Care of Cognitively Impaired Residents
Dementia is not delirium
Dementia is a slow, progressive loss of memory and thinking that interferes with daily life; Alzheimer's disease is the most common cause. Delirium is a sudden change in attention and awareness, often from infection, dehydration, medication, or pain - a medical emergency to report, not a behavior to manage. Always look for a physical cause behind new behavior: pain, constipation, urinary retention, hunger, noise, or an unfamiliar caregiver.
Communication that works
Get their attention first, then use one idea per sentence, simple words, and a calm, low voice. Allow extra time. Offer two choices, not many. Avoid quizzing ("Do you remember me?") and avoid arguing about facts. In middle and late stages, correction increases distress; validation and redirection work better.
Traps
- Arguing with a resident who insists on "going home," or bluntly announcing that a relative died years ago.
- Using restraints or locked exits instead of alarms, supervision, and safe wandering routes.
- Scheduling a shower at the busiest, noisiest time of day.
- Calling sundowning or a catastrophic reaction a "behavior problem" without reporting it.
Rule of thumb
When what you are doing isn't working, change your approach, not the resident.
Worked example
A resident with dementia keeps saying, "I need to go home; my mother is waiting." Arguing ("Your mother died; this is your home") escalates her. Instead: "You miss your mother. She must have meant a lot to you. Let's sit where it's warm and have some juice" - then note the trigger and report the increased agitation.