Mental Health and Social Service Needs
Behavior is communication
A resident who strikes out, refuses care, or calls out repeatedly is usually expressing pain, fear, loneliness, boredom, or loss of control. Your first question is never "how do I stop this?" but "what is this person telling me?"
Concepts to know cold
Normal aging may bring loss, grief, and changed roles, but depression is not normal aging and must be reported. Delirium is sudden, fluctuating, and often caused by infection, medication, or dehydration. Dementia is gradual and progressive. Anger, withdrawal, paranoia, and suicidal talk all warrant reporting. Know validation therapy (accept the feeling behind the statement), reminiscence (life review), and reality orientation (gentle reminders of time and place). Social services handle discharge planning, placement, finances, and advocacy.
Traps
- Arguing with a delusion or hallucination. Do not confirm it either; acknowledge the feeling: "That sounds frightening."
- Saying "Your husband died years ago, don't you remember?" This causes fresh grief.
- Treating a change in mood or behavior as "just old age" instead of reporting it.
- Confusing delirium with dementia; sudden confusion is a medical emergency.
- Assuming an older adult is not interested in intimacy, spirituality, or privacy.
Rule of thumb
When behavior changes, look backward: ask what happened just before. Pain, a wet brief, a noisy hallway, or a new medication often explains more than the diagnosis does.