Covid has affected one and all in one way or the other. All age groups have been jeopardized but the major threat of its menace has been graver for the elderly. The truth is that the elderly section is suffering from the overall impact of the pandemic if not from Covid.

Aging is a natural process that arrives with many altering factors leaving you vulnerable and susceptible to several health concerns- both physical and mental. Aging is associated with progressive deterioration in the central nervous system (CNS) - it affects the immune system within the CNS making all elders prone to the SARS CoV-2 infection. Having Dementia in addition to this, only makes matters more complicated. Our blood-brain barrier (BBB) acts as a protective fence to prevent pathogens and toxins from entering our brain through the bloodstream. People with Dementia have an increased permeability in the BBB allowing certain bacteria or viruses to access the brain more easily.

Some (very) early studies have also revealed that the relationship between Covid and Dementia is interlinked- people with Dementia have an increased risk of infection and elders who suffered a prolonged Covid infection showed signs of cognitive impairment & confusion.

Handling Dementia and Covid together have been part of the Epoch homes for 2 subsequent summers now. With detecting, preventing and then managing the infection and it’s spread, it has been a huge individual-driven responsibility as we cater to the safety and care of dementia residents. We have managed all Epoch homes with the help of our emotionally and professionally trained nurses and care team.

Ensuring the safety of dementia residents in this current scenario has been quite challenging for us. Elders with dementia have difficulty in understanding (and remembering) the rationale behind masks, social-distancing, hand washing and other covid guidelines and protocols. The risk of getting infected is a constant responsibility, and the isolation after that has grave psychological impacts on their stage progression and overall well-being.

Among other things that take a toll is the whole distancing from their loved ones and families. For us, it is heartbreaking to see couples and children meet and greet from a distance. Our elders miss their warm hugs and struggle to relate to the faces behind the masks. Covid testing is more agitating because they do not familiarize themselves well with the RT PCR way. A blood test is more relatable.

At Epoch, we practice “good dementia sense” the crux of which is mainly to do with managing their emotions versus their cognitive health. As dementia progresses, factual memory slowly fades away while the emotional memory stays. Good dementia management is working on these emotional memories through means of (lots of) meaningful engagement and social activities. Our focus has also been on providing as much physical presence as could be. The feel of touch, gentle pats, soft strokes on their hands, and caressing helps them acknowledge assurance in the presence of someone. With the pandemic, practicing good dementia sense became next to impossible and we had to completely rewire our management strategy.

A routine for an elderly with dementia is as crucial as other aspects, and a caregiver plays a key role in assuring that this happens. Caregivers were counselled to stay with the dementia residents 24x7 so that the routine does not tamper. The team devised better ways to deal with Covid and its uproar. Ensuring that a single day of activity is not missed along with light exercises and strolls that are constantly checked. A structure is maintained and followed with discipline regarding their periods of sleep, meals, medications, and activities. These along with a tagged care staff are not disrupted. We figure out all creative ways to engage them, one being technology and its usage. Voice calls, video calls with friends and families have proven to be more beneficial during these times. It gives them a good sense of connectivity. They are taken out of the homes to the lawns or porch with complete precautions. What has also worked is creating mini bubbles inside our homes to help them socialize. These mini bubbles are groups of not more than 4 elders taken out at intervals to engage over chit-chats, meals, activities, rituals, and celebrations. Keeping them isolated can be a great way of preventing covid and its spread but finding a pragmatic approach, such as this, can be more effective. As a matter of fact, it balances everything in their lives.

Covid has been manageable for us to date in the sense that nobody faced a prolonged illness. What comes to me is the effort and work we do, and suddenly it appears again, for things to be started all over anew. Nonetheless, figuring out a sensible approach to make lives as normal as possible, although nothing seems normal, is our main objective.

With dementia, we need to remember that they live in their own world, their own bubble. They are partially connected with the present world. It’s up to us to fix their worlds with every possible way around.

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