Dementia is a slow, progressive decline in memory, thinking, and the ability to do daily tasks, with Alzheimer disease being the most common type. It does not get better, so care focuses on safety, keeping the client as independent as possible, and supporting the family.
Each care plan below follows the nursing process (ADPIE).
Chronic Confusion
- Progressive brain changes from dementia
- Memory loss, especially of recent events
- Trouble finding words
- Getting lost in familiar places
- Increased confusion in the late afternoon or evening
- Client takes part in a structured daily routine
- Client follows simple one-step directions
- Client keeps the highest possible level of function for as long as possible
- Baseline mental status and memory
- Ability to do activities of daily living
- Changes in behavior or sudden worsening that may signal delirium
- Sleep and evening behavior
| INTERVENTION | RATIONALE |
|---|---|
| Keep a consistent daily routine and the same caregivers when possible | Routine lowers confusion and anxiety. |
| Use short, simple sentences and give one step at a time | Simple directions are easier to process. |
| Do not argue with the client's reality; redirect instead | Arguing increases agitation, while redirection calms. |
| Keep the room well lit in the late afternoon and limit noise | This can reduce sundowning behaviors. |
EVALUATION
- Client follows the daily routine
- Client completes simple tasks with cues
- Agitation episodes are fewer
Risk for Injury
- Poor judgment and memory loss
- Wandering
- Unsteady gait
- Client stays free of injury and does not leave the unit unsafely
- Family sets up a safe home environment
- Fall risk and gait
- Wandering behavior
- Home safety concerns such as stoves and medications
| INTERVENTION | RATIONALE |
|---|---|
| Use bed and door alarms and an identification bracelet | These alert staff and help return a client who wanders. |
| Keep the area clutter free with night lights | Clear, lit paths prevent falls. |
| Teach family to lock up medications, chemicals, and car keys | Removing hazards prevents accidental injury at home. |
| Offer toileting on a schedule | Meeting needs reduces restless wandering. |
EVALUATION
- Client is free of injury
- Client stays in a safe area
- Family describes home safety changes
Practice this in Everyday RN
Care for a confused older client during a full med-surg shift.
Play Everyday RNQuick answers
A client with dementia keeps asking for her late husband. What is the best response?
Redirect and validate the feeling, such as "You miss him. Tell me about him." Do not argue or repeat painful news.
What is sundowning?
Increased confusion and agitation in the late afternoon and evening. Good lighting, routine, and less noise can help.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.