Recognizing and Preventing the 3 Ds: Delirium, Dementia & Depression

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Featured Speaker:
Evalyn Michira

Evalyn Michira, MSN, RN
Evalyn Michira, MSN, RN is a Master's prepared Advanced Practice Nurse with a specialty as an Adult Gerontology Clinical Nurse Specialist. Grounded in evidence based practice and research, focused on improving clinical outcomes and practice improvement for patients, fellow staff, and the institution.

About This Podcast

Elderly patients are at high risk for depression and cognitive disorders. As the population ages, many older adults will suffer one or more of the three D's: delirium, dementia, and depression. Because signs and symptoms overlap, distinguishing one from the others isn't always easy. Yet an accurate assessment is essential because treatments depend on the diagnosis.

Listen is as Evalyn Michira, MSN, RN, Gerontology Clinical Nurse Specialist at Aspirus Health System, helps families of elderly patients learn what to look for to recognize the 3 Ds: Delirium, Dementia & Depression, so that the best help for their loved one may be administered.


Melanie Cole (Host): Elderly patients are at a high risk for depression and cognitive disorders. As this population ages, many older adults will suffer one or more of the three D’s: delirium, dementia, and depression. Because signs and symptoms overlap, distinguishing one from the other isn't always easy, yet an accurate assessment is essential because treatments depend on the diagnosis. My guest today is Evelyn Michira. She's a gerontology clinical nurse specialist at Aspirus Health System. Welcome to the show, Evelyn. What are the three D’s?

Evelyn Michira (Guest): The three D’s are delirium, dementia and depression and they're very different from each other and they may be difficult to identify and distinguish from each other. One thing I would like to point out is that delirium, dementia and depression are not part of normal aging.

Melanie: Okay. So, then, let's start with delirium. What is that?

Evelyn: Delirium is truly is a medical emergency which is characterized by an acute, unfluctuating onset of confusion. One thing to note here is the acute. It's pretty sudden, the patient becomes suddenly confused, and that's what distinguished delirium from dementia. It develops very rapidly and it does fluctuate. There is always, always an evidence of underlying physical or medical condition and it's very common in older adults who are in the hospital.

Melanie: So, is this a temporary state of confusion?

Evelyn: Yes. It is temporary if, and only if, identified and treated appropriately.

Melanie: Then, what's the difference with dementia? People hear dementia; they think right away Alzheimer's. Not necessarily the same thing.

Evelyn: No. Alzheimer's is a part of dementia. Dementia is a gradual and progressive decline in medical processing ability that usually affects the short-term memory. It does affect communication. It does affect language, judgment, reasoning, and abstract thinking. Dementia eventually ends up affecting the long-term memory and the ability of the patient to perform familiar tasks. Sometimes, there are changes in mood and behavior, but what distinguishes dementia from delirium is that dementia progresses over a long period of time, usually between five to ten years.

Melanie: So, this develops over the months or years and progresses and is basically irreversible, yes?

Evelyn: It is irreversible.

Melanie: Okay. So, then, depression. People hear about that in the media and how does depression fit in with these three D’s?

Evelyn: Okay. So, depression, it actually is a common mental health concern nationwide. It often occurs at a time of a major life change, usually at the loss of a spouse or the loss of a child. Any major life changes can cause depression. Good thing about depression is that it's usually reversible, if treated, and if it's not treated, it can result in physical illness, substance abuse, loneliness, and even suicide.

Melanie: And, it would seem to me that depression can go along with dementia as people start to sort of realize a little bit about what's going on. How do you diagnose these, then, so that they can get a proper assessment for a diagnosis and treatment?

Evelyn: Okay. The patient will need to see their physician so that their physician is able to distinguish it, too. There are tests and exams that the physician can conduct to be able to know when the patient has delirium on top of the dementia or when the patient has delirium superimposed in the dementia. So, it will require the patient to have their physician do a physical exam and do some tests, also, so that they can be able to distinguish the three.

Melanie: Where speech is concerned, is there a difference with these three D’s in the patient? Would a family member notice some of these things?

Evelyn: Yes. Yes. A family member would know if a patient has depression, especially, because they may see some loneliness. They may make some words and state that their words, their lives, is not more pleasing, and with delirium, I think the only thing that a family member can see is the confusion.

Melanie: So, then, delirium being sort of the most acute and emergent of these three situations, what are some treatments if you notice that somebody is suffering from delirium, something that comes on pretty suddenly. What do you do for them?

Evelyn: Okay. The most successful approach to delirium is finding out what has caused the delirium. We have to find out what is causing it. Most of the time, it could be a urinary tract infection, especially for the older adult, and they develop delirium as the only symptom. So, by taking care of the urinary tract infection, then we will take care of the delirium. So, as far as delirium is concerned, when we take care of the physiological condition that is causing the delirium, then we will be able to take care of the delirium.

Melanie: Very good explanation, Evelyn. And, what about dementia? Because this is progressive and it's cognitive decline. What do you tell family members about being able to deal with this particular situation?

Evelyn: Okay. Dementia does not have treatment, it is a progressive disease. However; there are treatments that are aimed at lessening the symptoms and slowing the progression of the disease, and I would recommend starting having this conversation at the beginning when the patient is newly diagnosed so they can have the medications and the treatment required to lessen and slow the progression of the disease.

Melanie: We've all heard about depression medications. There are so many on the market. What do you tell people about treatment for depression as it would even go along with dementia and delirium?

Evelyn: I would say that treatment is very critical. We need to have the conversations with the physician about what medications are pertinent to the patient and the patient needs to follow the physician's recommendation for treatment.

Melanie: So, then, when we're talking about these three D’s, when you're working with family members, Evelyn, a particular one that's hard for family members is dementia because they see no light at the end of the tunnel.

Evelyn: Yes.

Melanie: How do you tell them about support, things that they can do for their loved one and for themselves as caregivers to deal with this progressive disease?

Evelyn: Okay. You're right. It is very, very difficult for family members to deal with a patient who has dementia, and also for the patient. There are some techniques, or rather advice, that I would give to the family members. One of the things is talking to the patient slowly and repeat what you said, okay? Writing down their appointments and other activities in a planner or a calendar, posting messages around the home where they can see them, such as the bathroom or the mirror or next to the coffeepot, you know? Keeping a list of important phone numbers next to the phone would be very, very important, labeling important items that you would like them to know, and also, most importantly, developing habits and routines that are easy to follow.

Melanie: What about when delirium or depression complicates existing dementia, because now you've got one overlapping the other and, again, I'll ask you what do you tell caregivers about reinforcing routines or making sure that there's fall prevention in place?

Evelyn: Oh, I'm so glad you brought up the fall prevention. Fall prevention is very critical, especially for the patient who has dementia. Just looking around the home, looking around the environment, you know, take off the rugs, look around the environment, just the same way you would child-proof a home to keep the child safe, is the same way we would fall-proof a home to make sure that the patient is safe. It's all about safety. There are community resources. Kind of look at what is available in the community for patients who have dementia and those would also be very helpful.

Melanie: Evelyn, do patient with dementia have moments of lucidity and that's when depression can kick in because they realize what's going on, or doesn't that happen?

Evelyn: Depression can kick in with dementia. I haven't seen any evidence out there that shows that the patient now realizes what's going on and they start having depression; however, yes, the patient can have depression because they can see that there are changes. They can see that there are cognitive as well as changes around the home and this can cause depression, especially as we enter toward the end, the patient will start withdrawing and that is the moment when depression does kick in, mostly.

Melanie: Can behavioral therapy, psychotherapy, or counseling help when these three D’s are combined or depression and dementia are together?

Evelyn: Definitely. Definitely. And, once again, I would say continue having conversations with their physician. Continue having conversations with the physician and following the recommendations that are provided.

Melanie: And, in just the last few minutes, give your best advice for caregivers where their loved ones might be suffering from one or a combination of these three D’s and why they should come to Aspirus for their care.

Evelyn: It can be difficult to care for a patient who has dementia, depression, or delirium. It can be difficult for the family and most of the time, they will end up with what we call “caregiver all burden” because you want to take care of them, but we're not always able to do that. So, it is okay to always ask for help and Aspirus has Aspirus At Home which offers home care services for patients. So, go to our website at and look at the Aspirus At Home and all the services that we can offer, that we can help with respite care, with home care, and we can at least help you and help reduce the caregiver all burden.

Melanie: Thank you so much for being with us today, Evelyn. You're listening to Aspirus Health Talk and for information about Aspirus at Home, you can go to That's This is Melanie Cole, thanks so much for listening.

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