Lisa A. Hou, DDS, MS provides actionable tips to support older patients with dementia during COVID-19 at home, assisted living facilities, and hospitals.

1. DEMENTIA & COVID-19 LISA A. HOU, DDS, MS
GERIDEN BOOT CAMP
2020

2. COVID-19 AND
OLDER ADULTS
◼ Risk for severe illness from
COVID-19 increases with age
◼ Older adults at higher risk
◼ Underlying medical conditions
Source: https://www.cdc.gov/coronavirus/2019-ncov/images/need-extra-precautions/high-risk-80-percent.jpg

5. CONSIDERATIONS FOR PERSON WITH DEMENTIA
◼ Role of the caregiver
◼ Dementia care

6. CASES FROM CHINA
◼ Changes seen in cognition, behavior and function
◼ Impact on dementia patient is location dependent
◼ Impact on family/caregivers is also location dependent

7. PERSONS WITH DEMENTIA
Hospitalized
• Isolated surrounding
• Somatic discomforts
• Delirium
Home
• Irrationality
• Change in home care
arrangement
• Unscheduled home life
• Decline in memory and
comprehension
• Deterioration of
existing cognitive
problems
Assisted Living Facilities
• Reduced face-face-
communication with
family
• Reduce interactions
with caregiver
• Essential medications
interrupted

8. HOSPITAL & ICU SETTING
• Strong feelings of insecurity
• Sleep problems
• Anxiety and agitation
• Hostility and aggression
Isolated surroundings
• Anxiety and agitation
• Irritability
Challenging behaviors due to somatic discomforts of COVID 19
• Acute changes in consciousness
• Impaired attention
• Sleep-wake cycle disturbances
• Abnormal sensory experience
• Emotional disturbances
Delirium

10. AT HOME
• Excessive stress and tension
• Sleep difficulties
• Irritability
Irrational analysis
• Anxiety
• Impact from caregiver anxiety
• Disrupted routine
• Caregiver unable to work or replaced
• Aggression
Change in Home Care Arrangements

11. AT HOME
Unscheduled Home Life
• Feeling bored due to
limited activities
• Sleep disturbance
• Increased anxiety
• Irritability, agitation &
aggression
Decline memory and
Comprehension
• Poor understanding of
infection control
• Unable to cooperate
with care
• Conflict with
caregivers
Deterioration of existing
cognitive problem
• Memory decline
• Disorganized daily life

12. ASSISTED LIVING
FACILITIES
Reduced interactions with
caregivers
Restlessness
Apathy, withdrawal

13. CLINICAL PRESENTATION
Cognition
• Increased confusion
• Slower processing
Decline in Function
Behavior
• Anxiety/agitation/aggression
• Apathy/depression/fatigue/increased sleep
Hypoxia presents with delirium
• Changes in consciousness
• Impair attention
• Sleep/wake cycle disturbances

14. PUBLIC HEALTH REGULATION
Social Distancing Infection Control Stay at Home

15. IMPACT FROM PUBLIC HEALTH REGULATION
Boredom and loneliness 🡪 anxiety,
irritability, agitation
Poor understanding 🡪 uncooperative,
confusion

16. IMPACT FROM PUBLIC HEALTH REGULATION
Unscheduled daily life 🡪 increased naps,
sleep problems, wandering and pacing
Closer family observation 🡪 increased
awareness of limitations and challenges

17. HELP/PREPARATIO
N
◼ If a person with dementia gets sick:
◼ If a person with dementia needs to be quarantined
at home, how will caregiver minimize exposure?
◼ What conversations need to be had with friends,
family and neighbors to support the caregivers?

18. PLANNING
AHEAD
◼ What if the caregiver gets sick?
◼ Who will care for the person with dementia?
◼ Where will the person with dementia be cared for?
◼ Medication management?
◼ Self quarantine for the caregiver?

19. HELPING
FAMILIES PREPARE
Helping caregivers create a routine/schedule to minimize
anxiety and behavioral issues
Regularly scheduled meal time
Activities throughout the day
Limit day time naps
Anticipate any behavioral changes

20. HELPING
FAMILIES
PREPARE
◼ Social distancing challenges
◼ Glove sand masks may frighten the person with dementia
◼ Observe infection control guidelines and frequent repetition
◼ Staying connected with loved ones

21. REFERENCE
◼ CDC.gov
◼ H. Wang. Dementia Care During the COVID-19 outbreak, Chinese J of Psychiatry 2020; 53
◼ A. Bianchetti. Clinical Presentation of COVID 19 in Dementia Patients, J Nutr Health Aging. 2020 May
15: 1-3
◼ Coronavirus (COVID-19): Tip for Dementia Caregiver. Alzheimer’s Association.
https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care
◼ H. Wang. Lecture: Dementia Care during the COVID-19 Outbreak in China. International
Psychogeriatric Association. 2020.