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Dementia communication can be difficult, but if positive approaches are used, your loved one or resident will respond better and with less frustration. Here are some tips:

• Always approach the person with Dementia from the front, not from the back. 
• Communicate at eye level and maintain eye contact. 
• Keep the environment quiet, not only to reduce over stimulation, but to allow the person with Dementia to better hear and understand what is being said. 
• Turn off the television and radio when communicating.
• If the person with Dementia is in a noisy area, take him or her to a quiet area. 
• Give the person with Dementia time to respond to you. Speak in a calm and gentle tone using short sentences and use simple words they can understand. 
• Do not use "baby talk" as this may embarrass or annoy the person with Dementia.
• Only discuss one topic at a time. Speak in your normal tone of voice, and do not shout or yell. 
• Never contradict the person with Dementia, as they have lost their reasoning skills and arguing is reasoning. 
• Remember to be aware of your body language as it speaks volumes. If you stand in front of the person with Dementia with your arms crossed in front of you, they  may think you are angry. If you have a frown on your face they will respond in an angry manner, as you look angry as well. 
• Focus on feelings, not the facts.
• Banish “don’t you remember”? From your vocabulary.
• One step, one comment at a time, avoid quizzing and asking questions.
• Don’t use the word no or any words that end in n’t such as can’t, won’t, shouldn’t---only positive language.
• If guiding - use arm in arm, a hand on the back of a shoulder, hand over hand
• Use smells as appropriate to communicate versus words/vocal communication. Smell of food communicates its time to eat. The smell of soap or shampoo communicates its time to bathe.

Overview of Delirium

Delirium is a sudden change in a person’s mental abilities that results in confused thinking and reduced awareness of the environment. The start of delirium is usually rapid and could develop within hours. In comparison dementia develops over a long period of time. 

It is very important to know a person and know their baseline and their brain strengths as Delirium could lead to increased confusion, disorientation, or difficulty with concentration. If you don’t know a person’s baseline or strengths, then how are you going to know if this is delirium or the progression of Dementia? 

Remember, delirium is acute, Dementia is not.

How Delirium and Dementia Interact

Delirium and dementia can be similar and difficult to distinguish, so input from a family member or caregiver is important to help establish that baseline. Delirium is a treatable   condition and may co-exist with dementia. However, a person experiencing delirium does not always mean that person has dementia. It is sometimes difficult to recognize delirium in persons with dementia because it has similar symptoms such as confusion and difficulties with thinking and concentration. Remember, Dementia is the progressive decline of memory and other thinking skills due to the gradual dysfunction and loss of brain cells.   

Some differences between the symptoms of delirium and dementia include:

· Onset - The onset of delirium occurs within a short time, while dementia usually begins with relatively minor symptoms that gradually worsen over time.

· Attention - The ability to stay focused or maintain attention is significantly impaired with   delirium. A person in the early stages of dementia remains generally alert and maintains the ability to stay focused.

· Fluctuation - The appearance of delirium symptoms can fluctuate significantly and frequently   throughout the day. While persons with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.

Signs/Symptoms of Delirium

Signs and symptoms of delirium usually begin over a few hours or a few days. They often fluctuate throughout the day, and there may be periods of no symptoms. Symptoms tend to be worse during the night when it's dark and things look less familiar. If someone with Dementia had delirium, the signs and symptoms would be heightened.

Primary signs and symptoms include:

· Reduced awareness of the environment, which can result in:

       o An inability to stay focused on a topic or to switch topics

       o Getting stuck on an idea rather than responding to questions or conversation

       o Being easily   distracted by unimportant things

       o Being withdrawn, with little or no activity or little response to the environment

· Poor thinking skills (cognitive impairment), which can be identified as:

       o Poor memory, particularly of recent events

       o Disorientation — for example, not knowing where you are or who you are

       o Difficulty speaking or recalling words

       o Rambling or nonsense speech

       o Trouble understanding speech

       o Difficulty reading or writing

· Changes, which can include:

      o Seeing things that don't exist (hallucinations)

      o Restlessness, agitation or combative behavior

      o Calling out, moaning or making other sounds

      o Being quiet and withdrawn — especially in older adults

      o Slowed movement or lethargy

      o Disturbed sleep habits

      o Reversal of night-day sleep-wake cycle

· Emotional disturbances, which can be identified as:

      o Anxiety, fear or paranoia

      o Depression

      o Irritability or anger

      o A sense of feeling elated (euphoria)

      o Apathy

      o Rapid and unpredictable mood shifts

      o Personality changes

Causes of Delirium

Delirium can often be traced to one or more contributing factors, such as a severe or chronic illness maybe advancing, changes in metabolic balance (such as low sodium or low calcium), medication or medication combinations, or post-surgery – after anesthesia. It can occur when you are medically unwell and can be caused by infections such as a UTI (and remember low level   infection may not show up on tests), pain, dehydration, constipation, urine retention, sleep deprivation or severe emotional distress, or lack of nutrition. Other causes not listed are medical conditions, such as a stroke, heart attack, worsening lung or liver disease, or an injury from a fall.

Delirium can last for a few days, weeks or even months but it may   take longer for people with dementia to recover. People with delirium and dementia have been found to be at increased risk of complications such as falls, accidents or pressure sores; and be more likely to be admitted into a hospital.

Several medications or combinations of drugs can trigger delirium, including some types of:

· Pain drugs

· Sleep medications

· Medications for mood disorders, such as anxiety and depression

· Allergy medications 

· Asthma medications

· Steroid medicines 

· Parkinson's disease drugs

· Drugs for treating spasms or convulsions

Prevention of Delirium

Research also shows that there are effective ways to prevent delirium before it happens. Here are a few healthy behavior strategies that can reduce the likelihood of delirium in older adults:

*Conversation - Having regular visits or discussions about interesting topics can be useful for keeping their thinking on track. Help to keep your loved one oriented to the time of day.

*Sunlight - If possible, open the curtains in the room to allow light to enter, which can   help to signal the time of day.

*Movement - When it is medically safe, encourage your loved one to walk or move regularly (for   example, after surgery), using a cane or walker if necessary.

*Hearing and vision aids - Remind him or her to use hearing aids and glasses when needed.

*Nutrition - Help your loved one stick to the eating and drinking plan that is recommended   by the medical team. Let the medical team know if he or she develops constipation or other problems.

*Nighttime sleep - Establish a calming bedtime routine, and try to avoid waking him or her up   at night when possible. If your loved one is in a new environment like a hospital, try to make him or her more comfortable by bringing familiar items from home, such as a favorite blanket or book.

*  Address any underlying causes or triggers — for example, by stopping  use of a particular medication, addressing metabolic imbalances or treating  an infection. All can help prevent or reduce the severity of delirium.

1.  What is the difference between Dementia and Alzheimer's Disease? 

Alzheimer's Disease is one very common form of Dementia. Dementia is a symptom of a disease or injury of the brain.  There are many types of diseases that cause Dementia symptoms. Easy answer, Dementia is a symptom caused by a disease such as Alzheimer's disease, so if you have Alzheimer's Disease you have Dementia.  This is the reason finding out the WHY is so important....WHY do you have Dementia, is it due to a disease or injury, or is it something reversible such as a thyroid disorder or vitamin deficiency?

 
2.  What can you do if you are worried about your driving safety or the driving safety of a friend or family member?

It is important to voice your concerns and to discuss the possibility of not driving any longer. This conversation can be difficult, but don't hesitate to ask for advice from your doctor on how to proceed.  Concerns about driving safety may be raised by your physician, friends, or family members, and it is very common for there to be disagreement about whether a person's driving skills have changed or what to do next. There are many possible reasons why someone's driving safety might be a cause for concern, such as reaction time, vision, spatial perception, navigation, judgment, memory, language, or arm or leg coordination. Importantly, these reasons may have nothing to do with overall cognitive strengths or with the individual's driving record, which may be perfect.  It is better to retire from driving before a near-miss or an actual collision leads to property damage or—worse—injury.

If you need help deciding whether it is time to give up driving, you can ask the Department of Motor Vehicles (DMV) to perform a driving assessment, which usually consists of an in-person consultation, a written test, and a road test. The DMV can exchange a driver's license for an identification card, so that the individual would not have to go without this important picture ID card.