COVID-19 and Dementia: Advice for Caregivers 

In March 2020, the novel coronavirus (COVID-19 from the SARS-CoV-2 virus) became a global pandemic that affected us all.  In the early months of the pandemic, we learned that older adults, and particularly those living with dementia, were at higher risk of severe illness and death due to COVID-19.  

Researchers in the UK (1) looked at data about how COVID-19 affected older adults, and provided three reasons why people with dementia were particularly vulnerable: 

1. The virus causes more severe illness in older people.
2. The health problems that make COVID-19 infection worse (e.g., heart disease, diabetes) are also the conditions that increase the risk of developing dementia.
3. Having dementia makes it harder for people to understand and follow self-isolation and social distancing recommendations, which puts them more at risk for exposure to the virus.  People with dementia are also more likely to live in assisted living or nursing home facilities, where the rates of COVID-19 infection and deaths have been very high.  

How Has COVID-19 Affected People Living with Dementia?

The COVID-19 pandemic has had a significant impact on people living with dementia and their caregivers, even if they have not become infected with the virus itself. 

Many communities imposed social distancing restrictions and lockdown measures to try to reduce the spread of COVID-19, and while this made a big difference in infection rates, it has been particularly hard for people living with dementia, who have not been able to see their families or their doctors in person, or do as many activities to stimulate their brains.  

Older adults living by themselves have felt isolated and lonely, and also very worried about themselves and their family’s health. We know that participation in social activities is important for brain health, and the more socially active older adults are, the less at risk they are for cognitive decline. Studies have shown that the rate of cognitive decline among people with dementia has been more rapid since the start of the pandemic (2), and if they became infected with COVID-19, their dementia became worse.  In all people who had COVID-19, the amount of cognitive impairment they had after infection was directly related to how ill they became, as measured by the length of time they spent on the ICU (3).

People with dementia are also having a harder time with depression, anxiety, agitation, and sleep than they did before the COVID-19 pandemic. Social deprivation and the lack of interaction with family and friends is emotionally challenging, and stress, depression, and anxiety can make difficulties with memory worse.

Public health measures have also caused increased caregiver burden, since people caring for loved ones with dementia may not want to have an outside caregiver come into their house due to the risk of their bringing in COVID-19. Senior centers and daycare programs have not been open, and this gives caregivers fewer opportunities to take a break from caregiving and take care of themselves.

In my clinical practice, I see many people with dementia get upset about wearing facemasks or about others wearing facemasks, because they do not remember why they must be worn. It is also harder for someone with hearing loss to understand what is being said when a speaker’s mouth is covered by a mask, and this can be very frustrating for everyone.

What Can Friends and Loved Ones Do to Help?

The most important thing you can do is ensure that you and your loved ones, and particularly those living with dementia, receive the COVID-19 vaccine. 

As the weather gets nicer, make outdoor plans that promote light physical activity and fresh air.  Encourage a return to senior center and adult day care programs to provide mental stimulation and give caregivers a break, and schedule appointments with the dentist, eye doctor, audiologist, or hairdresser that were put on hold.

Prepare ahead for a possible return to social distancing restrictions next winter by looking into purchasing a simple device for video calls to help the person with dementia to stay connected when visits can no longer be held outdoors. Devices like The Grandpad, ViewClix, Amazon Echo Show, and Google Nest Hub are designed to be easy for even the least tech savvy seniors to use.    

For more tips for caregivers of people living with dementia, check out: https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care

As always, watch for changes in your loved one’s thinking and behavior, stay on track with physician visits, and talk to your care provider if you have any concerns.

References

1. Page S, Davies-Abbott I, Jones A. Dementia care from behind the mask? Maintaining well-being during Covid-19 pandemic restrictions; observations from Dementia Care Mapping on NHS mental health hospital wards in Wales. Journal of psychiatric and mental health nursing. April 2021. doi:10.1111/jpm.12763
2. Ismail II, Kamel WA, Al-Hashel JY. Association of COVID-19 Pandemic and Rate of Cognitive Decline in Patients with Dementia and Mild Cognitive Impairment: A Cross-sectional Study. Gerontology & geriatric medicine. 2021;7:23337214211005224. doi:10.1177/23337214211005223
3. Negrini F, Ferrario I, Mazziotti D, et al. Neuropsychological Features of Severe Hospitalized Coronavirus Disease 2019 Patients at Clinical Stability and Clues for Postacute Rehabilitation. Archives of physical medicine and rehabilitation. 2021;102(1):155-158. doi:10.1016/j.apmr.2020.09.376