What is your thoughts on this questions

What is your thoughts on this questions : Are Cognitive changes and changes in behavior in older adults a normal part of ageing? If Bill had changes in his urinalysis results indicating positive results for both leukocytes and blood, what would be the relevance of this in relation to neurological assessment and differentiating between confusion and delirium? What are the challenges when having a conversation with a person with dementia? What are the nursing implications of caring for Bill? What strategies can you put into place to assist in his care? What are some health promotion activity around a neurological system? Mr. Bill Rodgers is 73 year old man has a 10 month history of memory impairment. He had completed high school and worked in a packing warehouse until his retirement 5 years ago. He had lived alone and maintained his own home and financial affairs since the death of his wife in 12 years ago. Bills brother had begun to notice gradually worsening memory impairment and difficulty finding words, but then Bill became angry at the suggestion that he may have a progressive impairment. Friends at the local RSL which he frequented weekly had also made comment to Bills brother as they were concerned that he had a decline in his general living status and financial affairs, but he had no complaints. He had no children and the only family support was his younger brother of 10 years. On Bills last GP visit he had elevated a blood pressure reading, which was also documented on 2 previous visits occasions. When the GP enquired with the local community pharmacist it was noted that but he never presented the prescription. Bills brother suggested he attend the next GP appointment and Bill had no objections. During the appointment he described Bill’s speech had a tendency to use vague referents such as “things” and “stuff”. During the appointment Bill was able to provide his name, but when asked about his current age, he said: “I don’t know . . ., about 28 I think.” Bill incorrectly stated his birth month, but then became aware of this. Given three choices, he was able to give the correct month. Bill was unable to give the year of his birth, the current year. The GP handed bill a set of car keys and asked Bill to describe what they are and are used for, Bill was unable to find the words to answer the question. Diagnosis There is no single test that proves a person has Alzheimer’s. A diagnosis is made through a complete assessment that considers all possible causes. The first assessment the GP undertakes in a Glasgow Coma Score (GCS) and then the Mini Mental Status Examination (MMSE). The GP orders investigations to rule out organic causes of confusion and of behavioural and cognitive changes including; Blood tests to investigate: Anaemia Infection Electrolyte balance (salt and water) Liver function Vitamin B12 deficiency Thyroid function Drug interactions and dosing problems Urine tests to investigate infection. Results of initial assessment The GCS score was E4 V4 M6 His Cranial Nerves Were all intact and Pupils were equal at 3mm and reactive to light. Mini-mental State Examination shows cognitive impairment (MMSE score = 23) Waiting for Blood Results Urinalysis – NA

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