Mental Health, Social Service Needs, and Care of the Cognitively Impaired
Mental health
Common issues in nursing homes include depression, anxiety, delirium, dementia, and substance use. Signs of depression include withdrawal, poor appetite, sleep changes, flat affect, and hopelessness; report any statement about self-harm immediately. Delirium is a sudden change in mental status, often caused by infection, medication, dehydration, or pain. It is a medical emergency and must be reported at once. Dementia, by contrast, is gradual and relatively stable.
Dementia care
Alzheimer's disease and other dementias cause progressive memory loss and confusion. Do not argue with a resident about a mistaken belief or a hallucination; acknowledge the feeling and redirect. Keep routines consistent, use short simple sentences, give one instruction at a time, and keep the environment calm. Reduce noise at meals. Sundowning, increased confusion in late afternoon and evening, responds best to quiet activity and good lighting. For wandering, do not restrain; redirect, report, and know the elopement policy.
Social service needs
Residents may need help with money, legal issues, family conflict, or discharge planning; refer them to the social worker. Respect spiritual and cultural practices, sexual expression, and privacy during visits. Support the resident council and the grievance process.
Traps
Calling a confused resident a liar, or arguing about a deceased spouse. Using restraints or ignoring a resident because of dementia-related behavior. Dismissing sudden confusion as 'just their dementia.'
Rule of thumb
Look for the need behind the behavior - pain, hunger, toileting, fear, or too much noise - before trying to stop the behavior.