Subtle Signs: Assessing for Dementia Warning Signs During an Acute Episode of Grief in Recently Widowed Individuals

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1 Subtle Signs: Assessing for Dementia Warning Signs During an Acute Episode of Grief in Recently Widowed Individuals Debbie Nogueras, PhD, MSN, ANP/FNP-BC, FAANP Academic Director/Associate Professor Rand Wortman Kadlec Distinguished Chair in Nursing

2 Disclosures Learning Objectives Identify the warning signs of dementia. Recognize the difference between acute grief and early signs of dementia The presenter has no conflicts of interest. No sponsorship of commercial support was given to the author. Debbie Nogueras, PhD, MSN, ANP/FNP-BC, FAANP Washington State University College of Nursing

3 Adult Children of Elderly Parents Study Pilot study 13 participants Qualitative descriptive Themes

4 Participants said.. Because she has lost her spouse, I don t want to run any tests and I don t want her to worry. Let s see how she does. We lost time because we couldn t get a provider to assess her for dementia they kept telling us it was grief. Nobody with grief behaves that way. We could have started her on something 2 years ago if we had not be told- Well, we don t want to put that label on her yet. Five years after mom and dad were in a car accident which left mom in a lot of pain, she died. Dad started having some cognitive issues after that. They just diagnosed it as depression but it wasn t.

5 Dementia May be either a major or a mild neurocognitive disorder Dementia is not a normal part of aging although it mainly affects older people. Worldwide, 47.5 million people have dementia and there are 7.7 million new cases each year (WHO, 2015). An estimated 5.3 million Americans of all ages have Alzheimer s disease (Alzheimer s Association, 2015). Alzheimer s disease first identified more than 100 years ago, but only in the last 30 years has it been recognized as the most common cause of dementia and a major killer.

6 Signs and Symptoms of Dementia Early stage often overlooked because the onset is gradual Forgetfulness Losing track of the time Becoming lost in familiar places Middle stage signs and symptoms become clearer and more restricting Forgetful of recent events and people s names Becoming lost at home Increase difficulty with communication Needing help with personal care Behavior changes, including wandering and repeated questioning

7 Grief During the first few months after a loss, many signs and symptoms of normal grief are the same as those of complicated grief. Normal grief symptoms gradually start to fade over time, those of complicated grief linger or get worse. Symptoms similar to dementia Having trouble carrying out normal routines Withdrawal from social activities Irritability or agitation Lack of trust in others Forgetfulness and losing track of time Behavioral changes

8 Side-by-side Comparison Dementia (mild to early moderate) Forgetfulness Losing track of time Difficulty with social activities Needing help normal routines Irritability/agitation Complicated Grief Forgetfulness Losing track of time Difficulty with social activities Needing help normal routines Irritability/agitation

9 Assessment Ask adult children about the health and well-being of their elderly parents during clinical visits Inquire if there has been a loss (i.e. death of a spouse or child) Note if there has been a change in status from married to widow No normal trajectory in grief process not necessarily linear such as the 5-stage Kϋbler-Ross model Easy assessments: Short Portable Mental Status Questionnaire (SPMSQ) screens for cognitive impairment Geriatric Depression Scale (GDS) can be used with those with or without cognitive impairment Texas Revised Inventory of Grief (TRIG) assesses normal vs. pathological grief symptoms. Refer for complete geriatric assessment, follow-up, listen to family members

10 References Alzheimer's Association (2015). Alzheimer s Disease Facts and Figures. Chicago, IL: Author. Arizmendi, B.J. (2015). What is normal in grief? Australian Critical Care, 28, doi: /jaucc DiBello, K.K. (2015). Grief and depression at the end of life. The Nurse Practitioner, 40(5), doi: /01.npr _ Nogueras, D. (in-press). Difficult conversations: Educating adult patients about the warning signs of dementia and their aging parents. Advance for Nurses and Physician Assistants. Sikorski, C., Luppa, M., Heser, K., Ernst, A., Lange, C., Riedel-Heller, S.G. (2014). The role of spousal loss in the development of depressive symptoms in the elderly: Implications for diagnostic systems. Journal of Affective Disorders, 161, Retrieved from World Health Organization (2015). Dementia. Retrieved from

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