Care for Residents with Dementia/Cognitive Impairment
Dementia is not a specific disease and is rather a term used to describe a group of symptoms related to:
Loss of memory
Loss of judgment
Loss of complex motor skills
Loss of all other intellectual function
While common in the very elderly, dementia is not considered to be a normal part of the aging process.
When caring for someone with dementia it is important to do so keeping person-centered care practices in mind. In the right environment, residents living with dementia can still have a high quality of life that includes meaningful relationships and engagement.
People living with dementia or other cognitive impairment require special services and support, which will vary for each individual person. Cognitive impairment of any kind can be associated with a loss of ability to communicate, solve problems or cope with stressors, all of which can lead to agitation and the potential for depression or even behavioral concerns. Additionally, fear, confusion, sadness and agitation are other feelings often associated with someone who is living with dementia or other cognitive impairment.
At times, people living with dementia may have additional symptoms, known as co-symptoms. These symptoms may include:
Bipolar affective disorder
Often, when a resident with dementia exhibits a “behavior” such as agitation, yelling, repetitive movements, this can be their way of trying to communicate an unmet need, discomfort or other thoughts that they are no longer able to verbalize. For example, a resident with dementia who continuously takes his/her pants off may be uncomfortable due to constipation and should be assisted to the toilet before giving PRN medication for agitation.
While medications may be effective in some instances, medications can also be harmful when given without a clinical indication, too high of a dose or if they aren’t monitored. Please, do not use medication as the first line of defense with a resident who is living with dementia.
Caring for a resident with dementia can be mentally and physically tiring. It can be frustrating for you as the care giver, as it can be for the resident, when needs are unmet, or you can’t determine what needs exist. Be patient. Try to think through what may be going on when a resident is stressed, it’s usually not something that needs medication. Often time, it can be due to unmanaged pain, the need to use the restroom or hunger, just to name a few options.
You should also be aware that it is important to be flexible and willing to try different things when trying to meet the need of a resident with cognitive impairment. What helped one day with agitation may not be effective the next.
It’s not uncommon for a resident with dementia to want to be up and walking. If you are caring for a resident who is exhibiting the need to walk, check with the care plan and charge nurse to see what kind of assistance that resident requires and then assist them with walking, if they are able. Telling a resident to sit down over and over is not effective, leads to agitation, can increase the risk for fall and honestly requires more of your energy than taking a few minutes to assist with mobility as appropriate for that resident. Additionally, if you see a resident stand up and start walking who shouldn’t be doing such, please don’t shout at them out of fear. This can startle them, as it would anyone, and may lead to a fall or other negative outcome. Get to them as quickly and as calmly as you can and then assist them with getting into a safe position, as appropriate to that resident.
Always check with the care plan and the charge nurse to make sure you are aware of how to best care for the residents living with dementia or cognitive impairment.