Mental Health, Psychosocial Needs, and Care of the Cognitively Impaired
What you must know
Behavior has meaning. Unmet physical needs - pain, hunger, thirst, a full bladder, constipation, fatigue, noise, an uncomfortable temperature - often show up first as agitation, withdrawal, or refusal. Look for a cause before trying to manage the behavior.
Maslow's hierarchy explains priorities: food, water, safety, and rest come before belonging, esteem, and self-actualization. Grief is individual and not orderly; denial or anger may appear at any point and should not be corrected or hurried.
Depression is common and serious: sadness, loss of interest, appetite and sleep change, hopelessness. Any statement about suicide or self-harm is reported to the nurse immediately, and you do not promise secrecy.
With dementia, approach from the front, at eye level, calmly, one instruction at a time; use routine and familiar objects; redirect rather than argue. Do not correct a delusion or hallucination - respond to the feeling ('That sounds frightening') and move to a safer topic. Sundowning worsens in late afternoon and evening; limit late naps, reduce noise and stimulation, and keep routines steady.
Honor cultural, religious, and sexual needs: knock and give privacy, do not impose your values, and support practices that do not harm the resident.
Traps
- Repeating 'your husband is dead' to a resident with dementia who asks where he is causes fresh grief each time - redirect and comfort instead.
- Restraints are never used for staff convenience or simply because a resident wanders.
Worked example
A resident with dementia stands at the door saying, 'I have to go home; my children are waiting.' Instead of blocking or correcting, validate and redirect: 'You're worried about your children. Let's get your jacket and a cup of tea first.' Then report the pattern to the nurse.