Key Takeaways
- Create a safe environment by addressing wandering, falls, and other hazards
- Routine reduces anxiety and behavioral symptoms in dementia residents
- Use the ABC method (Antecedent-Behavior-Consequence) to understand and prevent behaviors
- Focus on abilities and independence—provide cues rather than doing tasks for them
- Activities should focus on the process, not the product, and match current abilities
Last updated: January 2026
Dementia Care Strategies
Caring for residents with dementia requires specific strategies to maintain safety, promote independence, and manage challenging behaviors. These techniques help create a calm, structured environment.
Creating a Safe Environment
Physical Safety:
| Hazard | Prevention Strategy |
|---|---|
| Wandering/elopement | Secure doors, alarms, camouflage exits with murals |
| Falls | Non-slip flooring, adequate lighting, remove clutter |
| Burns | Limit access to hot water, supervise near stoves |
| Poisoning | Lock up medications, cleaning supplies |
| Choking | Cut food appropriately, supervise eating |
| Getting lost | ID bracelet, GPS devices (per family/facility) |
Environmental Modifications:
- Good lighting (reduce shadows that cause confusion)
- Reduce noise levels (TVs, announcements)
- Simple room layouts (minimize clutter)
- Signs and labels on doors and drawers
- Remove mirrors (may cause confusion or fear)
- Contrasting colors (toilet seat vs. floor, plates vs. table)
Structured Routine
People with dementia thrive on routine because it reduces anxiety and confusion.
Benefits of Routine:
- Provides predictability and security
- Reduces decision-making stress
- Helps maintain remaining abilities
- Decreases behavioral symptoms
Establishing Routine:
- Same caregiver when possible
- Consistent times for meals, bathing, activities
- Same sequence of care steps
- Familiar objects and music
Managing Challenging Behaviors
General Approach: ABC Method
| Letter | Meaning | Application |
|---|---|---|
| A | Antecedent | What happened BEFORE the behavior? |
| B | Behavior | What is the SPECIFIC behavior? |
| C | Consequence | What happened AFTER? What was the result? |
Understanding the antecedent helps prevent future episodes.
Behavior Management Strategies:
| Behavior | Strategies |
|---|---|
| Wandering | Safe walking areas; meaningful activities; address need (bathroom, boredom); don't restrain |
| Aggression | Stay calm; don't argue; give space; identify triggers; rule out pain |
| Refusing care | Don't force; try again later; approach differently; offer choices |
| Repetitive questions | Answer calmly; redirect to activity; use written reminders |
| Sundowning | Calm afternoon activities; good lighting; limit caffeine; maintain routine |
| Inappropriate behavior | Don't embarrass; redirect; assess for UTI; ensure privacy |
Activities for Dementia Residents
Goals of Activities:
- Provide meaning and purpose
- Reduce boredom and anxiety
- Maintain remaining abilities
- Encourage social interaction
- Promote sense of accomplishment
Activity Principles:
- Focus on the PROCESS, not the product
- Break activities into simple steps
- Provide success opportunities
- Match to abilities and interests
- Use familiar activities from past
Appropriate Activities by Stage:
| Stage | Appropriate Activities |
|---|---|
| Early | Puzzles, card games, reading, cooking, gardening, social events |
| Middle | Simple crafts, music, folding laundry, sorting objects, reminiscing |
| Late | Sensory activities (soft fabrics, music), hand massage, one-on-one visits |
Promoting Independence
Abilities-Focused Care:
- Focus on what they CAN do, not what they can't
- Allow extra time for tasks
- Provide cues and prompts rather than doing for them
- Break tasks into single steps
- Offer two choices (not open-ended decisions)
Example: Getting Dressed
- Instead of dressing the resident:
- Lay out clothes in order
- Hand one item at a time
- Give verbal prompts: "Put your arm through here"
- Assist only as needed
Working with Families
Families of dementia residents often experience:
- Grief over "losing" their loved one
- Guilt about placement
- Frustration with behaviors
- Denial about progression
How CNAs Can Support Families:
- Welcome visits and involvement
- Share positive moments
- Be patient with questions
- Don't judge family dynamics
- Report concerns to nurse (don't counsel families yourself)
Test Your Knowledge
What does "sundowning" mean, and when does it occur?
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Test Your Knowledge
What should a CNA do when a dementia resident refuses care?
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Test Your Knowledge
Why is routine especially important for dementia residents?
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