1. Recognizing Changes in the Consumer that Need to be Addressed

2. Cognitive Impairment
A temporary or permanent change within the brain which affects a person’s ability to think, reason, and learn.
Temporary causes may include stress, medication, depression, vitamin deficiency, thyroid disease, alcohol, and head trauma.
Permanent causes include severe head trauma, illness, brain disease and brain damage at birth

3. Disorders that Cause Cognitive Impairment:
Depression- emotional sadness, and withdrawal
Anxiety- persistent feelings of fear and nervousness
Suspiciousness- distrust of others
Delusion- false belief not supported by reality
Paranoia- irrational feeling of being persecuted, suspiciousness, and hostility
Schizophrenia- suspiciousness, paranoia, and delusion resulting in inappropriate behavior
Mental retardation- process which slows or stops a child’s brain from maturing
Dementia- progressive mental deterioration due to organic brain disease which causes structural changes within the brain (ex. Alzheimer’s)

4. Reducing Effects of Advanced Dementia
Reality Orientation
Helps resident remain aware of their environment, of time, and of themselves
Validation Therapy
Helps resident improve dignity and self-worth by having their feelings and memories acknowledged
Reminiscing
Allows resident to talk about past experiences, especially pleasant ones.

5. Responses to Difficult Behavior
Difficult behavior may result from too much stimulation, change in routine or environment, physical pain or discomfort, reactions to medications, and fatigue.
Remain calm, speak slowly and clearly
Avoid approaching the resident from side or back
Try to calm the resident by holding hands, patting and singing (if appropriate)
Try to distract resident’s attention and redirect behavior
Allow resident to express feelings (if talking reduces agitation)

6. Dementia Clients Need Assistance with:
Safety
Monitor movement, watch for inappropriate use of objects, check that clothing is worn properly
Nutrition
Assist client to dining area when food is served, have food ready, allow resident extra time to chew and swallow, serve only one food at a time, monitor food intake
Hydration
Offer fluids more often and in smaller amounts, listen for spoken cues that resident may be thirsty, watch for nonverbal signs (dry mouth, smacking lips)
Dressing
Choosing appropriate clothing, offer choice of two outfits, assist to dress properly, simplify dressing according to needs
Bathing
Prepare bathing area before bringing resident into room, explain procedure, check temperature, assist resident in bathing
Elimination
Take resident to bathroom frequently, provide perineal care as needed