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.
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