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Dementia Care Tips during the COVID-19 Pandemic

With Singapore’s current circuit-breaker measures, including the closure of most eldercare services and facilities, many persons with dementia might find their routines disrupted significantly.

 

Those who have been actively going out within their communities may feel lost or frustrated, especially since they are unable to do what they’ve grown accustomed to doing. Some may also not be able to retain information about COVID-19 and the current measures within the country.

As a caregiver, you may be feeling more stressed or helpless in extraordinary times like these. To help you cope during such unprecedented times, we’ve put together this special page to share some dementia care tips and resources. Remember, you are not alone in your caregiving journey!

  • Ensure that information is presented to your loved one in a clear and simple manner. Visual aids such as videos may be used. Refer to Appendix 1 for suggested videos on COVID-19. You can also visit https://www.gov.sg/article/covid-19-resources and look for the section titled “Posters on COVID-19” for clear and informative posters.
  • Avoid overwhelming your loved one with too much information.
  • If he/she appears confused or distressed watching the news on television or videos about COVID-19, respond to his/her feelings. Try to divert his/her attention away by introducing another activity or switch off the television.
  • Take time to listen to your loved one and his/her concern(s).
  • Validate his/her feelings and provide reassurance.
  • If possible, take the body temperature of your loved one and yourself (and your domestic helper if you have one) twice a day. Keep a temperature logbook with the following columns: Date; Time; Temperature.
  • If your loved one is experiencing fever or respiratory symptoms, seek timely medical attention. You may want to use this online tool https://www.sgcovidcheck.com/ to decide the next course of action based on the symptoms.
  • For hand-washing steps, you may like to refer to this YouTube video titled “Hand hygiene with soap and water” by Singapore General Hospital: https://www.youtube.com/watch?v=4CcGLoYrIPU
  • Ensure that your loved one maintains proper hand hygiene by reminding him/her to wash his/her hands regularly. There may be a need to help him/her to apply moisturiser to prevent his/her skin from becoming too dry.
  • Ensure that your loved one washes his/her hands before mealtimes, after going to the toilet, coughing and blowing of nose.
  • Provide a demonstration of the proper hand-washing steps if necessary. To encourage your loved one to wash his/her hands, you can also join him/her in the hand-washing activity. You can also place signs or pictures in the toilet to remind him/her to wash his/her hands.
  • If he/she is not keen to wash his/her hands with water and soap, an alternative is to use hand sanitiser. Additionally, increase the frequency of environmental disinfection.
  • Check that you have sufficient face masks for yourself and your loved one (and your domestic helper if you have one)
  • Ensure that your loved one showers regularly.
  • If he/she is not keen to shower, here are some tips:
    • You can use a wet towel / body wipes and assist him/her to wipe his/her body. If they are able to care for themselves, give him/her the wet towel / wet wipes and encourage him/her to do it themselves.
    • Encourage him/her to shower/wipe, you can use statements such as “It is a hot day”, or “It is a hot day, I feel so sticky, I am going for a shower now. It will be your turn next ok?”
    • Get him/her to choose his/her favourite set of clothes to wear after the shower.
    • If he/she has a favourite snack or sweet treat, you may like to use that as an encouragement as well.
    • Take note of the timings when his/her mood tends to be much calmer. Pick those particular timings for shower-time.
  • It is unavoidable that caregivers have to touch their loved ones during care provision (i.e. feeding, hygiene care). Remember to practise hand hygiene regularly. Also, try to minimise hugging your loved one.
  • Maintain home environmental hygiene by cleaning commonly used surfaces with a clean cloth and household cleaning spray or disinfectant.
  • Ensure adequate air circulation within the house by opening the windows.
  • If there is anyone within the household who is not feeling well, if possible, try make arrangements so that your loved one does not use the same toilet as the family member who is unwell. However, if it is not logistically possible, try to clean the toilet with disinfectant every time that family member finishes using the toilet.
  • Do not share utensils during mealtimes.
  • Postpone non-urgent medical appointments to a later date.
  • Opt for tele-consultations if possible.
  • Ask your doctor or pharmacist about filling prescriptions for a longer period so as to reduce trips to the clinic or hospital.
  • Opt for home delivery of medications if possible.
  • Things to note when bringing your loved one out for medical appointments:
    1. Ensure that your loved one and you (and your domestic helper if you have one) are wearing face masks when going out.
      • If your loved one is not keen to wear a mask, try to explain to him/her about the current situation and that everyone is required to wear a mask. If he/she is still not keen, seek the help of a 3rd party (i.e. clinic staff) to talk to him/her.
      • For persons with moderate dementia who may not be able to understand the information, you may try to divert his/her attention by giving him/her a sweet to chew on, so that you can put the mask on for him/her.
    2. Remember to bring along your loved one’s NRIC, Pioneer/Merdeka Generation card (if applicable) and a bottle of hand sanitiser. If you are bringing your loved one to a GP, you can also bring along your loved one’s medical information/documents (i.e. list of his/her current medications, any medical memo which his/her primary doctor has written).
    3. After coming home, wash your loved one’s and your hands thoroughly. If your domestic helper went with you, remind her to wash her hands too.
  • Try to adhere to a routine if possible. For example, stick to the same waking up and sleeping schedule.
  • Ensure a balanced diet and sufficient water intake for your loved one.
  • Encourage your loved one to stay at home and refrain from going out unnecessarily. If he/she needs to go out, practise hand hygiene care immediately after he/she comes home.
  • Try to introduce some activities during the day if possible (refer to “Activity engagement” below). This will help to alleviate your loved one’s boredom at home, and he/she may also have less responsive behaviours such as mood irritability or wanting to go out. This will also help to enhance his/her sleep quality at night.
  • If there is a nearby park, you may like to bring your loved one there for a short walk/exercise. Ensure that the timing of the day is not too hot (i.e. nearing noon or early afternoon).
    • Avoid peak hours and crowded areas. Refer to the following website to check the crowd levels in public parks: https://safedistparks.nparks.gov.sg/
    • After coming home, wash your loved one’s and your hands thoroughly. If your domestic helper went with you, remind her to wash her hands too.
    • Keep updated about the latest safe distancing regulations in Singapore by visiting this website: https://www.mewr.gov.sg/safe-distancing
  • Ensure that your loved one continues to maintain in contact with his/her family members and/or friends. Check with your family members or your loved one’s friends if they are fine to phone your loved one regularly (video calls will be great too).
  • Refer to Appendix 2 for the info-kit titled “Home-Based Activities for Persons with Dementia – Online Resources” for activity suggestions.
  • Activities need to be tailored according to your loved one’s cognitive abilities, language, sensory abilities (e.g. any hearing issue), physical mobility (e.g. don’t do strenuous standing exercises if your loved one has poor standing balance).
  • Observe your loved one’s non-verbal during activities. If he/she is showing signs of displeasure or lack of interest, you may like to stop for a while or change to another activity.
  • Choose timings when your loved one is feeling calm. If he/she has sundowning syndrome, avoid engaging him/her in activities during the late afternoon and evening as he/she may feel more irritated or anxious.
  • Ask your loved one for his/her reason of wanting to go out. Respond to his/her feelings and thoughts accordingly.
  • Is there a common timing when he/she usually wants to go out? Is it possible to divert his/her attention before that particular timing so he/she will not think about going out?
  • Is there anyone in the family whom he/she usually listens to? Get that person to talk to your loved one.
  • For persons with mild dementia who are still going out independently, try to educate and remind them about the current situation and the government’s advisory to stay at home. Refer to the tips under “Sharing of COVID-19 information with persons with dementia” above.
  • If your loved one is literate, you can provide some visual cues. E.g. stick a reminder near the main door about COVID-19 situation and the government’s advisory for everyone to stay at home. Ensure that the information is succinct and easy to read (sometimes newspapers have very clear and good presentation of graphics/visuals). Visit https://www.gov.sg/article/covid-19-resources and look for the section titled “Posters on COVID-19” for informative and clear posters.
  • Family members who are staying together can still bring their loved one for a short walk in nearby parks. Ensure that the timing of the day is not too hot (i.e. nearing noon or early afternoon). Avoid peak hours and crowded areas. Refer to the following website to check the crowd levels in public parks: https://safedistparks.nparks.gov.sg/
  • If your loved one is still keen to go out:
    • Do remind him/her to wear a mask if he/she is going out. This is in view of the government’s guidelines that it is compulsory to wear a mask when one is going out.
    • Ensure that he/she carries his/her mobile phone with him/her. If he/she is carrying a smartphone, install a GPS-tracker app so that you can keep track of his/her whereabouts.
    • If he/she does not carry a mobile phone, you can consider purchasing a GPS tracker for him/her to carry (or put into his/her bag or hook onto his/her keys) when he/she goes out.
    • Does your loved one have the Safe Return Card? Do ensure that he/she carries it out.
    • If your loved one does not want to carry anything including a wallet, is there a pair of pants or shirt which he/she usually puts on? You can consider writing your name and contact number onto a piece of paper and placing it into the pocket. This is just in case if he/she is unable to remember where he/she is or if enforcement officers find him/her walking along the streets/in the community.
    • Ensure that he/she washes his/her hands thoroughly after he/she comes home.
    • In view of the increasing stricter safe distancing measures rolled out by the authorities, do have a family member to accompany your loved one whenever possible, in case he/she is unable to remember where he/she is or if enforcement officers find him/her walking along the streets/in the community.
    • Visit the Ministry of the Environment and Water Resources’ website for updated info about safe distancing measures: https://www.mewr.gov.sg/safe-distancing
  • Persons with dementia may be confused with the presence of more family members at home during the day (since many people are working-from-home now).
    • Try to provide reassurance and check-in with your loved one on how he/she is feeling.
    • Ask the other family members to stay in their rooms as much as possible to avoid overwhelming your loved one.
    • For persons with moderate dementia, observe their non-verbal to see if there are any signs of anxiety or distress. E.g. is there more pacing, frowning, mood changes?
  • When outside, persons with dementia may feel frightened or anxious when they see people wearing masks. Try to allay his/her anxiety by providing a supportive presence i.e. stay by his/her side.
  • Persons with dementia’s mood changes may also be attributed to having to stay at home now (especially for those who have a routine of going out or who are used to a routine of going to day care).
  • Take note of any physical discomfort which your loved one may be having. E.g. dehydration, any constipation, any aches or swelling, any sleep cycle changes. There may be a need to contact your loved one’s primary doctor or nurse for discussion and recommendations.
    • If you find yourself feeling anxious or worried every time you watch or receive news about COVID-19 (e.g. through WhatsApp, Facebook), try to refrain from reading/watching it, or refrain from spending too much time on it.
    • Try to allocate some time during the day for yourself to destress (e.g. do deep breathing exercises, meditate, journaling, listen to music).
    • Ensure a balanced diet and sufficient rest.
    • Avoid going out unnecessarily unless it is for essential reasons such as marketing and buying of food. Wear a mask and bring hand sanitiser.
    • If there is a nearby park, you may like to go there for a short walk for some physical exercise while maintaining at least 1m of safe distancing from others. Ensure that the timing of the day is not too hot (i.e. nearing noon or early afternoon).
    • If possible, take your body temperature twice a day. Keep a temperature logbook with the following columns: Date; Time; Temperature.
    • If you have a domestic helper, monitor your helper’s health and also ensure that she is practising proper hand hygiene. It is compulsory for domestic helpers to stay at home on their rest days, unless they need to go out for essential needs. Read the following Straits Times article for more info: https://www.straitstimes.com/singapore/coronavirus-foreign-domestic-workers-must-stay-home-on-rest-day-says-mom. If possible, allocate some time for your helper to contact their friends via phone call or social media.
    • It may be helpful to start thinking about alternative care arrangements in case you or your domestic helper fall sick during this period of time.
    • If your loved one with dementia is not staying with you, and you need to provide essential care to him/her as there is no other caregiver, you can still visit your loved one. Visit the Ministry of the Environment and Water Resources’ website: https://www.mewr.gov.sg/safe-distancing-faqs/ under Section 2 “Seniors/Vulnerable Persons” for more info.
    • Decline all visits by your family members or friends who do not stay with your loved one during this period. Use phone or video calls instead to stay connected.
    • If you are feeling unwell:
      • Seek timely medical attention.
      • Is there any alternate caregiver?
      • If possible, ensure that you do not use the same toilet as your loved one. However, if it is not logistically possible, try to clean the toilet with disinfectant every time you finish using the toilet.
      • Stay at home to rest.
      • If you are coughing or sneezing, cover your mouth/nose with tissue and throw the tissue into the rubbish bin.
      • Practise hand hygiene regularly.
      • Maintain home environmental hygiene by cleaning commonly used surfaces with a clean cloth and household cleaning spray or disinfectant.
    • Refer to Appendix 3 for a list of useful hotlines and websites for caregivers.