They Say She's Confused
They Say She's Confused
They Say She's Confused
Looking into her eyes, I see she is anxious and my immediate response is to help and say "of course, it is on my way home." But quickly I realize this seemingly "normal" looking person may be "confused". Confused is a commonly utilized word to describe many of the residents residing in our long term care facilities. It is a catch all word that is non-descriptive. The number of elders with cognitive impairments is increasing at staggering rates. According to the Alzheimer's Association, the number of individuals with Alzheimer's disease is expected to quadruple from today's number of 5.5 million people to 19 million people by the year 2050.
As activity professionals working with individuals with cognitive loss, it is imperative we become familiar with more descriptive terms than "confused". Individuals with dementia have varying degrees of cognitive loss which go beyond memory loss and time disorientation. To lump all residents or clients with cognitive loss into a "confused" category of residents does them a disservice and is not individualized care. There are a number of terms and functions associated with cognitive loss which should be considered, identified and evaluated within the assessment process. Once the true scope of cognitive loss is defined, specific programs, approaches and adaptations can be introduced. Here are some of the terms associated with cognitive function:
Cognition refers to the mental functions which focus on being aware of your surroundings, your ability to perceive events and cues in your surroundings, your ability to reason, make decisions and use sound judgment.
Confusion, when used in a psychological sense, refers to an individual's impaired orientation to their surroundings (place), the current time or passage of time (time) and people (person). Person, place and time are often referred to as the three spheres of orientation.
Memory is the registering (understanding and processing), retention (storing in the brain for future access) and retrieval (being able to recall the information when needed or desired) of new information. Short term memory (more recent events) impairment is a common symptom of dementing illnesses; while long term memory (events from one's youth and many years past) remain more intact.
Reasoning is the mental ability to interpret cues and information while coming to some sort of sound conclusion. Listening to the weather report will provide an individual with enough information to know what kind of outer garment might be necessary. With poor reasoning, elders begin to put themselves at risk.
Decision making is the act of making up one's mind about various options and choosing the best option. Impaired decision making, making poor decisions and not being able to follow through with decisions is a common concern and also puts the resident at risk.
Intelligence is one's ability to learn and apply information. Crystallized intelligence is accumulated knowledge over a life time which includes facts, data and factual information. Fluid intelligence is focused more on problem solving and reasoning. Research has found that Crystallized intelligence increases with age while fluid intelligence begins to decline in middle age. The decline of fluid intelligence can be slowed through cognitive exercise or "brain aerobics". The old adage of "you don't use it, you lose it" holds true with fluid intelligence.
In normal aging, one only sees a slowing down of cognitive function, not necessarily dysfunction. The elder may need additional time to process information and respond. However, the older person can still learn, problem solve and use complex thought processes. Becoming "confused" is not a normal part of aging.
With Alzheimer's disease and the many secondary diseases which affect brain function, one may see some decline in the mental abilities we all take for granted. We need to identify the remaining skills of our residents and structure cognitive approaches for success and appropriate stimulation. There are many programs and books available today which focus on Brain Fitness. The old adage "if you don't use it, you lose it", holds true here.
Debbie Hommel is a certified Activities Consultant through the National Certification Council of Activity Professions and is a Certified Therapeutic Recreation Specialist through the National Council of Therapeutic Recreation Certification. She consults for long term care, medical day care, assisted living and ICF/MR facilities throughout NJ, PA, and NY.
Debbie conducts the Modular Education Program for Activity Professionals, 2nd Edition in traditional classroom setting as well as through independent study. The MEPAP is approved by the NJ Department of Health and Senior Services and the National Certification Council for Activity Professionals.
Debbie is one of the founders and Charter Member of the New Jersey Activity Professional Association, serving terms as Vice President and President. Recipient of the Madison E. Weidner Lifetime Achievement Award, 1994.
Recipient of the Monmouth and Ocean County Activity Professionals Life Achievement Award, 1999.
Recipient of the National Certification Council of Activity Professionals MEPAP Instructor of the Year, 2009
Serving a two year term on the Executive Board for the National Certification Council of Activity Professional.
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