COVID-19 has resulted in significant inconvenience and unwelcome change to our lives. It is challenging for most of us to cope with the pandemic, but it must be even tougher for seniors, especially those with dementia, who typically deal poorly with change.
Cognitive deficits in people with dementia limit their ability to comprehend and register the new information. As such, they may not see the need to don a mask or adhere to physical distancing measures. Creative ways to convey information are necessary. These include pictorials, infographics and short videos. Repetition can be helpful, as is the need to communicate clearly and concisely with patience.
Those suffering from dementia generally do better with a structured daily routine, which may include outdoor walks to maintain their fitness and expend their energy. When they head outdoors, it is best their caregivers accompany them. They should also carry with them a means of identification so outsiders can help if they are lost or unintentionally breach COVID-19 regulations.
Those suffering from dementia generally do better with a structured daily routine, which may include outdoor walks to maintain their fitness and expend their energy.
In this regard, the Alzheimer’s Association of Singapore and Agency for Integrated Care recently launched the ADA memo (www.alz.org.sg/ADAmemo) to issue formal documents to explain the condition of people with dementia should enforcement officers approach them for violation of safe-distancing measures.
Enforcement officers are taught to look out for identifiers such as the ADA memo or Safe Return Card, issued in conjunction with National Council of Social Service, (www.agelessonline.net/a-safe-return/) to assist these people. These officers also receive lessons on recognising the signs and symptoms of dementia and how to better communicate with them. In addition, the Dementia Friends App, launched over a year ago, allows the public to relay information on dementia patients who are lost.
Nonetheless, it would still be prudent to limit their frequency of going outdoors, especially during the circuit breaker period. Caregivers can engage them in daily exercises and cognitive stimulation hosted on digital platforms. These include “Get Fit With Me – Overcome COVID-19” and “Come n Live@Zaobao.sg” which engage seniors through fitness, cooking and singing demonstrations.
There are also e-Getai shows (www.facebook.com/jackneock), hosted by celebrities our seniors are familiar with that provide tips on battling COVID-19. Repeating these videos can reinforce in those with dementia the importance of safe distancing measures, by tapping their implicit memory which remains intact for many with mild to moderate dementia.
Finally, making advance care plans is ever pertinent to people with dementia. COVID-19 calls for decisions on whether the benefits of hospitalisation outweigh the possible harms. The extent of treatment should also be considered as treatment outcomes are generally poor in frail, older people afflicted by COVID-19. The current pandemic certainly provides fresh impetus to initiate or revisit these conversations.
The issues mentioned above have been advocated in recent years, given the rising numbers of people who have dementia amid an ageing population. For example, the movement to build a dementia-friendly Singapore, initiated in 2017, educates the public on how to recognise and assist them and teaches ways to communicate and engage with them effectively.
The COVID-19 pandemic demands greater efforts to implement and scale these initiatives so that those with dementia, their families and society as a whole can reap their benefits.
The contributors are an Associate Consultant and a Senior Consultant from the Department of Geriatric Medicine at Khoo Teck Puat Hospital.