Care of Cognitively Impaired Residents
What this domain covers
Dementia and delirium change memory, judgment, language, and behavior. Care focuses on safety, routine, and meeting the person where they are.
Communication. Approach from the front, at eye level, and identify yourself. Use short, simple sentences and one instruction at a time. Allow extra time. Do not argue, correct, or quiz the resident about facts ("Do you remember me?"). If the resident says something inaccurate, respond to the feeling rather than the fact. Use gestures, pictures, and demonstration alongside words.
Behavior as communication. Wandering, agitation, repeated questions, refusal, and catastrophic reactions usually signal an unmet need: pain, hunger, thirst, toileting, fatigue, overstimulation, or fear. Look for the trigger first. Redirect gently to a safe activity rather than blocking or restraining. In the evening, restlessness may increase (sundowning), so reduce noise, provide calm routines, and limit naps.
Safety. Secure hazardous items and medications, supervise smoking, monitor for exit-seeking, and use alarms per facility policy. Keep the environment familiar and uncluttered, with consistent routines and caregivers when possible. Maintain a regular toileting schedule; incontinence in dementia is often a matter of timing, not laziness.
Function and dignity. Break tasks into small steps, cue each one, and allow the resident to do what they can. Do not treat a confused resident like a child or discuss them as if they are not present.
Traps. Items that reward correction ("Tell her your name again and insist she remember") or restraint ("Physically block the resident from leaving") are wrong.
Rule of thumb. When a cognitively impaired resident resists or acts out, ask "What is the need behind this?" before you ask "How do I stop this?"