Care of the Cognitively Impaired Resident
Know the difference
Dementia is chronic and progressive; Alzheimer's disease is the most common type. Delirium is a sudden change in attention and awareness, often from infection, dehydration, medication, or pain-it is a medical emergency. Depression can mimic dementia but is not normal aging. Know that dementia affects memory, judgment, language, orientation, and eventually ADLs. Report sudden worsening, new confusion, falls, or refusal to eat.
Communication and care
Use short sentences, one instruction at a time, and a calm, friendly tone. Approach from the front, identify yourself, and avoid quizzing memory ('Do you remember me?'). Establish routines, reduce noise, and keep dangerous items out of reach. For wandering, use safe redirecting and activities; never use restraints or locked doors without policy. For hallucinations or delusions, do not argue. Acknowledge the feeling, then redirect: 'You look frightened. Let's sit here with me.' Sundowning may worsen late in the day; provide quiet activity and report. Allow extra time for ADLs and preserve dignity.
Traps and rule of thumb
Common traps: treating delirium as normal dementia, arguing with a false belief, asking why, overstimulating the resident, or doing everything for them. Worked example: at 8 p.m. a resident with dementia says, 'I must go to work.' Do not correct the year or argue. Say, 'You sound worried about work; let's have a snack first,' then redirect to a quiet task. Rule of thumb: any sudden change in mental status is a reportable change, not a behavior problem.