but it is more common among older adults. One of the most common types of dementia is Alzheimer’s disease. The symptoms of dementia may include: memory loss that affects daily activities (e.g., dressing, grooming); difficulty performing tasks (e.g., banking, driving, brushing teeth); problem with language, poor or decreased judgment; misplacing things (e.g., “someone took them”); changes in mood, behaviour and/or personality; disorientation to time and place; getting lost; loss of initiative (e.g., often better if someone tells you what to do); difficulty with balance while walking.

Depression is the most common mental health concern in the older adults. Depression often occurs at the time of a major life change such as a loss of a spouse. Signs of depression may include: cutting back on enjoyable activities (e.g., losing interest); changes in appetite and weight (e.g., loss of interest in eating or eating more). Changes in sleep pattern (e.g., awake during the night and are not able to fall asleep again) is another warning sign. You may feel a lack of energy or always feel tired, even if you have slept. Depression that is not treated can result in physical illness, substance abuse, loneliness and suicide.

What can you do for yourself,or for someone you know who may be experiencing signs of delirium,dementia or depression?
Any older person who shows the signs and symptoms discussed above has the right to a timely and thorough geriatric/mental health evaluation and treatment. Contact your healthcare provider as soon as possible! Careful screening for these disorders leads to early understanding and treatment.

What kind of screening and treatment can you expect?
You should expect a thorough assessment that includes a variety of tests and meeting with different members of the healthcare team. This may include a geriatrician, a physician who specializes in care of older people. A family member or your caregiver may also be asked to be part of the screening process. Treatment options will focus on identifying risk for injury and strengthening your abilities. You may be referred to special programs and services that can help enhance involvement in activities of daily living.

Where else can you go for more information?
If you or a family member/friend have access to a computer, visit the Regional Geriatric Programs website at http://www.rgps.on.cafor additional information. Regional Geriatric Programs provide a network of specialized geriatric services that screen, assess and treat illness and disability in older adults with complex health problems.