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  • Rob

The 3 D's

This is a little bit different than my usual blog posts. Normally, I will talk about physical ailments or sports. However, this blog post is going to be around mental health. Mental health issues can be difficult to understand as they cannot be seen.

I never thought much of these three words but I seem to be getting asked more and more about them either when I am working at the hospital or on the job with NLP, in the community.. The 3 D words in which I am referring to is Delirium, Dementia and Depression. I will try to define these words and then give a description about them.

Delirium is an acute change in a client’s mental status. Some of the changes that can occur when someone goes into a delirium are inattention, disorganized thinking and an altered level of consciousness. These changes come on very acutely, recently.

This is something seen unfortunately, all too common in the hospital. Sometimes elderly people are brought into the hospital, by loved ones, simply because their personality has changed suddenly. People in a delirium may do some crazy things, for example, pull out IV’s in their arm, or pull out fully inflated catheters (ouch!!)! The delirious person is not aware they are doing this things, which may lead to pain or bleeding or another infection, which can keep the person in delirium longer.

In seniors, this mental change can seem to come on quite easily, with a simple urinary tract infection, UTI. The mystery is figuring out what has caused this change in cognition. However, once the source of the infection, pain or multiple other causes of delirium is found, corrective measures can be taken. Usually within 1-2 days of starting antibiotics, for infections, giving adequate pain control, for a fracture, the client’s mental state starts to return to normal, to their loved one’s delight. If the client’s suffer from depression and/or dementia, they are more likely to suffer from delirium. The presence of one or both, depression and dementia, make the diagnosis of delirium that much more difficult.

Dementia is the name for a group of symptoms, that may be caused by numerous illnesses. Dementia is most commonly progressive and affects the person’s memory, reasoning, communication and insight to name a few. This can lead to changes in the person’s personality, social aspects, communication, judgement and initiative. Did you know that Alzheimer’s disease is a form of dementia? Other common forms are vascular dementia and mixed dementia (combination of Alzheimer’s and vascular dementia). The onset of dementia is usually subtle and gradual. Sometimes the client’s are aware that they are getting dementia which can be very frustrating. When dealing with client’s suffering with dementia using an individual approach is best.

Depression is a mental illness. Like any illness it can be treated. With depression people may get feelings of sadness, hopelessness or a loss of pleasure from things they enjoyed doing, i.e. gardening. There may be mental and physical changes with depression such as difficulty concentrating, sleep that is not refreshing, decreased energy, difficulty getting out ofbed in the morning… Some people suffering with depression may hide how they actually feel or think that they just have “the blues”. If these symptoms are lasting continuously for more than a couple of weeks, the client should talk to their family doctor about ways to help them.

To make matters more difficult, sometimes people with dementia can suffer also from depression. This is especially true with people that are institutionalized, i.e. live in a nursing home, psychiatric ward.

Exercise is one, non-pharmaceutical, way to help with depression. It does not have to be vigorous exercise, simply walking, at a brisk pace, for 30 minutes, 3-4x/week.

Help for this post came from the Canadian Physiotherapy Association, Physiotherapy Practice Magazine, Holiday 2015, Volume 5, No.6, pp 13-15

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