Cognitive Decline in the Time of Corona

by | Sep 8, 2020 | Aging Posts

Aging Jewishly – What Our Traditions Tell Us about Growing Old

Effie found a private spot for herself. It was in a corner near the television where she sensed she wouldn’t be seen. That way she could pick at the scabs on her arms, rock back and forth and hum a song that she thought she once remembered. When a staff member found her, it was obvious that Effie had been crying.

“Miss Effie, what’s the trouble?”  Effie looked up at her long time caregiver but it was a face she didn’t quite recognize. “Why did you put me in the corner? Was I a bad girl? Is that why nobody comes anymore? I promise I’ll be good.”

As her caregiver gently urged Effie from her self-imposed exile, it became clear what had happened. As often occurs with persons with cognitive impairments such as dementia, Effie reverted to behavior brought on by childhood memories.

The isolation imposed by the Covid-19 virus seemed to have been the trigger.  Possibly decades ago Effie may have been naughty and had been made to stand in a corner. Now that the coronavirus required isolation from family and friends, Effie’s dementia made her think that she was being punished once again.

The coronavirus pandemic challenges all of us – parents, children, employers, teachers – everyone, but no one group seems more vulnerable psychologically than our elderly, especially those with debilitating cognitive issues.

Thanks to the work of Dr. Marla Bruns, cognitive neurologist and co-director of the Rochester (NY)  Regional Health’s Memory Center, family members and care givers can learn more about the effect of the coronavirus pandemic on those with Alzheimer’s and dementia and how to relate to those whose cognitive deficiencies present unique challenges.

In a recent article, “Effects of Coronavirus on Alzheimer’s Patients & Caregivers (June 2020),” Dr. Bruns  states that Isolation during the pandemic is a heavy burden to be faced with, and many of our patients in memory care facilities have endured an extended time alone without fully understanding why.”

Caring for a family member, in particular a parent or a spouse whose level of confusion due to degenerative cognitive conditions is already a daily challenge, adding social restrictions to the mix can create new problems for everyone involved.  That’s why Dr. Bruns offers coping strategies for care givers and family members as together they navigate these unchartered waters.

Dr. Bruns reminds us that disruption in routines accelerates the level of stress that many dementia patients experience. She writes,  “Due to memory loss, forgetting why they can’t go places causes more pent-up stress and can lead to pacing, picking at skin…sadness and loneliness if unable to be with family.” She reports that patients who are usually calm can fly into angry tirades when routines are broken and express great frustration about mask wearing and social distancing without understanding why.

How to cope? Dr. Bruns offers suggestions which include establishing a new routine. She writes, “If patients are used to going out to lunch, have a picnic lunch out in the yard. If they are accustomed to going out shopping, take them for a walk around the block. If they are in a facility and anticipate your visit, arrange for visits outside a window, or through video chats.”

Experts also point out that because cognitive decline is often accompanied by diminished understanding of spoken words and phrases,  responding on an emotional level is the best course of action. A warm smile along with body language that conveys confidence and security is often more effective than lengthy explanations. It’s not what we say, but how we say it, that will reduce anxiety in these tumultuous times. Dr. Bruns cautions, “While the person suffering from dementia might not always have the context of what’s going on, they are going to react to the stress levels of the caregiver.”

Dr. Bruns encourages family members of those with Alzheimer’s and dementia to take advantage of the myriad services now offered online and emphasizes that virtual support groups make it easier than ever to access help and share concerns.

For Effie, her grandson’s virtual visits, three days a week on the same day and at the same time, created a new routine for her to look forward to. Caregivers in Effie’s residential facility supported the effort by creating a large blocked weekly calendar with stars and stickers on her grandson’s visiting days – all in an effort to build Effie a new routine.

After all, it is in Proverbs (16:31) that we read that “A gray head is a crown of glory.” Sadly cognitive decline may have disheveled the “crown,” but for each of our precious elders, especially those confused and frustrated by coronavirus restrictions and requirements, we are reminded that for even those most debilitated, reaching out with respect, concern and patience is the righteous thing to do.

For ten years Rabbi Barbara Aiello served the Aviva Campus for Senior Life as resident rabbi. Her most popular columns are now published in her new book, “Aging Jewishly,” available on Amazon books. Rabbi Barbara now lives and works in Italy where she is rabbi of Italy’s first Reconstructionist synagogue. Contact her at Rabbi@RabbiBarbara.com