By Kathleen Weissberg, National Director of Education, Select Rehabilitation
During normal times, individuals with dementia are among the most vulnerable persons in society. The pandemic further exacerbated their vulnerability, due to the direct physical effects of COVID-19 and indirect effects on social supports upon which they depend. For those with dementia, social connection means everything; they are disproportionately affected by social distancing and isolation.
Even when the pandemic is in the rearview mirror, its impact — loneliness and depression — will still be present. Care providers need to be prepared for the “next time,” which may not be of pandemic proportion, but an infectious disease outbreak or natural disaster can have the same effect. So, what can providers do? What are some specific strategies they can implement to assist with loneliness and depression?
As stated in the Alzheimer’s Association Dementia Care Practice Recommendations, one of the most important steps in providing quality dementia care is to know the person. In the event of a major disease outbreak or disaster, this may be more difficult for temporary staff members or those working in a new department. It is recommended that a nurse, social worker or other staff completes a HIPAA-compliant personal information form for each person and keeps it in an easily accessible place, such as inside a folder attached to the inside of a closet door. Information on the form can include: preferred name/pronouns; cultural background; religious/spiritual practices; past hobbies/interests; names of family/friends; what upsets/what calms; ADL routine; and so on.
Even before the pandemic began, studies indicated that nearly 25 percent of older Americans were socially isolated. An even larger percentage of older people confess to feeling lonely. While anyone can feel lonely or isolated, older adults are at higher risk due to precipitating factors like chronic illness, hearing loss, sensory impairments, higher likelihood of living alone, and death of friends and/or family. Having few social connections and feeling isolated are associated with myriad health-related conditions, including chronic diseases and psychiatric disorders. Social isolation is now viewed as a risk factor for premature death, similar to cigarette smoking, physical inactivity or obesity. Social distancing protects older adults from some health risks, but limited interactions reduce feelings of connectedness and can exacerbate other health risks. Without frequent meaningful social interactions and stimulation, older adults’ cognitive functioning can decline.
So, how do we help elders stay active and engaged?
- Plan the day. Keeping up with routines can help to add meaning to one’s day.
- Stay physically active. Find exercises that can be done indoors or in one’s room. Therapy or activities can help find exercises that are appropriate.
- Reach out to others – via phone, email, virtually, or even by mail.
- Promote intergenerational connection. Most elders would love to hear from their grandchildren or receive their artwork in the mail.
Routine is critically important to help those in isolation. Routine tends to mitigate or reduce stress responses seen when dealing with trauma. Routine can help the person with dementia know what to expect and help them to continue to do things independently and in turn improve self-esteem, dignity, and confidence. When helping with routines, it is best to allow the person time to do an activity himself. This, of course, can be frustrating, especially when you know you could complete the task more quickly or more efficiently. As staff, we must avoid the temptation to take over, even if the individual is struggling. The loss of confidence could make it harder for him to keep trying. When you offer help, try doing the task together, rather than doing it for the person. This helps the person feel in control and more involved.
Therapists play a critical role and can help establish or adapt routines for seniors in isolation. Some tips for making routines easier:
- Try breaking tasks down into sections. Even if the person cannot complete a full task, carrying out one or two steps — particularly the final step — can give a sense of achievement.
- Make sure any reminders or instructions are simple. Use short sentences, gestures and body language to add meaning. If the person no longer understands words, try using color cues or pictures.
- Be tactful. Make sure the person does not feel supervised or criticized in any way. This means checking your tone of voice as well as your word choices.
- When dementia advances, try pointing, demonstrating, or guiding an action rather than giving a verbal explanation.
Therapists can help! They can:
- Assist in selecting activities in which an elder can engage. Activities cannot be a one-size-fits-all. Instead, careful consideration should be given to cognitive decline, remaining abilities, interests, and effective environmental aids/cues. It is important the activity does not require significant set-up time and can provide immediate feedback.
- Adapt activities for persons with differing skills levels.
- Suggest remote or virtual activities compatible with spared skills that can be used by family members who are not able to connect physically.
- Tailor activities to engage the senses. Sensory stimulation uses everyday objects to trigger emotions and memories in seniors who have lost ability to connect with the world with the goal of evoking positive feelings and reducing behaviors.
- Identify purposeful and meaningful activities based upon interests, roles, values, and history. These types of activities show the individual and others around them they are competent and valued and can help develop strong feelings of belonging.
- After assessment of cognitive and communication abilities, suggest interactive activities that can promote cognition.
- Recommend an exercise program to help the elder stay active in ways that he/she enjoys. This might include daily exercise outdoors, simple indoor exercises, or stretches.
- Suggest creative and art therapy pursuits indicated to sharpen sensory capacity, promote independence, and facilitate communication. Things such as painting, music, hobbies, other leisure skills can positively influence well-being.
- Advise regarding opportunities related to animal-assisted therapy using live or robotic animals. Studies show that pet attachment can alleviate loneliness by acting as a coping mechanism, possibly by providing social support and companionship.
It is a sad reality that loneliness can both increase risk of dementia and be increased by dementia. One reason why loneliness has attracted attention is that health and quality of life can be improved by reducing loneliness. Loneliness is seen as modifiable and, if recognized and addressed, can be a route to changing health outcomes.
Centers for Disease Control and Prevention (CDC). (2021). Loneliness and Social Isolation Linked to Serious Health Conditions. Accessed at https://www.cdc.gov/aging/publications/features/lonely-older-adults.html
Fullana, M., Hidalgo-Mazzei, D., Vieta, E., & Radua, J. (2020). Coping behaviors associated with decreased anxiety and depressive symptoms during the COVID-19 pandemic and lockdown. Journal of Affective Disorders, 275, 80-81.
Fuller, H. & Huseth-Zosel, A. (2021). Lessons in Resilience: Initial Coping Among Older Adults During the COVID-19 Pandemic. The Gerontologist, 61(1), 114–125.
National Academies of Sciences, Engineering, and Medicine. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press.
Wang, H., et al. (2020). Dementia care during COVID-19. The Lancet, 395(10231), 1190-1191.