Seniors Who Suffer from Dementia Struggle with Wearing Face Masks By Elizabth Nelson

My mom and I started sewing masks back in July www.momandbooboo.com and donating them. But recently it occurred to me because I have a 20 month old baby that I can't get a mask on his face as he tries taking it off. How do individuals who have Alzheimer's or dementia deal with wearing a mask? Does this make them panic? Maybe they are good one minute and then it doesn't bother them? I cam across this good article that discusses this critical topic for the current environment we are living in right now. 

https://blog.thealzheimerssite.greatergood.com/face-masks/

The COVID-19 pandemic is still spreading largely unchecked through many parts of the world, leading businesses to close their doors to the public and healthcare facilities like nursing homes to keep visitors from entering so as not to infect the elderly and those with weakened immune systems. But somehow, seniors living in these facilities have still been contracting the novel coronavirus. There have been reports of the virus spreading through entire nursing homes and veterans’ homes, infecting dozens of patients and killing many of them.

The Veterans Community Living Center at Fitzsimons in Aurora, Colorado, is a good example. The facility is home to 137 elderly veterans. So far, a total of 42 of these veterans have tested positive for coronavirus, along with 14 staff members, and nine have passed away. All this despite the home’s strict no-visitor policy, cleaning protocols, and other safety precautions that have been implemented. 

We’ve been so careful to protect some of the most vulnerable among us. Why isn’t it working?

Well, part of the problem, of course, lies in the fact that elderly people living in nursing homes, assisted living facilities, and veterans’ homes are in need of assistance on at least a daily basis, so they cannot be completely contact-free. Many of them are not allowed to see their families and friends, but they still see their nurses, doctors, and caregivers regularly. Of course, these healthcare workers are generally very careful to wear proper personal protective equipment to avoid catching or spreading the virus, but these safety measures are not entirely foolproof.

The patients themselves are also supposed to wear masks to help curb the spread of the virus, but this presents a few challenges. There are some elderly people who cannot wear masks due to health conditions and others who simply don’t see the point in wearing a mask and refuse to do so. 

And of course, there are also those who suffer from Alzheimer’s and dementia. They often have a hard time comprehending why they have to wear a mask, and even if they agree to do so, they may not be able to remember to do so. If caregivers put masks on them, they’re very likely to touch their faces or remove their masks without thinking. This inability to remember proper mask protocol throws a wrench in the plan to avoid spreading COVID-19.

“Helping those folks to wear masks and to continue to wear masks or to social distance is difficult because, you know, a few minutes after you work with them to get a mask on, they then don’t realize why they have a mask on and take it off—or the same thing goes for social distancing,” says May.

But masks are just the tip of the iceberg. An Alzheimer’s or dementia patient who cannot remember to wear a mask and stop touching their face is also unlikely to remember other proper hygiene rules, like washing their hands for 20 seconds on a regular basis. In many cases, patients’ hygiene is overseen by healthcare workers, and in ordinary times, this is enough to keep patients healthy. But in the time of COVID-19, when staff members are overworked, protective gear is scarce, and the coronavirus is highly contagious, extra hygienic practices must be in place to keep everyone safe. And for a person with dementia, it can be nearly impossible to understand that concept and put it into practice. 

COVID-19 rules in general have been difficult for seniors, who already suffer from loneliness and boredom. They haven’t been able to dine in common areas, have visitors, or get out of their rooms. Staff members try to visit more often and spend some time with them, but they have to do so while wearing protective equipment, which can be hard for residents to deal with, and many times they don’t have extra time to spend with their residents. All of this is putting extra strain on healthcare workers and residents of senior living facilities during the pandemic and stay-home orders.

For now, we’re all doing the best we can to keep elderly people safe and well during this difficult time, and healthcare staff is working around the clock to come up with new and innovative ideas to improve residents’ health and safety. We’re all in this together.

Face Masks for the Eldery

I have found more articles related to face masks for elderly, and them being a vulnerable population puts them at a higher risks. My mother and I have been making masks www.momandbooboo.com However its been great to see other individuals out there making masks for everyone including the elderly. 

https://www.helpinghandshomecare.co.uk/blog/face-masks-for-the-elderly/

By: Laura Belford-Thomas

Our lives have completely changed over the last five months, but we are slowly returning to how life was before the coronavirus. The latest and most dramatic regulations update is the wearing of face coverings across the UK in indoor public places. On 24^th July, it was made mandatory to wear a face covering in supermarkets, retail shops, banks, health and beauty facilities, including hairdressers and barbers, places of worship, leisure facilities, and anywhere where maintaining social distancing is difficult.

It’s taken time for everyone to adjust to these new rules, and for some people, such as those with dementia or who find it difficult to communicate, it has been an incredibly challenging time. So, how can we ensure our elderly loved ones comply with wearing a mask, and what can we do to help them understand why this is important?

Who is exempt from wearing a mask?

Not everyone needs to wear a mask. According to the Government guidelines, there are some groups of people that are exempt from wearing a face covering:

• Those unable to put on or remove a face covering because of a physical or mental disability
• Where putting on or removing a face covering will cause you severe distress
• If you care for or are assisting someone who relies on lipreading
• When exercising and wearing a mask would stop you doing this safely

For those that are worried about being asked why they are not wearing a face covering when entering a shop or supermarket, there are exemption templates you can download and print or keep on a mobile device so that you can show to anyone who may ask why you or a loved one is not wearing a mask. This can give you peace of mind that you won’t come under scrutiny for not wearing a face covering.

How to ensure elderly loved ones understand why wearing face masks is important

For those that have problems with their memory, or just don’t understand why we need to wear coronavirus face masks, it may mean that you need to gently remind your loved one each time you go out to remember to take a face covering with them and wear it in enclosed spaces.

It’s important to remember not to lie to them or embellish the facts; tell them how wearing a mask protects others, and this is the reason why collectively we all need to wear face coverings for the time being. You could remind them of the nationwide effort of being in lockdown for several months, and that wearing a face mask in public is an extension of that, helping us all to protect and look after each other unitedly.

Perhaps you could put a visual reminder by their front door if they are independent and like to go to the shops by themselves. An image of a face mask could remind them to check they have their face covering in their pocket ready to use.

Advice on what to do if an elderly family member with dementia refuses to wear a mask

It may be quite difficult to encourage your elderly loved one to wear a mask when they’re out and about, and this may be particularly difficult if they are living with dementia. They may not really understand what has happened during the pandemic and find wearing something covering their face and nose very strange and something only medical professionals normally do.

The symptoms of dementia usually include confusion, memory loss and anxiety, with these increasing in severity as someone progresses to the later stages of their condition. Combine this with a complete change of life as we know it, and this can be absolutely terrifying for someone with dementia. That being said, there are ways that you can support someone with dementia with wearing a face covering if they refuse:

Use non-medical face coverings 

Medical looking masks that are light blue in colour may cause someone with dementia to associate them with going to the doctors or dentist, and possibly bring up negative memories that may make them feel even more anxious. There are lots of different face masks designs out there which are being sold by most retailers. From different coloured fabrics to patterns with favourite characters adorned on them, there is something for everyone. You could even try making your own home-made masks together – a great way to involve your loved one in the process and also normalise face masks in general.

Check if their face mask is comfortable

The material of their face mask may not be very comfortable, or may be too tight around their ears and face. When buying or making face coverings, try to choose masks made from cotton instead of synthetic materials and ensure they try their face masks on at home first before taking a trip to the shops.

Always offer reassurance 

Whether they persistently lower their covering or forget why they need to wear one, it’s vital that you’re always there to offer them support and reassurance, especially if they are worried that their breathing will be restricted or that they won’t be able to communicate with others. Remind them that it’s for everyone’s safety but that as soon as they get outside into an open space, they can take their face mask off and perhaps sit outside their favourite café for a coffee and slice of cake.

There may be a very real and legitimate reason for them refusing to wear a face covering, perhaps because of a bad memory they have or a deep-rooted fear. Talk to them and gently ask them how they’re feeling and find out what’s causing them distress.

Remember: if your loved one becomes too upset or distressed and you have tried several times to encourage them to wear a face covering, they don’t have to wear a face mask as per Government guidelines.

5 Reasons The Pandemic Caused a Surge in Alzheimer’s Deaths

By: Alexandra Marvar

The National Center for Health Statistics attributes 266,000 deaths per year to Alzheimer’s and other forms of dementia. Upwards of 120,000 of those per year are from Alzheimer’s, which generally ranks sixth among causes of death in that year for white Americans and fourth for Black Americans. But this year, those numbers will be notably higher.

The Wall Street Journal reports that over the course of the past four months, while the world is under the thumb of the novel coronavirus pandemic, we’ve seen a surge in Alzheimer’s deaths and deaths from related dementias, in which 15,000 more Americans have died from dementias than in the same timeframe in past years — an estimated 100,000 total between February through May. According to the CDC, the death toll rose sharply in March, and by mid-April, some 250 extra people with dementia per day were dying. So far, deaths due to Alzheimer’s and dementia in California, New Jersey, New York and Texas are more than 1,000 beyond what would be normal in any other year.

So far in 2020, the dementia and Alzheimer’s fatality rate is nearly 20% higher than average from recent years.

Indeed, some of these deaths are the direct result of a COVID-19 infection, but without a positive test, the death certificate may just list the neurodegenerative disease with which the patient had long been diagnosed. On the other hand, some deaths are not directly caused by a COVID-19 infection, but still the result of the perfect storm of dementia and the circumstances of a pandemic.

Being Patient takes a closer look at just why this surge in deaths is occurring:

1. Higher Risk

Perhaps the most obvious reason that coronavirus is causing more dementia deaths is two-fold: People living with Alzheimer’s and dementia are 1) both more exposed to COVID-19, and 2) at greater risk of fatality once they are exposed to the virus.

The nation has watched as COVID-19 has swept through nursing homes and long-term care facilities like an unstoppable rising tide. Over 40% of coronavirus deaths in the U.S. have been in nursing homes. In one home in California, every resident became infected with coronavirus.

In residential care communities, more than 40 percent of residents have been diagnosed with some form of dementia. Nearly one in every two nursing home residents have. So people with Alzheimer’s or related dementias are disproportionately exposed.

They are also at greater risk once exposed: An estimated 80 percent of Americans living with Alzheimer’s are 75 or older, and older people are much more susceptible to fatality from COVID-19.

Some nursing homes have had their staff live onsite throughout the pandemic in order to reduce risk to residents, but few can afford to do so.

2. Less Accessible Medical Care

The surge in non-COVID-19 deaths during the pandemic hasn’t just befallen people living with dementia: The same surges have been documented in people living with hypertension, diabetes, stroke, coronary artery disease and others. And in a pandemic, medical care of all kinds is less accessible.

Dr. Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University, believes the coronavirus pandemic will take far more lives than those lost directly to fatal cases of COVID-19 for several reasons, one being that the pandemic is preventing people from taking preventive measures or seeking needed care.

She told the Wall Street Journal, “I have friends who tell me in the hospitals where they work they’ve never seen so many ruptured appendicitis cases” — one indicator that people are waiting longer to get care.

The WSJ reports that Goldman was part the research team on a 2018 study of estimated deaths in Puerto Rico following Hurricane Maria. The study found that thousands of deaths that were not a direct result of the storm occurred due to power outages, infrastructural failings and lack of access to healthcare and medicine. While the coronavirus pandemic is less acute than a hurricane, factors are preventing people who need care from accessing it soon enough, if at all. During disaster events, people with any kind of health condition are at higher risk across the board.

3. Disrupted Routines, Loneliness and Anxiety

Routines and regularity are central to the mental wellbeing of people with dementia and in the midst of a pandemic, for man, that routine has been one casualty. Visits halted, and in nursing homes and care facilities where staff was cut, staff may have less bandwidth to care for each resident. Those who were displaced from long-term care or day-care programs and are now at home are also experiencing massive disruptions.

With limited caregiver bandwidth may come higher risk of accidents or declining health.

“It’s one fall, and it sets everything off. It’s one day of no fluids and they become dehydrated and it sets off a chain of events,” Indiana University’s Center for Aging Research Associate Director Nicole Fowler told WSJ. “It’s amazing how little it actually takes to upset their environment.”

Plus, the pandemic put an abrupt stop to family visits in care facilities. The has caused heightened anxiety, agitation, depression, loneliness and isolation, all of which tax the brain and can lead to a steeper decline in health for people already living with cognitive impairment.

One reason it is so difficult is because people living with Alzheimer’s or dementia often don’t understand the reasons that visits have stopped, Lori Smetanka, executive director at the nonprofit National Consumer Voice for Quality Long-Term Care, told WSJ.

“We’re hearing stories of people declining and dying literally from loneliness and feelings of abandonment,” she said.

When Ruth “Dolly” Reigel, resident of an assisted-living facility in Marshfield, Wis., stopped receiving regular visitors in March, Ms. Reigel’s daughter, Amy Cattanach said their absence quickly led to Ms. Reigel’s decline.

Senior living communities have experimented with all manner of ways to reduce isolation and loneliness, from iPads, robotic pets and Skype calls to building plexiglass walls through which family members and residents can visit and eventually allowing outdoor visits.

4. Compounded Risk In Hospitalizations

Older people hav a higher risk of being hospitalized for COVID-19, and when people living with dementia are hospitalized, they are more likely to experience delirium, which can continue to worsen symptoms and it can lead to a heightened risk of death.

Dr. Jason Karlawish, a professor of medicine at the University of Pennsylvania and an Alzheimer’s expert, told Being Patient during a BrainTalk that this is for the same reason that worsening cognitive impairment increases the likelihood of someone dying. “You might not be able to adequately comply with your therapies and take them,” he said. “You extend the period of time that you’re in the hospital. You extend the period of time that you’re in bed … It’s one of these multi-factorial events, that sort of cascade of events, that in some cases sadly leads to death, and certainly lead to worsening disability.”

5. SARS-COV-2’s Neurological Effects

Coronaviruses can have adverse neurological effects, but we don’t yet know how SARS-COV-2 affects the brains of people with Alzheimer’s disease and other dementias.

Past studies on the neurological effects of coronaviruses indicate that the novel coronavirus and brain health are closely linked. One the one hand, it is possible that the Alzheimer’s biomarker gene may heighten a person’s risk of contracting COVID-19. On the other, some neurologists believe COVID-19 may heighten the risk of eventually developing Alzheimer’s.

Whatever the relationship, the virus’s exact impact on the brain is unclear — and this may remain the case for years or even generations to come.

Effects of Coronavirus on Alzheimer’s Patients & Caregivers

A big thank you too Dr. Marla Bruns from Rochester Regional Health for posting this important article on COVID and its affects on Alzheimer's patients and their caregivers!!! 

For people who suffer from dementia, or care for someone with dementia, the coronavirus can be devastating. Marla Bruns, MD, discusses how patients and caregivers can manage during the coronavirus pandemic.

The coronavirus has negatively impacted many lives throughout our community, and one way is the change to our normal routines. For people who suffer from dementia, or care for someone with dementia, the coronavirus can be devastating.

Marla Bruns, MD, cognitive neurologist and co-director of Rochester Regional Health’s Memory Center at Unity Hospital, spoke to us about the impact of the coronavirus on Alzheimer’s patients and patients with dementia, and provides tips for caregivers. 

Q: What challenges are your patients faced with as a result of COVID-19?

The new coronavirus (COVID-19) poses very unique challenges for people with Alzheimer's disease and other forms of dementia. Isolation during the pandemic is a heavy burden to be faced with, and many of our patients in memory care facilities have endured an extended time alone without fully understanding why.

Dementia patients suffer from memory loss and increased confusion, so sticking to a regular daily routine is essential to their care. But when their routine is disrupted, it often has effects on their behavior.

The disruption in routines has accelerated stress levels in many dementia patients. Due to memory loss, forgetting why they can’t go places causes more pent-up stress, can lead to pacing, picking at skin, more compulsive outlets, more sadness and loneliness if unable to be with family, anger at not being able to do what they want, and increased frustration with reminders about wearing masks, without understanding why.

Q: Are patients with dementia at any greater risk of getting COVID-19?

While no research indicates dementia increases risk for contracting COVID-19, other factors that often accompany dementia like dementia-related behaviors, increased age, and common health conditions may increase risk.

Dementia can be a predictor of greater severity of illness and poorer outcomes if contracted, like a higher risk of hospitalization, ICU care needs, and death.

Also, cognitive impairment makes it more difficult for patients to self-protect, because a vulnerable person may not understand the risk of disease or remember to be as careful as necessary when there is a virus in the air. This makes a person with dementia an easier target for coronavirus infection.

People with Alzheimer's disease and all other dementia may forget to wash their hands, wear a mask, or take other recommended precautions to prevent illness. 

Q: What tips do you have for people caring for Alzheimer’s and dementia patients during the coronavirus pandemic?

One of the best things you can do is establish a new routine. If patients are used to going out to lunch, have a picnic lunch out in the yard. If they are accustomed to going out shopping, take them for a walk around the block. If they are in a facility and are accustomed to you coming to visit, arrange for visits outside a window or through video chats.

Be patient. Give them the information that you think that they can understand and respond to them on an emotional level.

Patients with dementia often have trouble comprehending why things have changed. Reassure them that you are taking measures to ensure they’re going to be okay and focus on the positives as to not increase their anxiety.

Remember to take some time for yourself. Caregivers need to take a break and stay on top of their own mental and physical health.

While the person suffering from dementia might not always have the context of what's going on, they are going to react to the stress levels of the caregiver.

Patients with dementia might have language problems or aphasia, and not be able to remember what words mean or be able to articulate what they want to say. But the emotional memory is longstanding, so minding your tone in spite of your stress is very important.

Virtual support groups are available at www.alz.org/CRF and www.lifespan-roch.org/education

Q: What should caregivers look for regarding changing behaviors of someone with dementia?

Caregivers should look for worsening of cognitive symptoms, particularly in memory and orientation abilities, as well as worsening of behavioral disturbances, agitation, aggression, apathy, and depression.

Early signs of dementia include functional decline, mainly in personal care, the inability to care for self, weight loss, hygiene, missing medications, or full prescription bottles not taken.

Q: For caregivers noticing any of the things above, what should they do?

I urge caregivers to either call the patients’ primary care provider or call the Memory Center at Unity Hospital at (585) 723-7972. We will evaluate the patient as thoroughly as possible to ensure they receive the right type of treatments. 

What you can expect at The Memory Center:

• Discuss what’s been going on and for how long
• Review medications for anything that could be causing unnecessary confusion
• Memory screening test in the office
• Determine if any bloodwork, imaging, or additional in-depth testing with a neuropsychologist is warranted to help narrow down the diagnosis
• Assess home safety—remind patient and families that the goals of care are to maintain independence, a sense of self, but safety first
• Assess caregiver burden/stress
• Offer appropriate education & resources (we work closely with Lifespan of Rochester and the Alzheimer’s Association)
• Introduce discussions of advanced directives, POA/HCP and encourage families to share wishes

The Memory Center is open and is accepting new patients. 

Q: Is there anything else you would like patients or caregivers to know?

We know many people are wary about visiting doctors’ offices, but we want to reassure you that we are taking all proper health and safety precautions and following all guidelines from the CDC and NYS Department of Health.

If anyone has any questions, please call us at (585) 723-7972.