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Andrew Pollack-Gray

Nursing Notes

Dementia Care

3 min read

Patient Needs

Residents with dementia may experience changes in memory, orientation, communication, judgment, and ability to perform daily activities.

Care Goals:

  • Preserve dignity, independence, and personal preferences.
  • Maintain familiar routines when helpful.
  • Reduce avoidable confusion and distress.
  • Support safe participation in daily activities.
  • Adapt care to the resident’s current abilities rather than assuming all residents with dementia need the same assistance.

What Should I Assess?

Observe and report changes in:

  • Alertness, orientation, and responsiveness.
  • Communication and ability to express needs.
  • Mood, agitation, anxiety, withdrawal, or unusual behavior.
  • Mobility, balance, and ability to complete daily activities.
  • Eating, drinking, toileting, sleep, and comfort.

Potential Causes of Distress:

  • Pain or discomfort.
  • Hunger, thirst, or toileting needs.
  • Fear or difficulty understanding what is happening.
  • Excessive noise, unfamiliar surroundings, or overstimulation.
  • Illness, infection, or sudden changes in mental status.

Important: Sudden confusion or an abrupt change from baseline requires prompt reporting. Do not assume it is simply a progression of dementia.

How Do I Provide Care?

Communication

  • Approach calmly, introduce yourself, and explain what you are doing.
  • Use short, clear statements and allow time for responses.
  • Offer simple choices when appropriate.
  • Use gestures, visual cues, or demonstrations when helpful.
  • Avoid arguing, criticizing, or repeatedly correcting the resident.
  • Listen to verbal and nonverbal expressions of needs.
  • Identify perseveration, which is when they repeat the same task over and over. Redirect to something else.

Supporting Daily Activities

  • Encourage the resident to perform tasks they can safely manage.
  • Break complicated activities into smaller steps.
  • Offer guidance without rushing.
  • Follow familiar routines and preferences whenever possible.
  • Maintain privacy during bathing, dressing, and toileting.

Responding to Distress

  1. Remain calm and maintain a respectful tone.
  2. Check for immediate safety concerns.
  3. Consider possible unmet needs or environmental triggers.
  4. Reduce unnecessary stimulation when appropriate.
  5. Offer reassurance, choices, or a change in activity.
  6. Stop nonurgent care if the resident becomes significantly distressed.
  7. Seek nursing assistance when distress persists or safety is threatened.

Safety & Precautions

  • Follow the individualized care plan and required supervision level.
  • Maintain a safe environment without unnecessarily restricting independence.
  • Do not use threats, punishment, confrontation, or coercion.
  • Respect refusal of care and follow facility procedures for reporting and reassessment.
  • Never assume a resident lacks all decision-making ability because they have dementia.
  • Follow approved procedures for wandering, falls, and other identified risks.
    • Wandering tends to be okay, so long as they are on-premises.
  • Do not use restraints for staff convenience.

What Should I Report?

  • Sudden or significant changes in cognition or behavior.
  • New confusion, unusual drowsiness, or difficulty waking.
  • Persistent agitation or distress.
  • New difficulty eating, drinking, swallowing, walking, or completing daily activities.
  • Suspected pain, illness, injury, or unmet needs.
  • Safety concerns, falls, or changes requiring a different level of assistance.
  • Resident preferences or approaches that successfully reduce distress.

Sources

Flashcards

What should be considered when a resident with dementia becomes agitated?03-application / patient-care
Answer

Unmet needs such as pain, fear, toileting, or overstimulation.

Why use predictable routines for dementia care?03-application / patient-care
Answer

They may reduce confusion and distress.

Why must sudden confusion in a resident with dementia be reported?03-application / patient-care
Answer

It may indicate delirium, illness, or another acute change.

How should instructions be adapted for residents with dementia?03-application / patient-care
Answer

Use clear language, simple steps, and adequate response time.

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