Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineDementia is a syndrome of progressive decline in multiple areas of cognitive functioneventually leading to a significant inability to maintain occupational and social performance.The estimates of the prevalence of dementia range from 2.4 percent among persons aged65-74 years, to 34.5 percent among those aged 85 and over (Loney, Chambers, Bennett, Roberts &Stratford, 1998). Research shows there are presently over 250,000 seniors with dementia inCanada, and it is estimated to rise to 778,000 by 2031 (Canadian Study on Health and Aging, 1994b;Patterson et al., 2001). The incidence suggests that there will be approximately 60,150 new casesof dementia in Canada each year. Patterson et al. (2001) conclude that because of the increasingburden of suffering which dementing disorders impose on individuals, their caregiversand the healthcare system, recommendations on the assessment and management of theseconditions are both timely and important.21Depression is a syndrome comprised of a constellation of affective, cognitive and somatic orphysiological manifestations in varying severity from mild to severe (Kurlowicz & NICHE Faculty,1997; National Institute of Health Consensus Development Panel, 1992). Depressive symptoms occur in 15 to20 percent of community-based elders requiring clinical attention and 37 percent of eldersin primary care settings.Depression in late life is a major public health concern. Mortality and morbidity ratesincrease in the older adult experiencing depression, and there is a high incidence ofcomorbidity with medical conditions (Conwell, 1994). It is widely known that depression canlead to increased mortality from other diseases such as heart disease, myocardial infarction,cancer and chronic depression (U.S. Dept. of Health and Human Services, 1997). Untreated depressionmay also result in increased substance abuse, slowed recovery from medical illness orsurgery, malnutrition and social isolation (Katz, 1996). The most troubling outcome of depressionis elder suicide, and older adults have the highest risk of suicide rates of any age group.The suicide rate for individuals aged 85 and older is the highest at about 21 suicides per100,000 people, a 25 percent increase from 1980 to 1986 (Conwell, 1994). Studies reveal thatsingle, white, elderly males have the highest rate of suicide and are more likely to succeedthan their female counterparts.