Report on Dementia, Delirium, and Depression: Mr. Geoffries' Case

This report provides a detailed analysis of a case study involving Mr. David Geoffries, who is diagnosed with dementia, with a history of CVA, and presenting symptoms of delirium and depression. The report explores the interconnectedness of these conditions, highlighting how Mr. Geoffries' dementia manifests in memory loss, communication difficulties, and confusion, while also contributing to his depression and aggressive behaviors. The report further discusses the symptoms of delirium, such as disorientation and speech difficulties, as observed in Mr. Geoffries' case. It details the interventions undertaken, including antibiotic treatment for a urinary tract infection, the application of zinc cream, and the consideration of medication for aggression and depression. Furthermore, the report emphasizes the importance of physical activities and psychosocial interventions to improve the patient's quality of life, alongside environmental considerations such as creating a calming atmosphere and addressing the potential use of physical restraints. The report concludes by emphasizing the necessity of creating a soothing environment to minimize confusion and provide a peaceful environment.

Running Head: DEMENTIA, DELIRIUM AND DEPRESSION 1
Dementia, Delirium and Depression
Name:
Institution:

Dementia, Delirium and Depression 2
Introduction
This article is meant to create a clear relation between dementia, delirium and depression
and how they are related to Mr. David Geoffries’ health situation in the case study. The case
study Mr. Geoffries had been diagnosed with dementia and had past medical history of CVA.
The diagnosis of dementia is made by the memory loss and communication difficulties that Mr.
Geoffries faces (Cerejeira et al., 2012, p.73). Though dementia also causes communication
difficulty, Mr. David got diagnosed 20years with cerebrovascular disease that greatly affect his
speech and its one of dementia symptoms that Mr. Geoffries experiences when his grandson
speaks on his behalf. Furthermore, Mr. David suffers from atrial fibrillation which also causes
confusion, fatigue, and dizziness. He also suffers from Type 2 diabetes which is often caused by
the lack production of insulin by the pancreas, moreover, he suffers from depression which is
often caused by dementia if it is not treated early. He further suffers from glaucoma which
causes severe pain of the eye and headaches that are due to the pains caused by the affected eye.
Mr. David appeared confused and even hit out at the person who was trying to shower him which
is a clear symptom of delirium (Voyer et al., 2012, p. 264). It is also observed that Mr. David is
brought to the hospital due to incontinent in urine and feces which is mainly caused by recurring
urinary tract infection, diabetes, old age and senile dementia (Bardsley, 2013, p.41). This article
also addresses the interventions that the nurses are to undertake to make sure that Mr. David’s
condition improves.
Description of Dementia, Delirium and Depression from the Case Study
1. Dementia
From the case study, it is evident that Mr. Geoffries suffers severely from these diseases which
have caused communication difficulty and confusion. For instance, Dementia affects Mr. David

Dementia, Delirium and Depression 3
in that it has created his memory loss and communication difficulty. Other signs and symptoms
include confusion and disorientation which result in difficulty in problem-solving ability. The
disorder is one of the primary reasons why the patient got brought to the hospital, and it is clear
that dementia could be the most probable cause. Furthermore, on the psychological side
dementia is known to cause depression, anxiety and inappropriate behaviors such as aggression
when Mr. David hits out at the person who was trying to shower him and he reacts the same way
to the nurses (Gitlin et al., 2012, p.2020).
2. Delirium
This disease causes the reduction in awareness of the environment that the patients are within.
For instance, due to the confusion and disorientation Mr. David's grandson acts as his guardian
because his grandfather is unaware of the environment which he is within. Another symptom
includes difficulty in speech, nonsense speech and trouble understanding what is getting
communicated to the patient. These symptoms are evident when Mr. David lashes out at the
person who was trying to shower him and when his grandson represented him in the hospital as
his guardian because his speech was not sufficient (Lundström et al., 2012, p.164). Furthermore,
delirium makes the patient feel restless and agitated; these are evident in Mr. David's case when
he is restless and keeps wanting to get up from the chair next to his bed. Moreover, Mr. David
gets personality and mood changes when he proves difficult to the staff who try to get him into
the shower. The unpredicted mood shift that Mr. David experiences are due him suffering from
delirium.
3. Depression

Dementia, Delirium and Depression 4
Mr. David experiences depression because the doctor believes that he is disinterested in life other
than food and his sleeping pattern. These are clear signs and symptoms of depression in that the
loss of interest in life is because Mr. Geoffries has no social experience that could excite him.
Furthermore, depression may cause decrease or increase in appetite and Mr. David's case it has
increased his appetite because that is the only thing that he is interested. Moreover, the sleeping
pattern of Mr. Geoffries has changed which is a clear indication of depression (Brown and
Harris, 2012). The patient is also unsteady on his feet which proves that he is weak and this is
another sign of distress. Therefore, when Mr. David hit out at the nurses who were trying to get
him into the shower can be attributed to recession because he proved agitated which is another
sign and symptom of depression. Moreover, Mr. David feels worthless because some of the staff
members had been heard talking about him saying that Mr. Geoffries is like a baby and they also
admonished him. These behaviors demonstrated by the staff members further proved devastating
to the state of Mr. Geofferies as he got more depressed and felt neglected.
Interventions for Mr. David’s Health Situation
Mr. David is placed on antibiotics and the use of incontinence pads continues with an
order of zinc cream application to the groin. The zinc cream is applied on Mr. David on the
weepy or bleeding areas three times a day and whenever stooling occurs. It is also essential that
when the next application happens, the zinc cream should not get scrubbed entirely. The stool
should be gently stooled off and this should be done daily using oil to soften it and balance Mr.
David’s skin pH level then the stool is gently removed with incontinence cleanser (Junkin,
2008). Also, Mr. David can be positioned semi-prone for about 30 minutes twice or thrice per
day to expose the affected skin to the air, and this gets done so that the affected area may dry up
which fastens the healing process. The care practitioner should also consider treatment that

Dementia, Delirium and Depression 5
reduces moisture which gets done by using low air loss mattress and more frequent turning of
Mr. David so that the affected skin may not get tampered. Moreover, Mr. Geoffries is given
antibiotics because he is in pain due to the urinary tract infection which causes pain whenever he
goes for a short call (Silver, 2017). Furthermore, the doctor considers prescribing respiridone for
his aggression and an antidepressant because the doctor assessed Mr. David as being depressed.
The doctor prescribed the respiridone because it is an antipsychotic drug which is used to treat
restlessness, psychotic symptoms such as hallucination and aggression which are often present
with people who have contracted dementia. The doctor also prescribes antidepressant drugs
which are most used to reduce aggression and create a calm feeling for patients such as Mr.
David who have dementia (Ames, 2016, p.2).
Physical Aspects and Psychosocial Needs
Physical aspects may include performing various physical activities by the patient under
the supervision of a professional health practitioner. These physical activities should be safe, and
the training should at least take 30 minutes. Physical exercise is a certified useful method that
improves the condition of dementia patients such as Mr. David. The physical exercise
intervention would effective on Mr. Geoffries because it is often used on old individuals who are
affected by dementia to improve their health and well-being (Zeng et al., 2016, p.168).
Moreover, physical activity programs are helpful in that they help relieve dementia patients who
have mild and moderate conditions such as Mr. David who is often aggressive and restless.
Another significant purpose of physical activities is that they improve the structure and
functioning of the brain which is key to enhancing Mr. David's situation because he experiences
memory loss. From the case study, Mr. Geoffries’ son sometimes plays poker with him when he
visits which help in brain structure and functioning. It is also seen that Mr. David is unsteady on

Dementia, Delirium and Depression 6
his feet and physical activities can improve the balance, stride length and performance on his
daily living activities (Zeng et al., 2016, p.168).
Psychosocial interventions have a purpose of improving the quality of life of the patient
and maximizing it in spite of the existing challenges. This intervention uses various methods
which include behavior-oriented approach, stimulation-oriented approach, and emotional-
approach. Therefore, most psychosocial interventions are aimed at improving the cognitive skill
and behavior of the patient following diagnosis of dementia (Vernooij-Dassen et al. 2010,
p.1121). Psychosocial interventions help the patient and their family to come to terms with the
fact that their loved one is affected by dementia. From the case study, Mr. Geofferies appears
depressed and spends most of his time sleeping due to the infection rendering him dependent on
the nurses. Furthermore, this intervention helps Mr. David and his family to maintain their social
life and relationship even after the diagnosis are made that he is affected with dementia (Guss et
al., 2014, p.2). We can see that his family visits him frequently and even his son tries to play
poker with him when he visits. Moreover, the family has placed photographs around the room of
Mr. Geofferies, and they start a diary of their visits which is a significant example of
psychosocial intervention. Another purpose of psychosocial response is to reduce stress and
improve the mood of Mr. David and improve his memory and thinking. From the case study, we
can see that this is effective in that Mr. Geofferies appears awake, happy and interacts with his
children and grandchildren when they visit. Moreover, he is also able to answer closed-ended
questions and has a good memory because he can remember his children and grandchildren.
Addressing the Environmental Considerations
It is essential to create a soothing and calming environment which is helpful in the
recovery of patients with dementia. The essence of this is that the calm atmosphere will

Dementia, Delirium and Depression 7
minimize the chances of confusion and help the dementia patients concentrate and rest. To create
this calm and soothing environment the lighting and the effects of mirrors may need to be
considered. Moreover, the colors and patterns used in decorating the room must also be put into
consideration because some of the patients who have dementia hallucinate and this may affect
them severely. Moreover, dementia patients find the noise annoying therefore the radio and
television may be turned off so as give the patient a peaceful environment. From the case study,
Mr. David used to sleep most of the time when he gets taken to the television room, and this
could be because he was not pleased with the noise that was made by the television. The
environment should also be free from shadows and reflections which may frighten the dementia
patient. We can also see that the family of Mr. Geoffries makes an effort in placing photographs
around his room and start a diary of their visits. The environmental consideration by the family
helps in the recovery process of Mr. David who appeared to be enjoying spending time with his
family. Another factor to consider is when the patient fails to visit the toilet when it is necessary,
and this is crucial in that they should be checked medically (Bier, 2016). In this case, Mr. David
failed to visit the toilet when necessary, and this made it possible for a medical check done on
him where he was found to be infected by urinary tract infection.
The Use of Physical Restraint
Physical restraints often get used with the aim of minimizing the risk of harming the
dementia patient or the patient hurting any other person in the medical facility. Most of the time
the families and medical practitioners perceive this as the best way to minimize falls by the
dementia patient and to control the inappropriate behavior of the patient (Peisah and Skladzien,
2014, p.11). When a patient exhibits inappropriate behavior the probability of them harming
other people in the facility is high and this when the restraints get used. From the case study, the

Dementia, Delirium and Depression 8
doctor is considering future use of restraints on Mr. Geoffries because he was aggressive to the
staff who were trying to get him into the shower. The restraints prove necessary because the staff
became fearful of Mr. Geoffries since he was aggressive and he could have harmed them.
Moreover, the restraint gets used for people who are in their old age who have dementia because
they may hurt themselves in the process of being aggressive (Peisah and Skladzien, 2014, p.11).
Person-centred Dementia Care
Person-centred care often involves crafting a patient’s care to their interest, personality,
and abilities and this helps the patients to take part in what they enjoy. The care technique can
be useful in that it enables management of the behavior and psychological symptoms of the
dementia patient. One of the most significant purposes of person-centred care is treating the
dementia patient with dignity and respect and understanding their lifestyle and preferences which
includes what they like and what they do not. From the case study, it is unfortunate that some of
the staff lack respect for Mr. Geofferies in that they have been heard speaking about his saying
that he is like a baby and also they admonish him (Mitchell and Agnelli, 2015, p.46). In spite of
this, the nurses also lack interest in taking their time to understand Mr. David’s preferences
hence they assume that he did not get orientated in time. Furthermore, they wheel Mr. Geofferies
to the television though it is evident that Mr. Geoffries is disinterested and spends most of his
time sleeping.
Support Needed of Significant Others
A person who has dementia sometimes get affected emotionally, psychologically and
socially hence they require help from their family and friends who understand their condition.
Therefore, the social environment and relationship of the dementia patient with other people are

Dementia, Delirium and Depression 9
essential regardless of their age or mental state. From the case study, we can see that the family
of Mr. Geoffries visit him frequently and even his son plays poker with him. Furthermore, his
children and grandchildren interact, and he enjoys spending time with them. The family takes a
step further to place photographs around the room of Mr. Geoffries and even start a diary of their
visits. These steps were made by the family create a social and emotional part of Mr. Geoffries
well-being because they prove to understand the condition that he has. It is also crucial for the
staff to understand the personality and preferences of the dementia patient so that they may focus
on what they enjoy doing and like. From the case study, the staff fails to understand Mr. David's
situation and some staff members are heard saying that he behaves like a baby.
When communicating with a patient who has dementia, they may have trouble
communicating, and people are advised to speak slowly and use more simple words that the
patient may understand (Alzheimer’s Society, 2015, p.4). From the case study, Mr. David can
answer closed-ended questions which are simple for him to respond. Sometimes, the patient may
gradually become dependent and relay more on the care and support given by the family and the
staff at the facility. It is often hard for some patients to adjust to this rate of dependency and it
can be distressing to everyone from the family to the staff members. Mr. David also becomes
increasingly dependent on the nursing staff for all activities on a daily basis, and this makes him
restless; when he keeps wanting to get up from the chair next to his bed though his feet are
unsteady.
Discharge Planning Evident
The discharge of the patient from the dementia facility is only enabled when the doctor at
the facility decides that the person is medically and mentally fit. Furthermore, every hospital has
its discharge policy which is a public document that gives details on how the hospital

Dementia, Delirium and Depression 10
administration arranges the discharge. The hospital discharge process includes the assessment of
the treated person’s living environment with considerations on the people involved in supporting
the treated patient. There is then the documentation of the care plan and a system for monitoring
the recovery process of the patient. Lastly, the hospital discusses the date and time of discharge
that the treated person will be allowed to leave the facility (Alzheimer’s Society, 2015, p.3).
Moreover, the hospital should consider transportation of the recovering patient to his home or
caregiver’s home. Most patients who have dementia have complex needs which need to get
considered before safely being discharged. From the case study, we can see that the hospital
made arrangements for Mr. David to have his medication ready which would ensure that he
recovers fully from dementia. Furthermore, the family makes arrangements that Mr. Geofferies
gets admitted to the residential aged care bed which is near the wife's home. It is evident that the
family had prior arrangements of how Mr. David's condition was going to be managed post-
hospital admission as required by the hospital.
Moreover, Mr. Geofferies' children then purchase a chair for their father which was going
to enable him to move from the chair to the bed in the room whenever he wanted. The family
adheres to the hospital discharge policy by making sure that Mr. Geofferies is comfortable at the
residential aged care bed. The family also arrange how they are going to be visiting Mr. David as
required by the hospital policy. It is also evident that post-hospitalization of Mr. Geofferies the
residential aged care bed had a significant level of strain trying to care for the well-being of the
patient. Mr. David suddenly becomes aggressive to the staff members after about three weeks at
the aged care bed. Moreover, some staff members are heard saying that Mr. Geoffries is like a
baby which proves that they had a hard time caring for the patient. The probable cause of this is

Dementia, Delirium and Depression 11
that the family and the residential aged care bed did not keep in contact with the hospital after
Mr. Geofferies was discharged (Mockford, 2015, p.21).
Conclusion
From the article, there is a great need for the family and friend support for the care and
recovery of the dementia patient. We can also note that dementia affected patients have their
daily routines affected by the disease because it makes them dependent on nurses for care.
Moreover, the dementia is observed to cause memory loss and result in language difficulties
which the family should be there to support the patient and represent them. The article also states
the interventions that can be put forward to care for the patient and enhance their recovery
process efficiently. In spite of that, the report identifies the care support steps that the family can
undertake to ensure that the environmental considerations are adhered to for the quick recovery
of the patient. There is also the discharge plan that was put in place by the family for Mr.
Geoffries' care to ensure that he is comfortable and safe though they missed some essential steps
in his post-hospitalization care. Therefore, it is necessary that the family keeps in contact with
the hospital even after the patient gets discharged from the hospital.

Dementia, Delirium and Depression 12
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