Creating Meaningful Moments in the Midst of Social Isolation

ALZHEIMER'S CARE ARMENIA·TUESDAY, APRIL 7, 2020·

This is the final segment in a three-part series by Dr. Jane Mahakian and Alyson Kuhn about taking care of someone with dementia in a home setting. The COVID-19 crisis has particularly impacted the daily routines of many people with dementia, especially those who have been removed from their care communities by their families for the duration and those whose daycare programs have been suspended. The necessary social isolation comes as a double whammy. Engaging a person living with dementia (PLWD) at this time can be especially challenging. Here are some ways to connect with the person to enrich their daily routine.

Suggestion 1: Decide what, if anything, you are going to discuss with the PLWD about the COVID-19 crisis. You want to be reassuring but avoid overwhelming someone who has difficulty processing new information by giving them too much detail. People whose sense of time is impaired are very susceptible to “playing” the same story over and over in their minds, which is distressing for them.

For example, if the PLWD asks you how much longer she has to stay in the house, or how long it will be until she can go to her adult daycare program … your telling her “another month” is counter-productive. It sounds like a really long time (and it is). A better approach might be, if you are comfortable with it, downplaying the duration. You could say “about one more week,” and then, in a week, you can say, “just one more week,” as the PLWD may not remember when you’d previously told her this. There are instances when reducing the PLWD’s anxiety may outweigh your discomfort with “stretching” the truth.

If the PLWD is aware that something serious is happening in the world, you can minimize her fear and confusion by downplaying the coronavirus as a “bug” rather than saying “global pandemic.”

Suggestion 2: Establish a predictable, structured daily schedule to promote a sense of safety and contentment. The PLWD’s previous routine has been disrupted, and her usual sources of pleasure may not be available during the crisis. Putting the schedule at the PLWD’s place, whether at the table where you eat, or next to her favorite armchair, makes the schedule seem more personal. She can hold it and carry it around the house with her.

Writing up a daily schedule, even if the PLWD can’t read it for herself, either because of her eyesight or because of cognitive impairment, gives the day’s activities a heightened importance. Ask the PLWD’s input on things she’d like to do. If she doesn’t seem to have any ideas, you can prompt her: Shall we put our walk on the schedule? O, weren’t we going to watch “Jeopardy” while we have dinner?

Having a schedule can also provide a sense of anticipation, starting with getting up in the morning. You can review the schedule and the newspaper together over tea or coffee. Even if you have to repeat what’s on the schedule, the PLWD will feel engaged each time to know what the day has in store.

Suggestion 3: Help the PLWD to feel useful. It’s human nature to enjoy feeling useful and doing kindnesses for others. Asking the PLWD to do you a favor is so easy and so gratifying: Can you turn on the light for me while you’re over there? Would you mind bringing me my sweater? Giving the PLWD the opportunity to help you is a little gift. A PLWD may also find repetitive domestic tasks very satisfying. Drying dishes and folding laundry are great examples. (The possibility that you could do a task more quickly, or better, is really beside the point.)

You can also invent projects and routines to help the PLWD feel useful. Doing laundry, which most of us would love to avoid, appeals to many people with dementia: the results are so satisfying, the aroma so fresh, and the clothes feel so cozy and comforting. Laundry provides a sensory treat as well as a feeling of accomplishment.

You can propose organizing something, and tailor the PLWD’s part to suit her abilities: a sock drawer that needs sorting, a stack of mail that needs opening, and a boxful of family photos that need “filing.” Browsing through the photos may turn into a trip down memory lane. That in itself is a prize ...and if you hear some interesting reminiscences, ask if you can write them down to accompany the photos in an album. It doesn’t matter when, or even if, you get to this. The exercise is its own reward.

Suggestion 4: Gather an “activity box” full of items you can pull out to present as potential projects to do together. Puzzles are great, particularly the time-consuming but easy first step of breaking all the pieces apart and spreading them out. “Matching” card games such as “Concentration” are very popular and engaging—and provide some brain stimulation. Coloring books or paint-by-number sets are great for someone who doesn’t feel up to undertaking a free-form project. Stringing beads or working with clay are tactile and can culminate in having an actual object to admire or share. The feeling of making something is gratifying.

If you propose an activity, and the PLWD says No, wait 5 minutes and re-propose the activity or a different possibility. You can also simply set up a little task or project and begin working on it yourself. If the PLWD looks curious, invite her to join you. Stimulating activities reduce the tendency to withdraw inward.

Suggestion 5: Use the power of energy to brighten the mood, calm anxiety, and lessen depression. Simply opening the blinds is a good way to “greet the day.” You can see the sky and discuss the weather. If it’s a dreary day, do something to make wherever you are seem cozy but alive—not sleepy or cave-like. Certain lighting can really give the feeling of daylight, and that is always energizing. (Daily walks in the fresh air are good for everyone.)

Music is also a wonderful way to shift the mood. Playing tunes from the PLWD’s earlier years can bring an immediate feeling of well-being and possibly a reminiscence … and even singing along or moving in time to the music. Ambient music is designed to be pleasant and calming, so even though it doesn’t carry specific associations, it’s worth giving a try. Spiritual music can also tap into someone’s emotional self.

Engaging the PLWD’s other senses can be very fulfilling for her. Cooking and baking are tactile and aromatic, and mentally stimulating. Plus, there is the prospect of a treat when you are done.

A special presentation for whatever you’ve baked together makes it even more special (and photogenic): a memorable moment in the making.

Dr. Jane Mahakian is the founder of Alzheimer’s Care Armenia. For more information about the organization and its work, please visit alzheimerscarearmenia.org.

Simply click to find our first post, Keeping Your “Dementia Cool” in the Heat of COVID-19, or our second post, A Daughter Orchestrates the Dance of Dementia With Her Mother. And you can read co-author Alyson Kuhn’s thoughts about creating this three-part series in her post Writing About Dementia in the Time of COVID-19.

Illustrations ? pastesf.com 2020