Mental Health, Cognitive Impairment, and Social Service Needs
Behavior is communication
Most behavior questions come back to one idea: a behavior is an unmet need. Look for pain, hunger, thirst, toileting, fatigue, noise, fear, or boredom before responding to the behavior itself. This approach works for dementia, depression, anxiety, and psychosis alike.
Know the differences
- Dementia is progressive and gradual, affecting memory, language, and judgment.
- Delirium is acute, fluctuating, and often caused by illness, medication, or dehydration; it is a medical emergency to report.
- Depression may look like withdrawal, poor appetite, or refusal of care.
Communication strategies
Use short sentences, one step at a time, a calm tone, and a routine. Validate feelings, redirect gently, and avoid arguing about facts. For wandering, provide safe activity and supervision rather than restraint. Sundowning may improve with daylight, a calm evening routine, and reduced noise.
Social service needs
Know the role of activities, family involvement, the resident council, advance care planning, discharge planning, and community resources. Isolation and loss of roles harm health, so meaningful activity is a care need, not an extra.
Traps
Do not use reality orientation in mid- or late-stage dementia, such as correcting a resident about a parent's death. Do not label behavior as manipulative or attention-seeking. Do not treat behavior with medication; report and look for the cause.
Rule of thumb
Find the need before you respond to the behavior; comfort and safety before correction.