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Mental Health Nursing · Chapter 12

The Three Ds Bench: Sorting Delirium, Dementia and Depression

All three produce confusion, so confusion is not the discriminator — onset, course, attention and level of consciousness are. Sort six older adults, and watch the reference table light up the column you chose so the pattern becomes visible rather than memorised. Then take four real charting entries and rewrite each one into language the next nurse can actually use.

Sort the presentation

1 of 6

Rewrite the chart

Each entry below was really written on a ward. Every one of them hides an assessment, turns a behaviour into an identity, or blames a person for a symptom. Choose the replacement that a nurse on the next shift could act on.

The discriminator

FeatureDeliriumDementiaDepression
Answer a case on the left and the matching column lights up here. Where the answer is delirium superimposed on dementia, two columns light — because both are true at once, and only one of them is the emergency.

Your bench

0
Cases sorted
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First-pass correct
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Charts rewritten
The golden rule. Any acute change in a person living with dementia is delirium until proven otherwise. Dementia progresses over months, not overnight — so “his dementia is getting worse” describes a timescale that does not fit what you are looking at.
“A little confused” is not an assessment. Replace it with three specifics every time: confused compared with when, confused in what domain, and can the person hold attention. Months of the year backwards takes twenty seconds and needs no form.
Ageism is a clinical error. “She is 88 and gets like this” has hidden urinary tract infections, subdural haematomas and hyponatraemias. Age is a risk factor for delirium, never an explanation for it.