Living with a person with dementia during COVID19: Creating cognitive ramps, daily routines and meaningful activities
By Dr. Eva S. van der Ploeg [1] and Dr. Cameron J. Camp [2]
[1] Soulful Brain, Mindfulness and Montessori for Dementia, Indonesia. e-mail: esvdploeg@gmail.com
[2] Center for Applied Research in Dementia, Director of Research and Development, Solon, OH, U.S.A.
The COVID-19 outbreak is impacting everyone, not only physically when becoming ill and socially because of the new distancing regulations, but the WHO also has concerns about people’s mental health. A large proportion of people with dementia lives at home, even more so in LMIC’s, where frequently care homes are rare and restricted to urban areas. Family carers such as partners or adult children take care of older people, more often than not without support from professional services. Being forced to stay at home, wearing masks and social distancing may lead to increased confusion in people with dementia. In memory care, an additional challenge is that residents may no longer be allowed to be visited by their families. The main challenge for everyone who cares for people with dementia face is to explain over and over again why these new rules are in place and what they imply. From our work with people with dementia and those caring for them, we have two suggestions how to respond to the repeated queries and possibly emotional responses that follow from the situation. These are, creating: 1) an extended memory source that the person can use to remind them of the current situation, and; 2) daily routines and meaningful activity.
Creating an extended memory is what we call a cognitive ramp in the Original Montessori for Dementia method (dr. Camp). Instead of repeatedly trying to provide the information in the hope that it will be processed, stored and remembered, use an external ‘brain’ to make the information accessible. This could be an alternative version of a Memory Book, a so-called Event Book. It is essential to create this book together with the person with dementia. Firstly, this requires a conversation, where you try to find out what the person thinks is going on; are there associations with war times; are they upset that someone seems to keep them indoors and isolated against their will? The second step would be to explain the situation. Examples of external aids for this have been created by the French organization AG&D. English translations of these are found at the website of the second author. After ensuring the situation is understood, the pair creates their own storybook in words or images that the person with dementia choses. If the person with dementia can write it themselves this is preferred. If not, they should be invited to sign their name on the bottom of each page. If the older person is illiterate, the book should consists of images or drawings, that are again chosen in close collaboration with the person themselves. If they are able to draw themselves they should be part of the creation of the book. As an alternative, they may ‘sign’ the pages with a figure that has meaning to them and which they will recognise as their own later. They may not remember making this book, but seeing their own handwriting or signature gives reassurance that they had part in this documentation. The book should be placed in the same, easy accessible place. If everyone consistently refers the person to the book when questions arise, it may automatically become the place to go to after some practice. The book also may be used as a diary to document daily activities, news, and developments.
Complementary to having an Event Book, is to create a routine and activities that will be the focus of attention for the person with dementia in this new situation. When truly engaged in meaningful activity, it is not possible to also be engaged in behaviours such as repeated questions or emotional responses. For example, it would be helpful for the carer if the person with dementia assists with duties around the house. Again, the person with dementia’s input is essential to ensure what they like to be involved with. Some examples are assisting with cooking, baking, setting the table, cleaning, drying dishes. It is essential to break tasks down in smaller steps, to demonstrate the task and practice together – there are principles of Original Montessori for Dementia (Joltin et al., 2012). If stories are printed in large font, the person with dementia might read to others during domestic activities. In a dementia care residence in Oregon, U.S.A., residents began planting individual plants. Every resident chooses what they want to plant. They plant tomato plants, herbs and lettuce in large pails (socially distanced). On a regular basis, staff will put the pails on carts and visit residents in their room so they can monitor the growth of their plants.
Like for everyone, it is important to stay in contact with other people. As keeping physical distance may be difficult, this may involve the use of video conferencing. If keeping a conversation going is difficult, these are options for other things to do: make music or sing together, providing written lyrics when needed; asking the person with dementia to read stories to young children; practice religious rituals, and; play online games together. Offline, the person with dementia can stay connected to the community by calling other older adults who are isolated to check up on them; writing postcards, or; making gifts or cloth masks to send out. We know of a memory care centre where residents are given components of masks and sew them together, then put them outside their rooms for collection. The masks are sanitized and distributed to health care workers. Finally, staying active is important. Again digital means can be supportive, for example to use recorded sessions of (chair) exercise, yoga and meditation (please see supplementary powerpoint with a number of mindfulness practices made especially for people with dementia and family carers). Remember, everybody can help: a head of the kitchen of a facility that we work with took the time to explain the facetime app to a resident so that he could connect with his family through his phone.
Disclosure statements
Dr. Camp is the developer of Original Montessori for Dementia.
REFERENCES
Joltin, A., Camp, C. J., Noble, B. H., & Antenucci, V. M. (2012). A different visit:
Activities for caregivers and their loved ones with memory impairment (2nd Edition). Solon, OH: Center for Applied Research in Dementia.
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