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close this bookAids Home Care Handbook (WHO, 1993, 178 p.)
close this folderPart II: Reference Guide
close this folderChapter Five: Management of the common symptoms of AIDS in the home
View the document(introduction...)
View the documentFever
View the documentDiarrhoea
View the documentSkin Problems
View the documentMouth and throat problems
View the documentCoughing and difficulty in breathing
View the documentGenital problems
View the documentNutrition problems
View the documentNausea and vomiting
View the documentAnxiety and depression
View the documentPain
View the documentTiredness and weakness
View the documentMental confusion and dementia
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Mental confusion and dementia

Problems and possible causes

Some degree of mental confusion (or dementia) is common among people with AIDS. These symptoms may be caused by infection of the brain with HIV. The mental changes resulting from this may be barely noticeable or they may become a serious disability.

People with AIDS may describe feeling "dulled" or "slow" in their thinking. However, it is usually the family who are the first to notice the changes.

These problems often start in a mild, barely noticeable way but may gradually worsen over time. It is not possible to predict whether the symptoms will become severe.

The mental changes may include difficulty in one or all of three areas:

· The ability to think clearly. This may be noticed as a problem in concentrating, and losing track of conversations or tasks.

· Behaviour. The person may become irritable, disinterested or unpredictable.

· Strength or coordination. The person may start dropping things more often, falling, or may develop slowness in movements, or shakiness.

HIV infection of the brain is the most common cause of mental confusion in people with AIDS. However, other possible causes include:

· the side-effects of many medicines

· infection with numerous other bacteria, viruses, and parasites

· severe depression.

What to do at home

Mental confusion can be a very upsetting and frightening problem for everyone involved. People with these problems may have moments when they realize that they are not able to think as clearly as before and will be aware of actions they have taken that were inappropriate. This is deeply distressing to them. Family members are also often very upset and not sure what to do. Support and guidance from pastors, counsellors and friends will be very important.

There is no specific treatment for these problems and people must learn to live with them and to make the sick person's environment as safe as possible. Mental confusion in the sick person, perhaps more than any other symptom, can make caregivers feel like giving up and cause them to feel overwhelmed by the demands of caring for someone they love.

A person who has a sudden change in thinking, behaviour or ability to move should seek help. Some of the sudden mental changes may be treatable and the person will recover. However, if such changes are allowed to continue, they may contribute to the rate of mental deterioration.

If it is determined that nothing further can be done, then the family will need to give whatever help they can. This will include protecting the sick person from harm.

Carers may need help to occasionally arrange time away from the home. Taking care of a sick family member for 24 hours a day, every day, is very difficult and people need their physical and emotional strength to deal with this.

To prevent accidents in the home, people should:

· pay attention to open fires or boiling water
· provide canes or walkers for people who are weak or off balance when walking
· remove loose and potentially dangerous objects, including rugs
· keep walkways clear
· avoid rearranging furniture
· store poisonous or toxic substances safely out of reach
· keep medicines out of reach and only give them according to the prescribed schedule
· install handrails or put a chair in showers or tubs
· store sharp objects like knives, scissors, razors and saws safely and out of reach
· try not to leave the sick person alone and unattended for long periods.

To help the functioning of the confused or demented person, people can:

· remind the person where he or she is and what time it is - use cues to help, for example:

- provide reminders of daily activities in a form the person understands
- provide familiar objects in easily visible places, such as pictures, clocks, calendars, etc.

· keep a calm, accepting and open manner when dealing with the person

· be aware of their actions and consciously slow down and relax

· speak slowly

· use a low-pitched tone of voice - this is reassuring

· ask questions that can be answered "yes" or "no"

· give simple short directions, or explanations to questions

· be concrete and specific

· give the person lots of time to respond to questions, directions or conversation

· try to interpret the feelings the person is trying to express rather than just the words

· talk about the distant past - the person's memory of events that happened long ago may be good and this will be pleasurable.

People should avoid:

· arguing, as it will not convince the person and may only upset him or her
· directly challenging the sick person's delusions or fantasies; it is better to cast doubt in a kindly way
· giving the person multiple tasks; instead give the person one thing at a time to do
· talking to the person as if he or she is a child
· giving choices, as this can be confusing.

To help a confused person who is upset or angry

Distraction is helpful; for example people can:

· change the subject
· provide music or switch on the radio
· give the person a manual task, e.g. folding clothes
· leave the room for a few minutes; the person may forget why he or she is angry
· remove the person from an upsetting situation.

The following may also help:

· maintaining a quiet environment
· setting limits
· saying "no" gently, but firmly
· not challenging or responding to the content of the angry words directed at the caregiver or others.

When sick people and their families must seek help

· If there is any sudden change in the person's ability to think or move, especially if this is associated with new fever, high fever, headache or difficulty in breathing.

· If other mental or character changes occur - such changes should be evaluated by a health care worker, who may be able to offer help or provide treatment for the underlying cause.

A confused and aggressive person can be very difficult to manage at home. There may come a time when the people around them cannot manage and they will need the help of a health care worker in placing the person elsewhere in order to protect the sick person or family members.

Notes on mental confusion and dementia