While social distancing may be effective in preventing COVID-19, there are many negative effects that merit further investigation. Rambam’s experts speak out on the impact of social distancing and isolation on patients suffering from dementia.
The events of the past several months have turned lives upside-down and forced people to adjust to a new kind of "normal". But when it comes to patients suffering from cognitive impairment or dementia, the problems are even more acute. According to experts at Rambam Health Care Campus, current circumstances may contribute to a marked decline in the health of these patients.
"The initial period of adjusting to the threats of COVID-19 was one of uncertainty and lack of control for everyone," says Professor David Tanne, Director of Rambam’s Stroke and Cognition Institute. “However, for patients suffering from dementia, maintaining control over their daily lives is crucial. When their daily schedules are altered and messages received via the media, family, and caregivers are not always understood, this can upset the routine for these patients and in some cases, lead to a decline in their medical condition," he explains.
A lack of physical activity, difficulty in obtaining medical treatment and follow-up visits, changes in the daily routine, and the loss of important social ties characterize the recent time period. "But for the already high-risk dementia population, such activities are precisely what these patients need to maintain their cognitive condition," notes Dr. Rachel Ben Hayoun, Director of Cognitive Services at Rambam. “Even patients with minor cognitive impairment who are independent in their day-to-day functioning have experienced difficulties during the last several months. I predict that now that our society is returning to a more normal routine, we will see a deterioration in the condition of our patients and an increase in the number of new patients suffering from dementia and cognitive impairment," says Dr. Ben Hayoun.
Due to the importance of consistent medical care, Professor Tanne explained that Rambam's medical team has devised an array of methods for patients to continue with their care. "Just as in ordinary times, we are available for our patients for in-person visits at the Stroke and Cognition Institute, as well as for meetings via video-conferencing," states Professor Tanne, who emphasized that there are hidden dangers in avoiding the necessary treatment and follow-up for these patients. "At Rambam's Cognition Institute, we have a team of multidisciplinary experts that is well-positioned to respond to a wide range of issues and provides a broad support network. People who suffer from cognitive decline in general, and our patients in particular, are invited to come see us and receive the care they need."
The staff of the Stroke and Cognition Institute has compiled the following suggestions for friends and family members of people suffering from dementia or impaired cognition to follow, in order to maintain the affected person’s ability to function:
- Provide explanations and instructions in clear and comprehensible language, in particular on the following topics:
- The reasons for using a mask and gloves, especially when the person first begins to use these items (example: “this mask is designed to protect people from getting infected by a sick person”). Explain to them the reasons for remaining in isolation, not seeing visitors, not going out for walks or visits to the day care center, and any other changes brought about by the need to protect them. (This may have to be done frequently.)
- The importance of coughing and sneezing into their elbows, and show them how this should be done.
- Social distancing and why it is important.
- Encourage maintenance of ordinary routines as much as possible, including:
- Regular meal and sleep times.
- Regular physical activity, in accordance with the person’s health and the amount of space available.
- Continuing with enjoyable, enriching experiences such as watching television, listening to music, and engaging in arts and crafts.
- Prayer, meditation, guided role playing, and activities that remind the person of their past, such as looking at photographs, watching videos, and listening to familiar music.
- Maintain social connections with family and friends using digital communication. Telephone conversations and video and Zoom chats with family and friends will help people with dementia to feel that things are "normal" and that "I am like everyone else."
Patients suffering from dementia may have difficulty complying with other important instructions and should be assisted with the following:
- Personal hygiene, including frequent hand-washing, or use of hand sanitizer when soap and water are not available.
- Cleaning the home environment using disinfectant wipes, and cleaning frequently used devices such as television remote controls, air-conditioning controls, and cell phones.
- Ensuring that adequate supplies of food, medicine, and other necessary items are available.
Most important of all, be attentive to signs of fear and depression in loved ones who are suffering from dementia, and make every effort to help them feel relaxed and optimistic.