A. COVID-19 and the Older Person

While COVID-19 infection affects people of all age groups, the elderly population is more vulnerable to this disease as they have a weaker immune system and may have multiple chronic health issues which further impair their ability to fight off the infection. As of 19 March 2020, around 25% of those confirmed with COVID-19 in Singapore are above the age of 60. 9 out of 10 deaths due to COVID-19 infection as of 14 April 2020 are older persons aged 65 years and above.

This COVID-19 pandemic has drastically changed the way we live. Numerous safe distancing measures have been implemented by the Singapore Government to curb the transmission of the virus and to protect our vulnerable groups, including our seniors, from contracting the disease. These measures include the nationwide closure of mosques with cessation of congregational Friday prayers, closure of senior activity centres, resident committees, Health Promotion Board and ActiveSG sport centres, as well as disallowing social gatherings between members of different households.

While these measures are important to halt the spread of the disease, the lack of social interaction could adversely impact on the psychological wellbeing and mental health of the elderly, causing loneliness and depression in an increasingly isolated environment.

Older person living with dementia are an especially vulnerable group. Many have limited access to accurate information and facts about the COVID-19 pandemic. Those that do may have difficulties understanding and processing the information provided.

B. What can our seniors and their caregivers do to keep themselves safe during this COVID-19 pandemic?

 Advice to The Older Person

1. Look after your health and ensure good control of your chronic medical conditions

• Seek medical attention when unwell
• Take your medications regularly and do not miss your doctor’s appointments.
• Monitor your blood pressure and blood sugar levels regularly if you have underlying hypertension or diabetes.
• A healthy body is essential in ensuring a strong immune system to fight against infections

2. Get your influenza and pneumococcal vaccinations

• While influenza and pneumococcal vaccinations may not protect you against COVID-19 infection, it would reduce the risk of contracting severe pneumonia caused by other viruses and bacteria which can resulting in hospitalisations and even death.
• These vaccinations are Medisave-claimable and may be done at outpatient clinics when possible

3. Avoid crowded places

• Avoid going out to crowded places such as markets, where social distancing may be difficult, as being in close proximity with potentially infectious individuals increases your chances of contracting the disease.

4. Ask your doctors regarding Advanced Care Planning (ACP)

• It is never too early to have a frank ACP discussion with your doctors and loved ones. Once a person develops COVID-19 infection and is hospitalized, he/she will be placed in isolation and making shared decisions with your loved ones can then be very challenging.
• It is important to convey your end-of-life care wishes to your doctors and family members early to avoid unnecessary distress later on.

 

  Advice to Caregivers of an Older Person (General)

1. Check in on elderly parents/grandparents

• Pay attention to their health regularly. They may not have the usual symptoms for any illness including COVID-19 due to their frailty and limited reserve. Bring them to see a doctor when unwell. Delays in seeking treatment may be detrimental to them.
• Ensure that they take their medications as prescribed according to schedule
• Monitor their appetite, diet and daily intake
• With social distancing measures and new rulings imposed by the government to discourage social gatherings between households, many older persons will become more isolated as their extended family members are not able to visit them regularly.
• For seniors who are technologically savvy, checking in on them frequently via Facetime or WhatsApp videos may alleviate loneliness inadvertently caused by these measures.
• For those parents/grandparents who are digitally illiterate, a simple phone call can make a big difference.

2. Observe strict hand hygiene and wear a mask when visiting the older person to render assistance, avoid shaking hands and hugging

• Younger patients may not display any symptoms from COVID-19 infection and may be unaware that they are harbouring the virus. Nonetheless, these asymptomatic individuals can spread the virus to vulnerable elderly.
• When visiting elderly parents/grandparents to assist them in their activities of daily living, avoid shaking hands and hugging them. Wear a mask at all times and wash hands or use hand sanitizers regularly.

3. Educate domestic helpers caring for the older person to be disciplined in observing hygiene while caring for the older person

• Many families rely on domestic helpers to assist in caring for their elderly parents/grandparents. They too must be educated to maintain good personal hygiene, frequent handwashing and wearing a mask when providing physical assistance to the elderly.

4. Be aware that the older person may not have common symptoms of the disease even when they are ill

• An older person may not present with typical symptoms such as shortness of breath, fever or cough. Instead many may present with vague symptoms such as confusion, falls, and new onset of urinary incontinence. If your elderly loved ones displays any of the above symptoms, consult a doctor early.

5. Avoid house visiting during the Eid festivities this year

• Meeting up virtually over video conferencing apps such as Zoom and Google Meet can bring you closer to your loved ones during this year’s Eid celebrations while prioritising health/safety and maintaining social distancing.

 

  Advice to Caregivers of an Older Person with Dementia

1. Keep the older person living with Dementia, engaged at home

• Keep older person with dementia on a daily routine
• Avoid unscheduled napping or prolonged sleeping, which may cause sleep issues
• Engage the older person with dementia engaged with activities that can be done at home
  •  '#StayHome Fun with ADA: Weekly Zoom sessions and activities for Persons with Dementia
  • AIC Dementia Toolkit: https://www.aic.sg/sites/silverpagesassets/SilverPages%20Assets/Publications%20(Caregiving)/Dementia%20Toolkit%20Activity%20Book.pdf
  • Silver activities: https://silveractivities.com/
• Continue to keep active at home with exercises to improve strength and balance and to prevent deconditioning (https://www.healthhub.sg/programmes/71/healthy-ageing-exercise)

 

2. Managing behavioural issues in patients with dementia

• Maintain consistency in daily routine; simplify and adopt a sequence
• Give assurance and respond calmly to agitated behaviour
• Distract or redirect with activity or food/drinks
• Avoid restraining or restricting unless he/she is causing harm to others

3. Apply for an Alzheimer’s Disease Association (ADA) memo to identify your elderly loved ones, as suffering from dementia.

• Patients with dementia may lack the ability to understand and comply with safety measures such as safe distancing and wearing a mask.
• The Alzheimer’s Disease Association (ADA) has started an initiative to provide people with dementia and their caregivers with memos to identify them as persons living with dementia
• This letter can be shown to enforcement officers/police if they inadvertently violate circuit breaker measures
• Application for this memo can be made on the association’s website or through community care providers.

4. Plans for gaps in caregiving

• If you care for an older person with dementia, make plans for another caregiver to step in in the event you become ill.
• It is critical for family caregivers to think of contingency plans for caregiving, ahead of a crisis.

5. Practice self-care and look after your own mental health

• Being a caregiver for an older person living with dementia is mentally, emotionally and physically challenging, especially when they display behavioural and psychological symptoms of dementia (BPSD) such as agitation and aggression
• This, compounded with social isolation, brought about by recent circuit breaker measures can take a toll on your mental and emotional well being
• Stay connected with other family members and friends through phone-calls and virtual meet-ups via applications such as Zoom or Google meet
• Helplines are available for you to speak about the issues that are affecting you and get help that you may need

 

 Conclusion

 While many of us go about with our daily lives, being socially responsible and remembering to take necessary precautions to protect ourselves, let us not forget to also care for the vulnerable elderly in our midst. Their health and safety depend on every one of us.