All caregivers and staff including dietary, housekeepers, maintenance & therapists who regularly work around residents need to know how to observe and report mood and behavior patterns captured in this part of the assessment because these are not part of normal aging. They are clues to get us thinking about "what can we do as a team to improve these stressors in our residents’ lives?" They tell us that interventions may be needed to better serve the resident and that, as a team, we need to find different ways to help the person with their distress.

Mood distress is a serious condition, and it is particularly important for us to identify signs and symptoms of mood distress among our residents because they are very treatable.

Mood and Behavior are one of the most difficult aspects of resident care that staff must contend with on a daily basis. Cares, feeding, and medication administration are activities that, for the most part, remain static and unchanging. Behavior, mood and the interventions of these processes never remain the same and change on a daily or minute by minute basis with our residents.

Verbal Expressions of Distress
Residents may say they are anxious, sad or depressed but more often, it is expressed by asking or saying the same thing over and over, by being easily annoyed or angry, or by speaking badly about themselves (e.g. I am of no use, etc.) It's important that these behaviors are reported and documented even if, over time, we perceive that they are "normal" or usual for a particular resident. Sometimes the source of agitation can be easily identified by an observer who hasn't become as "used to" the behavior and who is looking at the situation through a whole new set of eyes.

Distress may also be expressed non-verbally in these ways:

Sleep Cycle Issues
Sleep deprivation can be a root cause of mood issues with our residents. Be careful, though, not to make assumptions based on our own ideas about what "normal sleep patterns" are, and know that much of this is a reaction to the environment and the schedules that we set for the residents. In actuality, the resident may have never been a great sleeper and napped frequently prior to coming to the facility. Or- if we are getting the resident up at 6 a.m. every morning and they were used to getting up at 8 a.m., they WOULD be unpleasant. Wouldn’t you?

Sad, Apathetic, Anxious Appearance
Sad, pained, worried expressions, or crying, tearfulness, and repetitive movements such as pacing or fidgeting are non-verbal signs of distress.

Loss of Interest
Changes in usual behavior such as no interest in previously enjoyed activities or being with family/friends, or becoming less talkative or more isolated are indicators of distress as well.

The intent of this section of the MDS is to capture the scope—or number of times—that a resident exhibited the symptoms in the last 30 days regardless of the reason or cause.

The assessment tool only wants to know which behaviors the resident has and how often he/she has them. We choose between 3 coding options:

1. Not at all in the last 30 days
2. At least once during the last 30 days but less than 6 days a week;
3. Daily or almost daily (more than 5 days a week)

But what do we do with the information, now that we have it? The resident owns the behavior- but the problem is ours. We need to do something to help alleviate both. The most important thing is that we do something with the information once we observe it.

•  Is the resident worried about money, their spouse, their children, when is their next meal, or when is the doctor coming so they can talk to them?
•  Can reassurance about their finances help them?
•  Can reassurance that someone is present to talk to, help them?
•  Are they in pain?
•  Do they just need some personal attention?
•  Are they simply bored with “our” activities? (Notice the “our” in the previous sentence, it should be "their”.)

If we can identify the cause, we can usually find the solution. Hunger, pain, fear, exhaustion, boredom, loneliness, anger and grief- these are the most likely causes. And it is our duty, as caregivers, to help the resident with every one of them.

Now, do understand that it may be that the issue cannot be resolved if it is a true behavioral symptom. But also understand that even if these symptoms do occur and the resident cannot be easily reassured, we can still help the resident.