7.3 Depression, Anxiety, Confusion, and Delirium Awareness
Key Takeaways
- Depression and anxiety are not normal parts of aging; the CNA observes mood, sleep, appetite, participation, and statements of fear or hopelessness.
- Confusion can have many causes, and sudden confusion should be reported as a change in condition.
- Delirium is an acute change in attention, awareness, and thinking that may fluctuate and can signal serious illness.
- A nurse aide responds with safety, calm reassurance, basic needs checks, and prompt reporting rather than diagnosis or independent treatment.
Mood and Thinking Changes Are Care Findings
A nurse aide does not diagnose depression, anxiety, confusion, or delirium, but the aide is often the first person to notice them. The aide sees whether the resident ate breakfast, slept poorly, cried during care, avoided activities, answered questions differently, or became suddenly restless. These observations matter because mood and thinking changes affect safety, nutrition, hydration, mobility, skin care, and quality of life.
Depression is more than a sad day. It may show as persistent sadness, loss of interest, low energy, poor appetite, weight change, sleep change, withdrawal, slowed movement, irritability, frequent crying, poor concentration, or statements of guilt, worthlessness, or wanting to die. Some residents deny sadness but stop attending meals or refuse grooming. Depression is not a normal part of aging, and it is not something the aide should shame away.
Observe, Support, Report Aid
| Concern | What the aide may notice | What to do |
|---|---|---|
| Depression | Withdrawal, crying, poor appetite, hopeless statements | Listen, encourage routine, report changes and safety statements |
| Anxiety | Pacing, fear, repeated questions, short breathing, trembling | Use calm voice, reduce noise, offer simple information, report |
| Confusion | Wrong time or place, unsafe choices, trouble following cues | Reorient gently, check glasses and hearing aids, stay safe, report change |
| Delirium | Sudden confusion, fluctuating alertness, hallucinations, agitation or sleepiness | Report promptly as a change in condition |
| Grief | Tearfulness, anger, longing, spiritual questions | Respect feelings, support rituals, report severe or persistent distress |
| Medication or illness concern | New drowsiness, dizziness, falls, appetite change | Report objective facts to the nurse |
Anxiety may appear as fear, repeated call lights, pacing, trembling, restlessness, rapid speech, shortness of breath, stomach upset, or refusal to be alone. Anxiety can be triggered by pain, unfamiliar caregivers, noise, dementia, trauma history, family conflict, medical procedures, or fear of falling. The aide can reduce stimulation, explain what is happening, offer choices, stay with the resident briefly if safe, and report symptoms.
Confusion means the resident has trouble with orientation, memory, attention, or understanding. It can be chronic, as in dementia, or temporary. The aide should notice whether confusion is usual for the resident or new. A resident who is always forgetful but pleasant may be at baseline. A resident who was oriented yesterday and today does not know where they are needs prompt reporting. Sudden confusion is a change in condition.
Delirium is an acute change in attention and thinking. It may come on over hours or days and may fluctuate. A resident with delirium may be very agitated, sleepy, fearful, hallucinating, unable to follow conversation, or different from normal. Delirium can be related to infection, dehydration, low oxygen, medication effects, pain, constipation, urinary retention, sleep deprivation, or other serious causes. It is not simply old age.
The aide's response is safety first. Make sure the resident is not trying to climb out of bed, pull tubing, wander unsafely, or choke. Provide the call light, remove hazards, keep the bed in the care plan position, and stay calm. Use simple reorientation: It is Tuesday morning, you are in your room, and I am here to help you wash up. Avoid scolding or arguing with hallucinations. If the resident is frightened by something they see, acknowledge fear and report.
Basic needs can worsen mood and confusion. Check whether the resident needs the toilet, has pain cues, is hungry, thirsty, too hot, too cold, overstimulated, missing glasses, missing dentures, or unable to hear. Correct what is within the CNA role and report what is not. If the resident has diabetes, oxygen, urinary problems, recent falls, or infection signs, mention those facts when reporting.
Documentation and reporting should be objective. Instead of writing or saying the resident was crazy, report that the resident tried to climb over the side of the bed three times between 0700 and 0730, did not know where she was, and said there were people in the closet. Include what helped, such as lowering noise, toileting, or staying nearby.
Urgent Report Triggers
Report immediately if a resident says they want to hurt themselves or someone else, sees or hears things that frighten them, has sudden confusion, sudden severe anxiety, new extreme sleepiness, sudden agitation, a fall, head injury, fever signs, new weakness, poor intake, or a major change from usual mood or behavior.
A resident who was alert and oriented yesterday is now drowsy, picking at the bed sheets, and says there are insects on the wall. What should the CNA do?
A resident has stopped attending activities, eats very little, and says he is a burden to his family. Which CNA action is best?
A resident with anxiety repeatedly asks whether her daughter is coming. The daughter called and said she will arrive after lunch. What is the most helpful CNA response?