Mental Health, Social Needs, and Behavior
Behavior is communication
When a resident with dementia hits, yells, or refuses care, the behavior is usually a message: pain, a full bladder, hunger, thirst, noise, fear, or being rushed. Your first question is what happened just before this? Find the trigger and remove it. Do not argue, correct, or reason with a confused resident; join their reality, reassure, and redirect to a safe activity.
Approach: knock and identify yourself, come from the front rather than from behind (important for residents with PTSD), speak slowly and calmly, use one idea at a time, and offer choices rather than orders. Sundowning - late-afternoon restlessness in dementia - often responds to a snack, a walk, quiet music, and dimmed lights.
Mental health and social needs
Know the signs of depression: withdrawal, poor appetite, sleep change, hopelessness, loss of interest, statements about dying. Report them; do not assume it is just aging. Anxiety, grief, and loneliness are common. Support social connection: encourage activities the resident chooses, help with phone calls, welcome family, and respect religious and cultural practices. Residents have the right to intimacy and to make their own choices about relationships.
Never use restraints, threats, or medication threats to manage behavior. Report any sign of abuse - physical, verbal, financial, sexual, or neglect - by anyone, including staff and family.
Traps
- Calling a resident manipulative or attention-seeking in the chart.
- Arguing with a resident who insists it is 1975.
- Restricting a wanderer to a chair instead of providing safe activity and supervision.
- Assuming a quiet, withdrawn resident is fine.
Rule of thumb
Find the need behind the behavior, redirect rather than confront, and report anything that could be depression or abuse.