‫تطبيق برنامج تعليمي لتحسين المعرفة والسلوك لدى‬

‫للممرضين اتجاه الخرف‬

‫ورشة تدريبية تعقدها كلية األميرة سلمى بنت عبدهللا‬

‫للتمريض في جامعة آل البيت‬
‫لغايات جمع البيانات كمتطلب للحصول على رسالة الماجستير‬
‫ماجستير تمريض صحة المجتمع‬ ‫للطالبة دعاء عالن ‪/‬‬
‫‪1‬‬
 Physical Changes of Aging
Most physical changes that occur
with aging are gradual and take
place over a long period of time.

In addition, the rate and degree of

change varies among individuals.
2
Factors such as disease can increase the
speed and degree of the changes.

Lifestyle, nutrition, economic status,

and social environment can also have
effects.
Serial weigh management is the best
way to monitor nutritional status.
 Only 10% of elderly over 65
needs assistance in daily activities
like bathing, walking

At some point in life after age 65

years if people reach high age 45%
will need nursing homes or complete
supervisions from a care giver 4
 Case Study

• A 85 years old man has a stage 4

pressure ulcer with foul smell and
necrosis involving 50% with out
cellulitis

5
 Case Management
Debridement only
Not pre-application of any type of
ointments or dressing

6
• Changes in vision • Changes in hearing
– Problems reading small – Hearing loss usually
print gradual
– Seeing objects at a – Person may speak
distance louder than usual
– Decrease in peripheral – Ask for words to be
vision repeated
– Decrease in night – Not hear high
vision frequency sounds
– Increased sensitivity to – May not hear well in
glare crowded places
– Cataracts
– Glaucoma

7
• Decreased sensation to pain &
other stimuli = more susceptible
–Burns
–Frostbite
–Cuts
–Fractures
–Muscle strain and other injuries
8
 Case Study

78 years old with hemiplegia and

dysarthria, patient being fed through a
nasogastric tube
Gag reflex decreased
The patient wishes to resume oral eating
What should we do
9
 Case Management
Swallowing video fluoroscopy
Wait until gas reflex returns
Start with ice chips or some water

10
 Activities of Daily Living
• The most appropriate
instrument to assess physical
function abilities is:

11
Nervous System Changes
flow to brain decreases &
there is a progressive loss of
brain cells Interferes with
–Thinking - Reacting
–Interpreting - Remembering
12
 Senses of taste, smell, vision, &
hearing could decrease
Nerve endings less sensitive
Decreased ability to respond to pain and
other stimuli
Decrease in taste& smell frequently
affects appetite
13
Case Study

82 years old patient in nursing

home with a history of stroke
resulted in aphasia, the patient
does not want to eat, physical
examination shows no other
abnormalities.
14
 Case Management
The first step is contact family

Then begin nasogastric tube that may

progress to percutaneous endoscopic
gastrostomy

15
 Psychosocial Changes

Some individual cope with

psychosocial changes, and others
experience extreme frustration
and mental distress

16
• Fears of a sick person:
–Death
–Chronic illness
–Loss of function
–Pain

17
• Dealing with fears created by
an illness:
–Listening
–Patience
–Understanding
–Provide support

18
Confusion and Disorientation
• Six signs:
–Talking incoherently
–Not knowing their name
–Not recognizing others
–Wandering aimlessly
–Lacking awareness of time or place

19
–Displaying hostile and
combative behavior
–Hallucinating
–Regressing in behavior
–Paying less attention to
personal hygiene
–Inability to respond to simple
commands or instructions
20
• Causes of temporary confusion
/ disorientation
–Stress and/or depression
–Use of alcohol or chemicals
–Kidney disease
–Respiratory disease
–Liver disease
–Medication 21
 Memory deficit with
depression
The most common associated
with depression is
Difficulty with free recall

22
 Dementia
The term ‘dementia’, otherwise known as
‘major neurocognitive disorder’,

is not one specific

disease but rather
a group of symptoms
that happen because
of a disease.
 Dementia

A mental disorder o Loss of mental

that involves multiple ability characterized
cognitive deficits, by a decrease in
primarily memory o intellectual ability
impairment & at least
one of the following o loss of memory
cognitive o impaired judgment
disturbances:
o personality change
o and disorientation
24
25
Categories include NCDs due to:

• Alzheimer’s disease • Prion disease

• Frontotemporal lobar • Parkinson’s disease
degeneration • Huntington’s disease
• Lewy body disease • Another medical
• Vascular disease condition
• Traumatic brain injury • Multiple etiologies
• Substance/medication use• Unspecified
• HIV infection
26
27
 DEMENTIA IS A NATURAL AND
INEVITABLE PART OF AGEING RATHER
THAN A DISEASE PROCESS
???
‫ال َخ َرف هو جزء طبيعي وحتمي من الشيخوخة وليس‬
ً ‫مر‬
‫ضا‬

There is a common misconception that dementia is NOT NORMAL

part of ageing rather than a disease process, resulting in barriers to
diagnosis and care.
World
Health
Rankings
Live Height Profile:

Jordan Data
 Dementia can happen to anybody
The risk of getting dementia increases with age, but it is
important to remember that the majority of older people do
not get dementia.
It is not a normal part of ageing. Dementia can happen to
anybody, but it is more common after the age of 65 years.

When people between the age of 40 and 60 do develop

dementia, it is called younger-onset dementia.

The onset of symptoms is usually at a late age (>65 years);

however, dementia can start at a younger age.
30
Signs & Symptoms
• Acute dementia
–When the symptoms are caused
by temporary reason:
• High fever, dehydration, hypoxia
• Chronic dementia
–When symptoms are caused by
permanent, irreversible damage to
brain cells
32
 Alzheimer’s Disease
• Form of dementia that causes
progressive changes in brain
cells

33
 Early Stages:
• Memory loss
• Mood & personality changes
• Depression
• Poor judgment
• Confusion regarding time & place
• Inability to plan and follow through
with ADLs
34
Middle Stages:
• Nigh time restlessness
• Mood swings increase
• Personal hygiene ignored
• Weight fluctuates
• Paranoia & hallucinations
• Full time supervision needed
35
 Late Stages:
• Total disorientation
• Incoherent
• Unable to communicate with
words
• Loses control of bladder &
bowel functions
36
• Develops seizures
• Loses weight despite eating a
balanced diet
• Becomes totally dependent
• Lapses into a coma
• Dies
37
Know Dementia,
Know Alzheimer’s

• Receiving a diagnosis of dementia is

often a challenging and difficult
process. To add to this, the stigma
surrounding dementia means that many
avoid seeking a diagnosis until the very
late stages of the condition. We need
to change this.
Stigma is correlated
with underdiagnosis
Case Study

a 82 years old Alzheimer with a

hip fracture, before fracture
patient was independent in
ambulation, feeding, toileting, but
needs help in dressing and
bathing
40
 Management
First hip replacement with prosthetic
femoral head.

Then physiotherapy and training on

crutches

41
 Vascular dementia
• This type of dementia results
from infarctions that affect
the brain (strokes) and
accounts for 20% of the
causes of dementia.
42
• It can either result from
blocked blood vessel or
haemorrhage. Severity of the
symptoms depend on the size
and affected location of the
brain infarction

43
• In contrast to AD dementia,
the symptoms start with poor
judgment and inability to
organize tasks, not
forgetfulness
44
• only 10% of patients with
dementia have vascular
pathologies alone, most of
them have other pathologies
like AD
• So what we call dementia in
this case???
45
 Other types of Dementia
• Dementia with Lewy bodies
• Aggregation of a protein
called Alpha-synuclein in the
neurons in the cortical area
of the brain
46
• Fronto-temporal lobar
degeneration
• Atrophy of the brain cells in
the frontal area and the
temporal area
47
The global impact of
dementia
WHO’s Global action
plan on dementia

WHO target: In at
least 50% of
countries, as a
minimum, 50% of
the estimated
number of people
with dementia are
diagnosed by 2025
 Delirium
• confused thinking
• reduced awareness of the environment
• Easily distracted
• Does not respond coherently
• The start of delirium is usually rapid
(hours to days)
50
Care of patients with dementia

The patient capacity to make

decisions regarding their health care
is best determined by their ability to
understand treatment options.

51
• Provide a/an safe and secure
environment, follow the
same routine, keep activities
simple and last for short
periods of time.

52
Avoid loud noises, crowded
rooms, and excessive
commotion. Promote
awareness of person, time, and
place by providing reality
orientation (RO)

53
 Reality Orientation:
• Address person by name preferred
• Avoid: sweetie, baby, honey
• State your name, correct elderly if
calls you by the wrong name
• Make reference to day, time, place
• Use clocks, calendars, bulletin bd.
54
• Keep individual oriented to day
night cycles:
–Regular clothes during the day
–Open curtains during the day]
–Close curtains at night
–Pajamas at night

55
• Speak slowly, clearly / ask clear
& simple questions
• Never rush or hurry the
individual
• Repeat instructions patiently,
allow time for ind. to reaspond
• Encourage conversations about
familiar things or current events
56
• Encourage use of tv, radio
without overstimulating them
• Be sure ind. uses sensory aids
• Keep familiar objects in view
Avoid moving furniture &
belongings
• Do not agree with incorrect
statements
57
• Do not hesitate to touch
communicate with person
• Avoid arguments
• Encourage independence and
self help whenever possible

58
Meeting the Elderly Needs
• Culture: the values, beliefs,
ideas, customs, and
characteristics that are passed
from one generation to the next.

59
• Areas affected by an
individual’s culture:
–Language
–Food habits
–Dress
–Work
–Leisure activities
–Health care 60
• The spiritual beliefs and
practices of an individual is
called their religion. It is
important to accept an
individual’s belief without bias,
and that health care workers not
force their own religious beliefs
on the patient being cared for.61
• Respect and Consideratin of a
persons religious beliefs
–Proper treatment of religious
articles
–Allow person to practice religion
–Honor request for special food
–Provide privacy during clergy
visits
62
• Abuse
–Physical
–Verbal
–Psychological
–Sexual

Dr. Aljezawi 63
• Report any abuse observed to
proper agency
• Reasons elderly do not report
abuse
–Feel they deserve the abuse
–Want to protect abuser

64
Questions

?
? ?
 • You may wish to view our current
resources on
www.allan24doaa@gmail.com
1. Supervisor: Dr. Maen Aljezawi
Title: Associate Professor in Geriatric Nursing
Department: Community and Mental Health Nursing
THANK YOU Institution: Princess Salma Faculty of Nursing, Al al-
Bayt University
2. Co-Supervisor: Dr. Asem Abdalrahim
Title : Professor(Assistant) in Community Nursing
Department: Community and Mental Health Nursing
Institution: Princess Salma Faculty of Nursing, Al al-
Bayt University
Or
• If you require any further information
please contact
https://www.alzint.org/resource/world-
alzheimer-report-2021/