Dementia: Behavior, Communication and Orientation

Understanding Dementia and Behavioral Changes

Dementia causes progressive cognitive decline affecting memory, reasoning, and the ability to perform daily tasks. As these abilities change, individuals often lose the capacity to explain their discomfort or needs using regular words. For the nurse aide, it is essential to understand that challenging behaviors in dementia are often a form of nonverbal communication expressing unmet needs. Rather than viewing an action as deliberate misbehavior, the aide should look for the message behind the resident's distress.

Unmet physical needs are frequent triggers for agitation. A resident may become restless, irritable, or vocal because of physical discomforts such as pain, hunger, thirst, constipation, or the need to urinate. Environmental triggers can also cause agitation, including loud noises, bright glare, overstimulation from busy surroundings, and sudden room changes. Good, even room lighting can reduce shadows and glare that may confuse residents with dementia.

When a resident becomes suddenly agitated, the nurse aide should look for signs of discomfort and promptly report the change to the nurse. The nurse aide must not independently apply a restraint or give medication to control behavior; the aide should keep the resident and others safe and report the behavior to the nurse. Any new, worsening, or unusual behavioral change must always be reported promptly to the nurse so the resident can be properly evaluated.