Care of Cognitively Impaired Residents
What candidates must know
Dementia is progressive and irreversible, with Alzheimer's disease the most common cause. Short-term memory goes first while long-term memory is preserved, so a resident may recall childhood clearly and forget lunch. Behavior is communication: hitting may mean pain, fear, or a wet brief, and repeating a question may mean anxiety rather than stubbornness.
Use short, simple sentences, one idea at a time, and allow time to respond. Approach from the front at eye level, say the resident's name, and use gestures or demonstration. Maintain routines and keep the environment consistent and uncluttered. Reduce noise and glare, keep pathways clear, and use reality orientation gently rather than correcting repeatedly.
Traps in questions
- Asking do you remember me or quizzing the resident on facts.
- Reasoning with or correcting a resident who is confused; this escalates distress.
- Arguing during sundowning, when restlessness and confusion rise late in the day.
- Using physical restraint or locked doors as a first answer to wandering instead of safe wandering areas, alarms, and supervision.
- Rushing care or performing tasks silently without explanation.
- Discussing the resident's deficits as if they were not present.
Worked rule
When a resident insists it is time to go home to a parent who died years ago, do not say your mother is dead. Validate the feeling and redirect: You miss your mother. Let's have a cup of tea while we talk about her. The rule is validate the emotion, redirect the activity, and never argue with the reality the resident is living in.