Psychosocial Care, Mental Health, and Cognitive Impairment
Normal and not-so-normal
Care includes emotional and social needs: belonging, safety, self-esteem, and control. Anxiety, grief, and short-term sadness are normal responses. Major depression persists for weeks with loss of interest, appetite, sleep, and hope - report it. Delirium is sudden, fluctuating confusion with inattention, often caused by infection, pain, dehydration, or medications, and it is a medical emergency. Dementia is progressive and gradual; depression can look like dementia and dementia can mask depression.
Dementia care
Meet the resident where they are. Never argue about a false belief or scold; validate the feeling and redirect. Use one-step instructions, a calm tone, and a consistent routine. Sundowning worsens late in the day - reduce noise, turn on lights, and offer quiet activity. For wandering, provide safe walking, and use alarms and environmental cues rather than restraints.
Mental illness and end of life
Accept the resident as a person; mental illness is not a character flaw. Watch for medication side effects and report them. Respect culture, religion, and sexuality; provide privacy and ask before touching. Dying residents may move through grief stages - denial, anger, bargaining, depression, acceptance - not necessarily in order. Postmortem care is given with dignity and privacy, with the body positioned and the head slightly elevated.
Traps
Items offering to 'correct' a delusion or explain reality to a resident with dementia. Validation and redirection score better.
Rule of thumb
If a behavior is new and sudden, think delirium and report it before you try to manage it.