Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineRecommendation • 1Nurses should maintain a high index of suspicion for delirium, dementia and depressionin the older adult. (Strength of Evidence = B)Discussion of EvidenceDue to the aging population, nurses will be providing more care to the elderly in a variety ofsettings. While many older adults remain able to care for themselves independently or withsome formal and/or informal support, a smaller proportion of adults with cognitive andmedical needs consume a high level of service utilization.There is substantial evidence supporting the theory that the presentation of delirium,dementia and/or depression is associated with increasing age, including work published bythe Canadian Study on Health and Aging Working Group (1994a). While it is accepted thatsome aspects of cognitive performance deteriorate with age, dementia is usually “suspected”when cognitive losses are associated with decline in occupational, social, or day-to-dayfunctioning (Patterson et al., 2001).23The literature repeatedly confirms that among healthcare providers, there is a tendency toview mild dementing changes as “just old age”, and little or no follow-up is done (Costa, Williams,Somerfield et al., 1996). At the same time, evidence is inconclusive in supporting an assessmentof all asymptomatic older people, particularly for dementia.“Given the burden of dementia for some people and their caregivers, it is important for healthproviders to maintain a high index of suspicion” (Patterson et al., 2001, p. 7). This theme of “indexof suspicion” is echoed by the New Zealand Guidelines Group (1996), who supportmaintaining a high level of suspicion for depression, and feel that this could be the singlemost important factor contributing to early detection.