Care of Cognitively Impaired Residents
What the exam expects you to know
Dementia is chronic and progressive and includes memory loss, poor judgment, wandering, confusion, and personality change. Delirium is different: it comes on suddenly and is often caused by infection, dehydration, medication, or pain, so a new or rapidly worsening confusion is a medical report, not just dementia. Know communication basics: approach from the front, at eye level, use the resident's name, give one instruction at a time with short sentences, allow time, and avoid quizzing them about facts they cannot recall.
Treat behavior as communication. Ask what the resident needs: pain, hunger, toileting, noise, fatigue, fear, or a change in routine. Reduce evening stimulation for sundowning, keep routines consistent, and redirect rather than correct. Wandering is managed with a safe environment, supervision, and redirection; restraints require a physician's order and are not a substitute for care.
Traps built into questions
Trap answers include arguing with a false belief, reminding a resident over and over that a spouse has died, applying restraints to stop wandering, and assuming a sudden confusion is just the dementia getting worse. Also avoid baby talk, talking about the resident as if they are not there, and rushing care.
Worked example
A resident with dementia keeps saying, I have to go to work, I will be late. You do not say, You retired twenty years ago. You say, You have always been a hard worker. Let us have breakfast first, and you walk with them to the dining room.