Mental Health, Social Service, and Care of the Cognitively Impaired
Core concepts
Behavior in dementia is communication. Before reacting to agitation, look for a physical cause: pain, hunger, thirst, a full bladder, constipation, infection, too much noise, or an unfamiliar face. Then respond calmly with short sentences, one instruction at a time, a low reassuring voice, and extra time. Do not argue with a delusion or try to reason a confused resident into reality; acknowledge the feeling, redirect to a safe activity, and keep routines consistent. Validation often works better than correction.
Know the difference between delirium and dementia. Delirium has a sudden onset, fluctuating attention, and a medical cause; it is an emergency to report. Depression is not a normal part of aging, so report withdrawal, poor appetite, hopeless statements, or loss of interest.
Safety issues include wandering and elopement (secure exits, supervision, never restraint), sundowning (calmer evenings with good lighting, structure, and fewer late naps), and poor judgment with appliances. Social services can help with discharge planning, financial concerns, family conflict, and placement. The CNA's role is to report needs and support coping, not to counsel or advise on finances.
Traps
Answers that argue with the resident, offer complex choices, physically stop a wanderer, or label behavior as attention-seeking are wrong.
Rule of thumb
When a resident with dementia becomes agitated, check the body first: pain, toileting, thirst, temperature. Then simplify the task and redirect.