Staying Focused When Your Client Gets Confused

Confusion can be a manifestation of many disorders and medical conditions, yet caregivers overlook its significance because it presents without overly dramatic signs. But putting “confusion” at the bottom of your priorities is a big mistake because it signifies that a client's condition has worsened, or that they have developed new health problems.

Confusion is sometimes being observed as:

1. Memory loss. Confused clients forget things and misplace items easily. Sometimes they cannot remember what they had for breakfast or the name of the person they just met. At times, they forget the meaning of words, so they also have difficulty communicating.

2. Being unable to perform complex tasks. They find it hard to add or multiply numbers, plan the monthly budget, or cook.

3. Disorientation to time, place, and person. They are unaware of the time and date. They forget where they are, where they live, why they went somewhere, and cannot recognize family and friends.

4. Dressing inappropriately for the weather. Their confusion makes them unable to feel if it is cold or hot outside, so they go out in the snow barefoot or wearing only pajamas.

5. Poor judgment and decision-making. They give away their money and other valuables because they lose a sense of their value and cost.

6. Hallucinations, illusions, and delusions. They see, touch, smell, and hear things that are not there, or they misinterpret items as something else. Sometimes they believe that they are someone else, like a queen or the president, or are sure that their roommate is the villain from a story they just read.

7. Emotional signs. Sometimes confusion presents as emotional signs. They have mood swings; they can instantly switch from anger to joy to sadness and other emotions. Sometimes they cannot seem to feel anything, lacking interest in or awareness of their surroundings. Sexually suggestive behaviors could also be observed in confused clients.

Now that you know the many faces of confusion, you need to learn how to focus on your client by following these helpful tips:

1. Always consider their safety. Confused clients are prone to becoming lost or injured, such as in falls and other accidents. When you see signs of confusion, anticipate their needs and keep them safe.

2. Know the triggers for worsening confusion. In the elderly, confusion can be caused by any physical illness or discomfort. If confusion suddenly develops in an elderly client who reports that they are not feeling well, inform the supervisor or the physician immediately so the client can be examined and get medical attention. In those with Alzheimer's disease, confusion can worsen late in the day, so it helps to keep the room brightly lit, clutter-free, and quiet.

3. Reorient those with temporary confusion. Those clients who become temporarily confused due to medications, surgery, or infections will benefit from being oriented to reality. The caregiver can remind them of the present date and time, where they are, and who their family members are.

4. In some clients, validate their needs instead of reorienting them to reality. For some clients, such as those with advanced dementia, orienting them with reality would not be helpful at all. For example, a client demands to go home even if they are already at home. Telling the client that they are at their residence would upset them because they cannot recognize their own house. Instead, asking what they need or why they need to go home will help reduce their anxiety, meet their needs, and calm them down.

5. Maintain a routine and structure. Confusion can sometimes happen when activities are done out of schedule, or if there are new tasks introduced. For those with advanced dementia, maintaining a schedule of activities can help keep the client’s mind clear.

When clients get confused, it is important for caregivers to stay focused on keeping clients safe and reducing their stress. Caregivers must remain respectful and helpful, even when their clients show significant changes in behavior and mental status.