Depression in Dementia with Lewy Body

Residents Living with Dementia, Our Staff and the COVID-19 Pandemic

Lisa O'NeillHealth

Residents living with Dementia.

These residents may require more supervision than the traditional assisted living resident. They may need to be reminded frequently to wash their hands with soap and water (this should be supervised), to stay in the common area and/or their own room/apartment (wandering can be an issue as the resident doesn’t understand why they cant move about freely like every other day), they may be more curious which can result in objects being placed on their faces and in their mouths (try to discourage these behaviors as much as possible; or replace items with edible treats that have different textures etc.). Bottom line, social distancing can be challenging because residents living with dementia do not always honor personal space; let alone six feet of space.

During this pandemic, it is vitally important that residents adhere to their normal schedule; waking at the same time every day, participating in mealtimes, activities etc. This may be challenging for staff; especially in centers experiencing staff illness. Staffing challenges are tough to handle in any setting but for residents living with dementia, not having the same, familiar face or tone of voice can make or break a day. If the resident is not familiar with the staff member, they may become agitated, angry, frustrated or they pull inward and stop communicating etc.  Efforts to maintain continuity of care throughout the pandemic will also be an important aspect to daily living. 

Visitors during the pandemic.

Unfortunately, to protect the health and well-being of our residents and staff, centers have gone into self-isolation, allowing only essential health providers and families of residents at end of life/Hospice to have visitation privileges. For care staff, the standard today is to take staff temperatures, have them wash their hands thoroughly, answer screening questions etc. and visitors from Hospice, home health agencies and any family members permitted to enter should follow the same practice. It is also likely that residents and/or staff may show signs of illness. Ensure that you have a process in place that meets the CDC guidelines if someone does show signs of illness. Remember, family contact is vitally important for the overall well-being of all residents, consider arranging video chat times or a “window visits”, sometimes just the sight of a loved one or their voice can provide reassurance for the resident.  And of course, keep families updated throughout the pandemic as to changes in policy, procedure etc. and remember, even subtle changes to routine can be disruptive to those living with Dementia so you may want to try and arrange more frequent communications with the family during this time.

Just because we are in self-isolation mode and not allowing visitors, does not mean that we should be sitting around in our pajamas all day! Ensure residents are up and dressed just like any other day because remember, routine is important to them so try to keep things as calm and “normal” as you can. When there is a change in routine, you may see an increase in behaviors and/or a decrease in resident’s appetites. People living with Dementia do exhibit loss of appetite and thirst as they progress through the disease process; keeping that in mind during mealtimes documenting refusals, providing alternatives, etc., is necessary as there could be underlying infection, possible signs of decline or increased depression. Knowing the resident’s baseline will be key in identifying these changes.

That busy bee resident.

We are all too aware that we have residents who are always moving around, so to keep them engaged, consider placing painter’s tape on the floor and signs around at eye level for the resident to follow. They can either walk along the tape line on the floor or look at signs on the wall that will direct them around the common areas which may discourage “aimless” wandering. Consider placing activity centers around the center for residents to stop and engage in throughout the day; different magazines with bright pictures, sorting centers, texture centers etc. (Don’t forget infection control, have a policy for frequency of cleaning these areas and the responsible discipline). If your center has an enclosed courtyard, consider taking the residents outdoors (even for a few minutes each day), the fresh air is good for them and promotes movement/physical activity which will drum up appetites and promote healthy sleep patterns at night!

Continue working with your team and residents. Don’t dismiss the behavior but rather try to determine the root cause of new or escalating behaviors. Peel back the onion, have they been eating well, drinking, exercising, participating in their normal activities? Could they be fearful, experiencing hallucinations and not being able to communicate their fear, they may be lonely or if PPE is being used, it could be intimidating for the residents.

In summary

Try as much as possible to keep the environment “normal”:

  • Normal activities; engage residents in meaningful activities
  • Communication with family members via video chat, phone calls or window visits
  • Ensure medications continue to be administered per the physician order
  • Monitor nutrition/hydration
  • Provide calm, soothing music

If behaviors continue to escalate

  • Stand back to avoid injury to self or others
  • Ensure that the area is clear of any other residents
  • Get to their eye level, introduce yourself, talk to them slowly and calmly.
  • Try to validate their feelings and let them know that you understand.
  • Never physically force a resident to do something
  • Document behaviors being observed
  • If the resident is posing a risk to self or others, ensure that management is notified immediately and decide if the resident needs to be transported out for further medical evaluation (as a last resort). Most residents will have a PRN order for anxiety and/or depression but talking them into taking a medication when they are exhibiting these behaviors may be difficult.

We’ve created some helpful infographics in English and Spanish for ideas on managing the different personality types.

You can do this, we can all help, remember, it takes a village! Stay well!