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When Dementia Meets the Coronavirus Crisis When Dementia Meets the Coronavirus Crisis
(3 days later)
As the coronavirus advances, it is taking a particularly harsh toll on the many who are caring for a loved one with dementia or Alzheimer’s, the most common form of dementia. According to a report by the Alzheimer’s Association, more than 16 million Americans are providing unpaid care for those with Alzheimer’s or other types of dementia. For them the virus is “really a double whammy,” said Lynn Friss Feinberg, a senior strategic policy adviser at AARP’s Public Policy Institute. “You’re worrying about your own health and that of your family member.”As the coronavirus advances, it is taking a particularly harsh toll on the many who are caring for a loved one with dementia or Alzheimer’s, the most common form of dementia. According to a report by the Alzheimer’s Association, more than 16 million Americans are providing unpaid care for those with Alzheimer’s or other types of dementia. For them the virus is “really a double whammy,” said Lynn Friss Feinberg, a senior strategic policy adviser at AARP’s Public Policy Institute. “You’re worrying about your own health and that of your family member.”
While the disease itself does not necessarily place patients at high risk for contracting the virus, they and their caregivers face a range of special challenges. Dementia patients are typically very sensitive to changes in routine and often require a great deal of hands-on care, both factors that are hard to manage now. Family members who usually rely on day care programs or visiting caregivers may be finding themselves with full-time responsibilities, while others whose loved ones are in facilities are unable to visit them now.While the disease itself does not necessarily place patients at high risk for contracting the virus, they and their caregivers face a range of special challenges. Dementia patients are typically very sensitive to changes in routine and often require a great deal of hands-on care, both factors that are hard to manage now. Family members who usually rely on day care programs or visiting caregivers may be finding themselves with full-time responsibilities, while others whose loved ones are in facilities are unable to visit them now.
Among the greatest challenges is how to minimize disruption in care that is intensely personal. “Care for dementia patients is ‘high touch,’” said Peter Lichtenberg, a professor of psychology and director of the Institute of Gerontology at Wayne State University. He recommends that caregivers take measures to avoid their own exposures by having provisions delivered, disinfecting surfaces and employing proper hand-washing techniques.Among the greatest challenges is how to minimize disruption in care that is intensely personal. “Care for dementia patients is ‘high touch,’” said Peter Lichtenberg, a professor of psychology and director of the Institute of Gerontology at Wayne State University. He recommends that caregivers take measures to avoid their own exposures by having provisions delivered, disinfecting surfaces and employing proper hand-washing techniques.
K.C. Mehta has been caring for his wife, Sumi, since 2013, when she was given a diagnosis of Alzheimer’s at the age of 59. A former engineering executive at Chrysler, Mr. Mehta, who is 72 and lives in Rochester Hills, Mich., spends each day focused on maintaining his wife’s routine. Twice during the night, he changes her diaper. When she awakes, he bathes and dresses her.K.C. Mehta has been caring for his wife, Sumi, since 2013, when she was given a diagnosis of Alzheimer’s at the age of 59. A former engineering executive at Chrysler, Mr. Mehta, who is 72 and lives in Rochester Hills, Mich., spends each day focused on maintaining his wife’s routine. Twice during the night, he changes her diaper. When she awakes, he bathes and dresses her.
He prepares her meals that include fresh vegetables, hummus and Babybel cheese as well as homemade fruit smoothies.He prepares her meals that include fresh vegetables, hummus and Babybel cheese as well as homemade fruit smoothies.
Intent on reducing his wife’s risk of getting infected, he has temporarily let her evening caregiver go. He’s conflicted about reducing risk in a situation where touch is essential. His wife can’t fall asleep unless he is beside her. “She needs that comfort,” he said. “I cannot keep a safe distance from her. When she gets agitated, I pull her head upward to give her a kiss on the forehead or cheeks. This calms her down. For her, it is a kiss of love. For me, it could be a kiss of corona.”Intent on reducing his wife’s risk of getting infected, he has temporarily let her evening caregiver go. He’s conflicted about reducing risk in a situation where touch is essential. His wife can’t fall asleep unless he is beside her. “She needs that comfort,” he said. “I cannot keep a safe distance from her. When she gets agitated, I pull her head upward to give her a kiss on the forehead or cheeks. This calms her down. For her, it is a kiss of love. For me, it could be a kiss of corona.”
Dr. Ken Langa, a professor of medicine and co-director of the Institute of Gerontology at the University of Michigan, said that while dementia patients, whose social network tends to be small, may be at lower risk than the overall population of contracting the virus, they can be in greater danger of complications if they get it. Most dementia patients are in the high-risk older population; the Alzheimer’s Association report found that one out of 10 people over 65 suffer from Alzheimer’s. And many have chronic conditions that could make them more vulnerable to complications from the infection, Dr. Langa said.Dr. Ken Langa, a professor of medicine and co-director of the Institute of Gerontology at the University of Michigan, said that while dementia patients, whose social network tends to be small, may be at lower risk than the overall population of contracting the virus, they can be in greater danger of complications if they get it. Most dementia patients are in the high-risk older population; the Alzheimer’s Association report found that one out of 10 people over 65 suffer from Alzheimer’s. And many have chronic conditions that could make them more vulnerable to complications from the infection, Dr. Langa said.
Beth Kallmyer, vice president of care and support for the Alzheimer’s Association, said that if they do get sick, people with dementia often can’t articulate their symptoms; agitation or a change in behavior can be a warning sign. If caregivers are the least bit concerned, they should call their health care provider immediately, she said.Beth Kallmyer, vice president of care and support for the Alzheimer’s Association, said that if they do get sick, people with dementia often can’t articulate their symptoms; agitation or a change in behavior can be a warning sign. If caregivers are the least bit concerned, they should call their health care provider immediately, she said.
Ms. Feinberg said that because routine is so crucial for dementia patients, caregivers should provide security and comfort as much as possible. “It’s a time to help the person with dementia have the most normalcy in this most unnormal time,” she said. This could include trying not to watch the television news, playing soothing music and participating in small tasks together, like folding dish towels or winding a ball of yarn. Going for regular walks to get fresh air, even if it’s just in the back yard, can be helpful as well, she said. Staying in the present with something you have control over, Ms. Kallmyer said, “is the best way to get through the day with those you’re with.”Ms. Feinberg said that because routine is so crucial for dementia patients, caregivers should provide security and comfort as much as possible. “It’s a time to help the person with dementia have the most normalcy in this most unnormal time,” she said. This could include trying not to watch the television news, playing soothing music and participating in small tasks together, like folding dish towels or winding a ball of yarn. Going for regular walks to get fresh air, even if it’s just in the back yard, can be helpful as well, she said. Staying in the present with something you have control over, Ms. Kallmyer said, “is the best way to get through the day with those you’re with.”
Sherri Snelling, a corporate gerontologist and chief executive of the Caregiving Club, which provides consulting services to employers on caregiver wellness, especially Alzheimer’s caregivers, said it’s important to acknowledge the changes to routine with your loved one and address them. For example, if a caregiver is sick, you could say, “Susie is sick, so Jane is coming to help us out. You’ll really like her.” Or if bingo and arts-and-crafts outings have been canceled, you could say, “Everybody is off, so we’ll do those activities at home today.”Sherri Snelling, a corporate gerontologist and chief executive of the Caregiving Club, which provides consulting services to employers on caregiver wellness, especially Alzheimer’s caregivers, said it’s important to acknowledge the changes to routine with your loved one and address them. For example, if a caregiver is sick, you could say, “Susie is sick, so Jane is coming to help us out. You’ll really like her.” Or if bingo and arts-and-crafts outings have been canceled, you could say, “Everybody is off, so we’ll do those activities at home today.”
Those who do not live with their loved ones may feel anxious that they are not able to visit them at long-term care facilities now. Ms. Kallmyer suggested using phone calls or video chats, and she urges families to keep in mind that staying away is best for the health of those residents. “It’s hard, but you need to keep them safe,” she said.Those who do not live with their loved ones may feel anxious that they are not able to visit them at long-term care facilities now. Ms. Kallmyer suggested using phone calls or video chats, and she urges families to keep in mind that staying away is best for the health of those residents. “It’s hard, but you need to keep them safe,” she said.
Dr. Langa said the priority for caregivers should be to keep themselves healthy and act like emergency medical workers, “because if they get sick, two people are going to be in trouble.” He urges caregivers to get out, take walks by themselves and set up a pool of people who might be able to come in and give them breaks, perhaps while the patient is taking a nap. He acknowledges that this can introduce a risk of exposure, but says the downsides can be significant. Going it alone means “you’re putting yourself at risk of burning out and in danger of getting exhausted,” he said.Dr. Langa said the priority for caregivers should be to keep themselves healthy and act like emergency medical workers, “because if they get sick, two people are going to be in trouble.” He urges caregivers to get out, take walks by themselves and set up a pool of people who might be able to come in and give them breaks, perhaps while the patient is taking a nap. He acknowledges that this can introduce a risk of exposure, but says the downsides can be significant. Going it alone means “you’re putting yourself at risk of burning out and in danger of getting exhausted,” he said.
Mr. Mehta has kept his morning caregiver and asks her to take her temperature and change clothes when she arrives. Ms. Snelling says getting support from others through virtual support groups can be extremely beneficial. “In this crisis, there’s a fear of the unknown. If we can share those fears with other caregivers and get their insights, that is really key.” She says caregivers can also take time to practice mindfulness as a way to stay calm for their loved ones in a high anxiety environment.Mr. Mehta has kept his morning caregiver and asks her to take her temperature and change clothes when she arrives. Ms. Snelling says getting support from others through virtual support groups can be extremely beneficial. “In this crisis, there’s a fear of the unknown. If we can share those fears with other caregivers and get their insights, that is really key.” She says caregivers can also take time to practice mindfulness as a way to stay calm for their loved ones in a high anxiety environment.
Updated June 5, 2020 Updated June 12, 2020
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Mr. Mehta said his greatest fear is that he and his wife could be infected simultaneously and that he would not be in the position to take care of her. Though he has a power of attorney and guardianship for his wife, he fears those documents could get lost if he is not with her, should she be taken to the hospital. He worries that if she becomes agitated, his wife, who is unable to communicate and takes no medication, could be medicated with anti-psychotic drugs.Mr. Mehta said his greatest fear is that he and his wife could be infected simultaneously and that he would not be in the position to take care of her. Though he has a power of attorney and guardianship for his wife, he fears those documents could get lost if he is not with her, should she be taken to the hospital. He worries that if she becomes agitated, his wife, who is unable to communicate and takes no medication, could be medicated with anti-psychotic drugs.
To safeguard against this situation, Dr. Langa recommends developing a contingency plan outlining the logistics and points of contact if the patient or caregiver gets sick. Ms. Kallmyer said advance directives are essential. “Wherever the patient goes, those should go with them,” she said.To safeguard against this situation, Dr. Langa recommends developing a contingency plan outlining the logistics and points of contact if the patient or caregiver gets sick. Ms. Kallmyer said advance directives are essential. “Wherever the patient goes, those should go with them,” she said.
Mr. Mehta acknowledged that he has no choice but to take each day as it comes. He says he has managed to overcome many challenges in the seven years he has cared for his wife. “What I thought was a cliff was just another plateau — a new normal,” he said. “But now, I am uncertain of what this new normal will turn out to be. I am like the single pole of a tent taking care of my wife. It is scary to think what would happen if this pole crumbles.”Mr. Mehta acknowledged that he has no choice but to take each day as it comes. He says he has managed to overcome many challenges in the seven years he has cared for his wife. “What I thought was a cliff was just another plateau — a new normal,” he said. “But now, I am uncertain of what this new normal will turn out to be. I am like the single pole of a tent taking care of my wife. It is scary to think what would happen if this pole crumbles.”