Full disclosure: I do not have all the answers to the questions to be presented. However, as a professional gerontologist and a fellow-quarantiner, I’ve spent countless hours wrestling with what the future of geriatric care will look like.
As we’re all well aware, our world as we knew it came to a screeching halt mid-March, 2020 (actual date varies on your location within the United States, but here in California, our Stay-At-Home order went into effect March 16, 2020). Local assisted-living and memory-care units in my community were quick to, initially, restrict visitors and, ultimately, temporarily eliminate congregate dining and group activities. As a result, these residents were confined strictly to their rooms. Typically living alone in a unit, but X% of residents cohabitate with a spouse.
I don’t know about you, but quarantine was challenging for me. Sure, initially I tackled projects on a dust covered To Do list, but ultimately it became a monotony of cooking, cleaning and disinfecting. But it was the social isolation that wore me down – not seeing my family, friends, colleagues, the barista at Starbucks. I craved social interaction and conversation. As the lockdown slowly lifts in California, I can’t help but wonder the effects of isolation on dementia clients.
What We Knew Before Quarantine
For several years, experts in the field of aging have emphasized key areas of importance when caring for an older adult with dementia. Routine is commonly stressed as the foundation for successful caregiving. Routines help the person with dementia know what to expect and encourage him/her to continue to do things independently. Activities are also encouraged as a means to slow the decline of impairment. According to Daily Caring, in the article 4 reasons Dementia Activities Are Important And 5 Ways To Adapt Everyday Tasks, activities provide daily structure, give a feeling of productivity and can reduce challenging behaviors.
One-on-One contact and socialization are also key players in hastening the progression of dementia. Humans have a higher risk of developing Alzheimer’s Disease if they are lonely or isolated (Impact of Social Relationships on Alzheimer’s Memory Impairment: Mechanistic Studies; Ya-Hsin Hsiao, Shih-Hua Chang, and Po-Wu Gean).
At the onset of quarantine, there were an abundance of articles on “How To Care for Your Loved One Suffering From Dementia”: “How to Communicate During COVID-19”; “How to Avoid Stress During Isolation”; “Do-It-Yourself Home Activities for Dementia Caregivers”. Emphasis was repeatedly placed on the importance of routine: “Have the most normalcy in this most unnormal time” (Lynn Friss Feinberg, a senior strategic policy adviser at AARP’s Public Policy Institute).
What We Know Now
As the coronavirus ravaged our country, in particular our skilled nursing facilities, articles are now available on the effects of COVID-19 on dementia patients who were affected by the virus. Halloway and James reported that COVID-19 is directly relevant to the cognitive health of the aging brain (A Tsunami of Dementia Could Be on the Way The COVID-19 Pandemic Can Damage the Aging Brain Both Directly and Indirectly; May 19, 2020).
What Remains Uncertain in the Aftermath of Isolation
We’re all hopeful to reconnect with dementia patients coming out of quarantine. But the cognitively impaired who were not afflicted with the coronavirus, are they coming out unscathed? As a gerontologist, I foresee an increase in mental health complications as a result of prolonged isolation. According to the May 4, 2020 Washington Post article, The Coronavirus Pandemic is Pushing America Into a Mental Health Crisis (William Wan), anxiety and depression are rising across *all age groups and demographics*.
Without a solid understanding of COVID-19 and the risks involved, dementia patients might have had difficulty processing quarantine. Therefore, caregivers should also be prepared for increased signs and symptoms of paranoia and hallucinations as evidenced by questions such as, “Have I been hijacked?” or “Why did they lock me in my room against my will?”
Depression, anxiety, paranoia and hallucinations are mental health conditions that can appropriately be addressed with an array of methods, including approved pharmaceuticals. My question to fellow aging professionals, how are we going to address the growing needs of dementia patients who were not afflicted with COVID 19, but present with notable decline in cognition due to isolation and change in routine? How are we going to meet their changing needs?
Obvious treatment options include easing the dementia patient back into his/her pre-quarantine routine with a “Wait & See” attitude. As a caregiver and/or medical professional, we can provide constant redirection and reassurance. And then there is the question of the almighty medication. Is medication THE answer to increased cognitive decline when secondary mental health issues are not the challenge?
I circle back to the beginning in which I clearly state I don’t have the answers. In my research it appears that it’s too soon to have any conclusive approach on how to move forward, as studies are unavailable in these unprecedented times. The Alzheimer’s Association’s response to my inquiry on this subject matter attests to this: Please see our library links below, as the library itself is not currently able to conduct a search.
I am of the opinion that geriatrics and healthcare, in general, are going to be an ever-morphing field for many months to come. I’m grateful to all the healthcare and community-living workers who have fought so diligently to protect the lives of our aging population. I say silent prayers for all who have been compromised by COVID-19. Moving forward, my hope is that we can rise up together to meet the mounting needs of those who experienced an exacerbated decline in cognition due to the C0VID-19-induced isolation – no matter what the answer.
There is so much to think about when entering the later stages of life. If you are considering elder care options, we at Genson Geriatrics Management can help. Our professional staff specializes in assisting you to choose the right kind of care for your loved one.
We conduct regular check-ins when you are unable to do so. Genson Geriatrics Management also provides oversight and detailed feedback to the family to keep your loved one safe and well-cared for day or night, weekday or weekend, holiday and every day.
We have the resources. We can hold your hand. We can guide you. Your peace of mind is our main goal, and is well assured. To find out more, call us at 805-750-4755 or visit our website and sign up for our monthly newsletter: www.GensonGeriatrics.com