Nurses who hold the decline perspective undertake consequential
reasoning, that is, if people are old they are confused
and cognitive impairment is seen as inevitable among older
people. The vulnerable perspective involves ambivalent or
uncertain reasoning. Ageing is considered a time when the
threat of disease and ill health is constant and although not
inevitable both are likely to occur. The healthful perspective
involves diagnostic reasoning. These nurses consider ageing
to be a normal process and view older adults as essentially
well. Cognitive decline is considered to be pathological and
unusual. Nurses with a healthful perspective, in contrast to
those in the other two groups, were able to pick up on early
signs of confusion and take quick action and had an
understanding of the differences between dementia and
delirium. They also believed that in most cases of acute
confusion an underlying pathophysiological cause was likely,
however, they considered chronic confusion as possible when
other possible causes for the confusion were ruled out
(McCarthy, 2003a).