Care of Cognitively Impaired Residents
Dementia care questions reward patience and redirection over correction.
Core concepts
- Delirium versus dementia versus depression: delirium is sudden and fluctuating, often caused by infection, medication, dehydration, hypoxia, hypoglycemia, or a new environment - a medical emergency. Dementia is gradual and progressive. Depression can mimic both.
- Alzheimer's progression: early short-term memory loss and repetition; middle-stage wandering, sundowning, agitation, and ADL difficulty; late-stage loss of speech, swallowing, and continence.
- Communication: approach from the front, identify yourself, use short sentences with one instruction at a time, allow time to respond, and avoid quizzing ("Do you remember me?").
- Behaviors as communication: wandering, hitting, or calling out may mean pain, hunger, a full bladder, constipation, fatigue, noise, or fear. Look for the cause before reacting.
- Safety: door alarms, secured units per policy, supervision during ambulation, clutter removal, and monitoring for elopement risk.
Traps
Two common traps: repeatedly reorienting a resident who cannot retain the information, and treating sudden confusion as "just dementia." A new or worsening change in mental status must be reported because it usually signals a physical problem.
Rule of thumb
Redirect, don't correct. If a resident insists her mother is coming at four o'clock, do not argue; say, "You must be looking forward to that," and move to a safe activity.
Worked example
A resident becomes agitated during evening care and pushes your hand away. Correct: stop, lower your voice, check for pain, hunger, or the need to toilet, offer a choice ("Would you like your face washed first or your hands?"), and report the behavior change.