Dementia, Delirium, Depression, and Behavior Communication

Why this matters

Psychosocial care is not separate from physical safety. A resident who is frightened, confused, grieving, depressed, or overstimulated may refuse care, stop eating, wander, strike out during bathing, or withdraw from activity. On the Kansas CNA exam, the safest answer usually combines dignity with reporting: protect the resident now, communicate respectfully, and tell the nurse when a change could signal illness or harm.

Dementia, delirium, and depression

Dementia is a long-term decline in memory, judgment, language, and function. It usually develops gradually. A resident may repeat questions, misplace items, become suspicious, wander, or need cues for activities of daily living. The CNA should use routine, calm tone, simple words, and one step at a time.

Delirium is different. It is sudden, often fluctuates during the day, and may be caused by infection, dehydration, low oxygen, pain, medication effects, low blood sugar, stroke, or another medical problem. New confusion, sudden agitation, hallucinations, unusual sleepiness, or a major behavior change from baseline should be reported promptly.

Depression can look like sadness, but it can also look like poor appetite, sleep change, lack of interest, low energy, poor grooming, irritability, or statements such as "nothing matters." The CNA listens, stays calm, and reports exact statements and patterns. Any self-harm statement needs immediate nurse notification.

Behavior is communication

Before labeling a resident as difficult, ask what the behavior may be saying. A resident who pushes away a washcloth may be cold, embarrassed, in pain, unable to understand the task, or afraid of falling. A resident who wanders may need the bathroom, be looking for a familiar person, or be reacting to noise. The CNA should reduce triggers: lower noise, approach from the front, use the resident's preferred name, explain before touching, and offer two safe choices.

Helpful phrases include:

• "You look worried. I am here with you."
• "Let's walk together to the dining room."
• "Would you like to wash your face first or your hands first?"
• "I will check with the nurse about that."

Avoid arguing with false beliefs. Repeatedly saying "your husband died years ago" may increase grief and agitation. A safer response validates the feeling and redirects: "You miss him. Tell me about him while we get ready for lunch."

Exam traps

Do not choose answers that restrain a resident for staff convenience, lock a resident in a room, force care after refusal, threaten loss of privileges, diagnose a psychiatric condition, or ignore a sudden change. Also avoid answers that keep secrets. If a resident reports harm, hopelessness, abuse, pain, or a major change, the CNA reports through the facility chain.

CNA documentation language

Document and report objective facts: "Resident ate 25% of breakfast," "Resident stated, 'I want to die,'" or "Resident attempted to leave unit three times between 1900 and 2000." Objective reporting gives the nurse useful data while protecting the resident's dignity.