Confusion In Older People

I.D.: 20527301


Critically discuss the role of the nurse in the assessment and management of confusion in older people.

This essay will discuss the nurse’s role in assessing and managing confusion in older people, and will explore some of the issues and ideas concerning what constitutes best nursing practice in this field. It will be argued that all nurses, if they are to achieve bestpractice in dealing with elderly confused patients, will need to have an understanding, not only of the biological aspects of this condition but also of the way in which social processes can marginalize and stigmatise such patients. Nurses must cultivate an understanding which must go beyond popular stereotypes of the elderly confused individual.

What then is confusion, and how can it beidentified? An individual is regarded as confused when the cognitive faculties are compromised, such as in situations where individual is disoriented and/or fails to remember basic things, such as the faces of members of his/her family. Confusion is a state that can occur at any age but it is more common in the elderly, due to the anatomical and physiological processes associated with ageing.

Ageinghas been described as a process in which an organism loses its ability, over time, to adjust to the stresses of the environment in which it finds itself, coupled with an inability of to maintain homeostasis. (Webb and Copeman 199806).
An appreciation of the fact that confusion can manifest itself in various forms is the starting point for “nursing assessment”.

Nursing assessment entailsinformation processing and problem identification or ‘diagnostic reasoning’, these activities are obtained through primarily cognitive activity as suggest by Roper et al,1980, 1981;p.128 (Latimer, J.:2000). Nurses need to be aware that confusion, or the delirium state, can be defined as an acute temporary syndrome if it lasts less than 3 months, or chronic if it lasts more than three months. This typemost usually occurs because of underlying pathological causes. Although, the symptoms of this type of confusion can be misinterpreted as indicative only of chronic full dementia, Alzheimer’s or mental illness. It is often not appreciated that confusion of this kind is irreversible, however medical interventions can go beyond the mere attempt to manage and contain this condition. A lack of publicawareness that some kinds of confusion are acute and reversible is partly responsible for the stereotype of all confused patient as essentially and permanently helpless, and out of touch with reality as suggested by (Essential Guide to Confusion) Nursing Times.

A more challenging type of confusion is chronic confusion. Chronic confusion is long-term, not reversible, and medical interventionsare restricted to managing and containing the condition.

The descriptive word ‘delirium’ characterised by marked decrease in the capacity of being attentive stated by (Cole, C.S.:2006). The patient’s attention disturbance of orientation, attention and working memory is significant (Strub & Black, 2000) as quoted by Cole, C., 2006, associated with acute confusion. In this condition, the personbecomes disoriented of time and place too. An acute confusional state lasts for a few days up to three months, unlike a chronic confusional state which lasts longer than 3 months. A chronic confusional state manifests in irreversible conditions such as dementia (G. Bennett & M. Jones;2001).

In everyday parlance, the word ‘confused’ has no clear definition and young people with cognitivedeficits are often taken more seriously than older people. In older patients, such deficits are often too readily assumed to be merely part of the “natural process of ageing”. Therefore nurses, when observing behaviour, need to take care to ensure they are not making unwarranted assumptions. Amella E. J. ( pg.377:2006 ) states that delirium can be prevented by frequent reality orientation of the...