COVID-19 SPECIAL: Doc Talk

Help loved ones with dementia cope with pandemic

Use the time at home during the circuit breaker period to engage a family member who has dementia with meaningful activities

While the younger adults can adapt and cope with the stress the Covid-19 pandemic brings, seniors with dementia may not be able to do so.

Persons with dementia, delirium and behavioural issues require greater nursing care, which is a challenge at home.

Strict personal hygiene measures like frequent hand-washing with soap, monitoring temperature twice daily, appropriate disposal of used tissues or face masks, keeping tabletops clean and wearing a face mask if one is sick are key measures that younger adults can remember and build into their lives.

However, seniors with dementia may struggle to understand the situation and the measures they need to adhere to.

They may not retain information and carry out certain daily basic activities such as frequent hand-washing. They may even become agitated when told to do so by their family members.

There is thus additional stress placed on their caregivers, now that seniors with dementia have to stay home and not gather at day centres for their own sake.

Nevertheless, while caregivers may find the current period to be very challenging, it helps to know that it can work out well when they have the right mindset.

I have a 90-year-old patient whose wife, his caregiver, is 70. Towards the end of last year, he was admitted to Alexandra Hospital under the Healthy Ageing Programme for a fall and went through a period of delirium precipitated by pneumonia.

His wife had noticed changes in his cognitive and physical abilities for a period before this admission and she struggled to look after him all by herself.

She has broken down many times from the stress of doing so. She was torn between caring for him at home and sending him to a nursing home.

At the hospital, a team of us counselled and equipped the wife to care for her husband, which was her goal and desire.


ST ILLUSTRATION: CEL GULAPA

Delirium - an acute confusional state characterised by inattention and fluctuating levels of consciousness - is a serious but mostly reversible condition that affects up to 60 per cent of hospitalised elderly patients.

The patient was admitted to our hospital's special suite for those suffering from delirium, where we practise a physical restraint-free policy and offer a lower patient-nurse ratio to allow for more intensive care.

The husband's condition improved in a few days and rehabilitation care in our geriatric ward immediately followed to facilitate the recovery.

The medical team, including therapists and care managers, provided the wife with information on how she could manage his symptoms and behaviour, and gave her tips on fall prevention, on-site training and community care options.

Over the month-long stay, the entire "kampung" in the hospital worked in tandem - including doctors, nurses, care managers, allied health professionals and housekeeping staff - to care for him.

After his discharge, the hospital's care manager has continued to check on him to ensure care is continued.

His wife was also more confident of caring for him after she learnt to reframe her focus to dwell not on his limitations, but on what could be done to make his life more meaningful.

My patient's story underlines the importance of not deeming dementia to be a dreaded condition.

Current containment measures due to Covid-19 can be used for social bonding with our loved ones, as we spend time to understand their needs and connect with them.

This will help caregivers to engage them with more meaningful activities. These include recollecting rich memories, singing old songs, flipping through the pages of a favourite book or a photo album, and enjoying meals with them.

Reminiscence therapy is an intervention that can benefit the elderly as it allows them to relate to their past, which helps to calm them down. This could involve writing down the family's favourite old recipes or going through the old names of various parts of Singapore.

Caregivers can supervise the seniors as they do gentle exercises (as advised by healthcare professionals) at home, as this will keep them active, help them avoid boredom and promote good sleep.

The caregivers are not alone in this care journey. The hospital and the community are walking the journey with them.

• Dr Santhosh Kumar Seetharaman is the head and senior consultant of the Healthy Ageing Programme at Alexandra Hospital.

A version of this article appeared in the print edition of The Straits Times on April 20, 2020, with the headline 'Help loved ones with dementia cope with pandemic'. Subscribe