Confusion is one of the more significant features of dementia, especially in the elderly, and can be identified as physiological or situational. Physiological causes can be linked to some of the processes of aging; as blood vessels change and the blood vessels harden, insufficient amounts of oxygen and nourishment pass through to the brain. These then become starved and can die, reducing the capacity to function. Additionally ageing blood vessels develop faults, causing small haemorrhages which often go unnoticed but may cause things like memory loss and loss of insight. Confusion may be due to a number of clinical reasons, for example; medication reactions, interactions or overdosing, urinary tract infections, fever, constipation, chest infection, nutrition, e.g. diabetes, vitamin deficiency, cardiac problems, strokes, brain tumour. It is the short-term memory loss of people with dementia that also causes confusion, as their everyday environment changes and their inability to adapt to the changes causes them confusion. Hearing and sight problems can also be related to confusion; if someone can’t hear you, how can they understand you? Situational confusion is also usual, particularly when in a changed environment, e.g. hospital or residential care settings, causing loss of personal identity and individuality, and different demands and routines. Psychological causes of confusion can be the most difficult to manage, as the changes to the brain can make it difficult to treat them; depression, anxiety, bereavement and loss. Acute confusion is also known as delirium, and research shows acute confusional states occur in 30-50% of hospitalised geriatric patients and patients with dementia are particularly vulnerable. Acute confusion is characterised by confusion, restlessness, incoherence, inattention, anxiety or hallucinations, all which may be reversible with treatment. There is a clouding of consciousness, with impaired alertness, awareness, attention, variability in state of arousal, a reduced responsiveness interspersed with periods of excited outbursts, and the persons sleep/wake cycle may be disrupted.

Being confused becomes incredibly frustrating, as often one is not aware they are ‘confused’, merely ‘having trouble achieving something’. Frustration is also caused by the sense of loss people with dementia feel most of the time. Many of the symptoms of  dementia involve losses – loss of co-ordination, inability to recall events or conversations (memory), independence, and loss of the ability to communicate and control one’s own life. People with dementia are constantly faced with the evidence of these losses, and as the disease progresses, they become gradually less and less able to carry out routine activities such as talking to people, getting dressed and eating. They become increasingly dependent on others, and believe me, this can all be extremely frustrating. Carers and friends sometimes feel frustrated when their efforts to help fail or are badly accepted and when you cannot understand or be understood by the person you are caring for. However, your knowledge and understanding of what can be frustrating for the person with dementia can be useful in helping prevent these situations. I talked about humour yesterday, and this can sometimes help prevent everyone from being so frustrated, as long as it is used without ‘laughing at’ the person. Loss of skills and dependence on others can lead not only to frustration but also to the loss of a sense of dignity and self-worth and eventually to a state of helplessness, so the more we do for ourselves, the better we will feel about ourselves. Sometimes you will have to help us find ways to achieve things, new and innovative ways which will take time and some thought, but will be worth it for us all in the end. The added value to helping us deal with and overcome frustration, is we will be less likely to get angry. Think about how frustrated, and then angry a young child can become if they can’t learn a new skill or find a way to achieve something… would you help them, patiently, gently and thoughtfully, or would you simply expect them to get over it? If you left them alone, they would eventually give up, or get angry, which seems to me to be no different to that of someone with dementia who is frustrated, and who eventually gets angry. Ps. They would be upset too, if they were patronised, and then not helped patiently.