Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineRecommendation • 3Nurses must recognize that delirium, dementia and depression present with overlappingclinical features and may co-exist in the older adult. (Strength of Evidence = B)Discussion of EvidenceThe literature frequently focuses on the co-existence of delirium, dementia and depression.During screening assessment interviews with both the client and caregiver/informant, thenurse should be cognizant of the frequent co-existence of delirium, dementia and depression,and seek evidence to identify their presence (Costa et al., 1996). A review of articles also confirmsthat both delirium and depression are often mistaken for dementia, and because of thefrequency of this co-existence, nurses are advised to conduct ongoing assessments to ensureprompt medical attention for treatable and reversible conditions. If delirium or depressionis suspected, a prompt response of intervention and possible referral needs to happen(APA, 1999; Costa et al., 1996). (see Screening Assessment Flow Diagram on page 22)25Recommendation • 4Nurses should be aware of the differences in the clinical features of delirium, dementia anddepression and use a structured assessment method to facilitate this process.(Strength of Evidence = C – RNAO Consensus Panel, 2003)Discussion of EvidenceThe development panel reached consensus on this recommendation, noting that asnurses conduct a geriatric mental health assessment, it is important to start with a clearunderstanding of the variety of altered mental states and the varying behaviours that mightbe encountered. Table I outlines some of the clinical features a person can exhibit regardingdelirium, dementia and depression. The table can be used as a guide when assessing clientsand to differentiate between delirium, dementia and depression.