MOST COMMON QUESTIONS FOR DEMENTIA CARE IN TIMES OF PANDEMICS

Dementia Society of the Philippines

March 28, 2020

 1. “How can we refill our medications since we can’t get new prescriptions because most of the clinics are closed?”

Medications can be refilled in two ways during the quarantine period. You can use your old prescriptions because its validity is extended or you can request for a prescription from your respective doctors, which they can send to you via online services such as email, or through online messaging platforms such as Facebook messenger, Facetime, Skype, WhatsApp or Viber.

2. “Can my father’s medication be continued in spite of him missing the doctor’s appointment due to the quarantine?”

During the quarantine period, all current maintenance medications can be continued up until the time you see your respective doctors. Please take note of time-specified medications like antibiotics, when needed or as needed medications, and strictly follow the existing order of the doctor based on the patient’s last follow-up check-up. Should you notice any side effects or adverse reactions, please notify your doctor immediately so that he/she may re-assess the use of your current medications. Once the quarantine has been lifted, you may schedule an appointment with your doctor as soon as possible.

3. “I am used to seeing my parents once or twice a week to check on them and give them their needed supplies because they live in a separate house as I do. I can’t go out and visit them as much as I want to because of the lockdown/community quarantine. How can I make sure they are ok?”

Social and physical distancing are strictly encouraged during this time of pandemic. It is strongly advised that we stay at home as much as possible and avoid unnecessary travels. However, if it is unavoidable that you need to see them personally, make sure you maintain at least 1-meter (3 feet) distance between yourself and your parents. Limit physical contact as much as possible.

An alternative innovative way to check up on your parents regularly is through applications that offer video chat functions, such as Facebook messenger, Facetime, Skype, Zoom, Viber, and WhatsApp.  Daily video-chats may be preferable than the standard audio-calls as they provide more stimulation of the senses. If video-chats are impossible due to internet connection and availability issues, audio calls are the next best option. Ask them to share with you what their plans are for the day. If they plan to go out on a grocery run, ask them what are their usual procedures to ensure they follow disinfection protocol. Share your own stories about how you and your household leaves outside footwear outside, do 20-second hand-washing, and don masks.

If distance is really a problem and someone needs to attend to them personally, you can request a relative living closer to them to visit them and have a welfare check once in a while.

4. “My mom’s routine is to go out daily for church or the mall to keep herself busy. Now that she can’t do it because of the quarantine, she gets easily agitated. What can we do about this? Any home activities that you can suggest to get her preoccupied?”

Here are some practical tips that can be done during quarantine to keep everyone especially the elderly preoccupied and busy:

• Make this quarantine a time to reconnect and to revisit activities that the family can enjoy together at home.
• Establish a daily routine. This routine can be printed out in a big-font chart and placed on the wall, with check-boxes to tick.
• Help them stay active and exercise regularly even at home. Maintaining physical activity helps with both physical and mental fitness. Simple exercises can be done using basic house objects. Include active breaks such as moving around the house or standing up from table activities from time to time.
• Watch old movies with them. You may hold their hands and provide a soothing massage while doing so.
• Make sure that they spend their energies during the daytime so that they will sleep well at night.
• Caregivers and family must work around the lockdown and be creative. Activities should be drawn from what the patient likes to do such as his/her previous hobbies.
• Play cognitively stimulating games such as board games and card games.
• Play music of their preferred era or genre. You can also encourage them to sing along or dance along to the music to encourage physical activity.
• Encourage him/her to pray and read spiritual materials often to serve as an inspiration.

5. “I heard from the news that most of the hospitals cater only to COVID-19 cases. In case of emergency since my mom who has dementia has other diseases, where can we bring her?”

Whilst it is true that most hospitals cater and prioritize COVID-19 cases in designated areas in a particular hospital, cases of emergencies related to other diseases are still cared for. Only elective and out-patient services are temporarily suspended during the quarantine period.

6. “Most people say that COVID-19 affects the sick elderly seriously. As a caregiver, what should I strictly follow to prevent them from being infected?”

•  Stay aware of the latest information only from trusted websites such as the Department of Health (DOH) or World Health Organization (WHO).
• Ask them to just stay at home and advise them to avoid going out.
• If they insist on going out, gently remind them that:
  • Majority of the establishments are closed except for essential establishments like groceries, drugstores and banks.
  • Show them the Barangay Quarantine Pass and whose name is indicated on it.
  • Offer to do errands for them. Indicate on the calendar when the next supply run is scheduled for your household.
• Sanitize hands regularly and thoroughly with an alcohol-based hand rub or wash them with soap and water for at least 20 seconds.
• Wet the floor mat with disinfectant and ask those entering the house to swipe their shoes or footwear and leave it outside.
• Limit physical contact as much as possible. Do not let even kids or their grandchildren get physically too close to them especially if they have exposure outside.
  • Teach, demonstrate AND have them return-demonstrate alternatives to the usual mano, beso, hug, or kiss.
  • Teach and model air “high-fives” or apir, air mano, and flying kisses.
  • Children and grandchildren can be taught to “pretend” hug pillows. Explain to them that for now, that is the best way to show their love to their grandparents.
• Practice appropriate social distancing.
• Advise them (and demonstrate) how to avoid touching their eyes, face, nose and mouth.
• Practice respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Explain and demonstrate these. Have them return-demonstrate it to you.
• If the caregiver or other family members have a fever, cough, other flu-like symptoms, or diarrhea, isolate them and seek medical advice early.

7. “Are there simplified means of explaining the situation that we are in now to dementia patients so they can understand?”

We have summarized ways to effectively communicate with our dementia patients during this time. Please see the table below about the Do’s and Don’ts in communicating with our elderly loved ones:

DO’s

• Speak calmly all the time.
• Use a lower-pitched voice. Slow your speaking rate a bit.
• Simplify your instructions and requests.
• If possible, tell / ask the person only what you want them to do.
• If you must explain why, shorten your explanation (“Kasi po delikado,” “Mahahawa kayo.”).
• Rephrase and reframe your instructions to what is allowed (ex: if the person asks if puwede bang lumabas, shake your head then say “Pwede tayo sa loob ng bahay”.
• Use signs, posters, even pictures on posters as visual reminders.
• Point to these posters instead of repeatedly telling person what to do (ex: if the person washes hands too quickly, say “look” then point at the sign).

Examples:

• • “Wash hands 20 seconds” over sinks
  • “Stay Home” poster on main doors
  • “Wear Mask” “Sneeze in Elbow” on strategic places in the house

• Post the date of next grocery run beside a big calendar
• Demonstrate what needs to be done (ex: wash hands while singing a 20-second long song; putting a mask on, leaving outside shoes outside)

DON’Ts

• Do not speak too fast.
• Do not speak in an agitated, panicked tone.
• Do not use long, complicated sentences.
• Do not use if-then (kung, e di) instructions as these can be confusing.
• Avoid telling them what not to do.
• Do not explain too much as it may confuse them more.
• Never say the word “NO” to the patient.
• Avoid using confrontational, emotional words such as bawal, hindi pwede, ikaw kasi, sinabi na…, and the like.
• Do not rely on pure verbal reminders when telling the person what to do.
• Do not say tandaan mo then point to the poster / visual reminders.
• Do not expect the person to remember what needs to be done all the time.
• Do not quiz the person “Ano uli ang gagawin natin?”

8. “Will it be ok to let my mom/dad hear the news about COVID -19 especially the deaths?”

As much as possible limit their exposure to negative news and try to explain the situation calmly and in simpler terms for them to understand. Divert their attention to more positive and productive activities, engage them more in their leisure and hobbies.

9. “Will some symptoms of my mom worsen like anxiety, sadness, difficulty sleeping because of this COVID-19 pandemic?”

Sometimes dementia can be protective in stressful situations because they cannot process the gravity of the problem that will make them more anxious, restless and sad. Also, during this time of quarantine that everyone is advised to stay at home, family members are at home making them feel more secured and protected. It gives them more family support, more attention and more bonding time with the people who they care for and love. For older adults, it lessens the feeling of isolation and emptiness that makes them feel more loved and happier. However, we cannot negate the fact that worsening of some symptoms may happen because of some change in their activities and routine. Thus, it is strongly recommended that those routines that can still be performed be done and give them new activities to engage with, especially those that will entail better family bonding.

10. “I have read a lot of information on the internet. Is it true that taking lots of Vitamin C, giving multivitamins, drinking lemon and bicarbonate water are some of the things they say would benefit the elders during this pandemic?”

The internet is flooded with a lot of information. Stay informed and follow the advice given only by your doctor or healthcare provider, your national and local public health authority on how you can protect yourselves and your loved ones from COVID-19. Always check the source you are getting information from. To keep everyone in the household healthy, it is still best to exercise, practice appropriate social distancing, wash hands regularly and follow a balanced diet at this time.