March 31, 2020
Dear AGS Members and Friends,
WHERE WE ARE
Today we are faced with an unprecedented challenge. The COVID-9 virus has evolved into a pandemic unlike anything any of us have encountered in our lifetimes. While everyone in the world will be affected in some way, the impact on the caregivers of the elderly will be even more profound.
As I am sure you are aware, Seniors are at the greatest risk of dying from this disease. As I write this, the best medical minds around the world are tirelessly searching for effective treatment, but for the next several months, the best that modern medicine will be able to offer those afflicted is respiratory support, which is projected to be in short supply. While there is no crystal ball, most predictive models suggest that we have not yet hit the peak. The patterns seen in Italy and Spain are likely to be replicated in our large cities, including our home of Washington, D.C. As a proud product of local medical institutions, Howard University and Johns Hopkins, I can say from experience, that our area has some of the finest medical care in the country. However, these institutions, like those around the world, are going to be tested as they have never been tested before and they need all of the help that they can get.
It is incumbent upon every citizen to help protect themselves and each other by practicing social distancing and good hygiene.
This poses a particular challenge for AGS members, as so much of our work involves direct, hands-on, interactions with Seniors. We are geriatric care managers, physicians, operators of senior care residential communities/group homes, and more. The Seniors that we care for are dependent upon us for so much. We must continue to care for them through this crisis, but with greater levels of caution and judgement than in our previous day to day interactions. While there are some generalized universal recommendations, with which I am sure we are all familiar at this point, these may be insufficient. I will certainly reiterate the tenants of social distancing and hygiene, but would add that this is going to call for creativity and improvisation on all of our parts, which thankfully, play to our strengths.
When interacting with the seniors under your care, limit physical contact except when necessary, and use protective gear.
Disposable gowns, face masks and protective eyewear may need to be reused. Frequent cleansing by washing hands and using hand sanitizer is necessary. Cleaning doorknobs and other commonly touched areas in the senior's environment is necessary. Eye wear is recommended, even if all you have is a pair of sunglasses, it is better than nothing. Plastic garbage bags can be used in place of medical dressing gowns. While I often imagined that my apocalyptic outfit would be mostly leather and chain mail, what is described above may be more eminently practical.
Social Distancing to the extent possible – use protective gear when providing care
Good Hygiene (wash hands, don’t touch your face)
Wipe down counters, door knobs, floors – remove shoes
Disposable gowns (try garbage bags if gowns are not available
Face masks (use sunglasses or any protective eyewear)
GRASP VS PERCEPTION IN COGNITIVE IMPAIRMENT
Another tact that may be helpful is differentiating between “needs” and “wants”. In the fast food/on demand/land of plenty that has been our country for much of our lifetimes, we have not often had to make this distinction. For our seniors with cognitive impairment, this will prove particularly challenging. While all of us are drowning in uncertainties, they are even more so. Some of them are blissfully unaware of what is happening, others may only have bits and pieces. My experience working with seniors with cognitive impairment tells me that even though they cannot necessarily grasp the detailed factual data, many of them are still able to perceive the emotional temperature of their environment, and as best as their caregivers are trying to put on brave faces, we are all affected. The limitation of freedom of movement, both within and without their communities along with the changes in daily routine/reductions in social interaction are having an impact on their emotional well-being; this is, however, necessary to maintain their health. We can be supportive of them remotely and offer compassionate support and guidance to their family members who are unable to visit with them. I cannot express enough appreciation for the tireless work of the caregivers, administrators, healthcare workers, and support staff in these communities who are doing the hands-on, heavy lifting trying to maintain safety and a quality of life for those under their care.
Keep it simple
Walk outdoors when possible
RESPECT YOUR OWN RISK LEVEL
I would add a special message to those AGS members who are in the high-risk categories of being over the age of 60 or have pre-existing medical conditions. It is imperative that you care for yourselves, even if it is at the expense of those you care for. Ask colleagues for help filling in. You will be needed when this is all over and you will not be able to help if you are not here.
While we do not have a cure for this virus yet, we are not entirely helpless. While avoidance seems counterproductive, especially to those of us who are so hands-on with our seniors, I cannot stress enough that this is what will help them, and us, in the long run. Shortsightedness has contributed to this situation, we will need a longer-term mentality to get out of it.
As a psychiatrist I cannot emphasize enough the importance of finding a balance between remaining informed and not drowning in news overload. As we live in highly polarized times, it is not the least bit surprising that this pandemic has become politicized, and amidst the helpful informational messages that the media is providing, there is often a lot of finger pointing and highly expressed emotion which is not a healthy marinade for our minds at a time when we are all under profound stress. Please take time to distract yourselves with tasks both mundane and creative.
Be positive for the long-term mentality
Be creative and enjoy the mundane: watch movies, read books, listen to music, do art, plant a garden, meditate, take a walk
Say connected: take care of yourself and others
Our bodies and brains are bathing in stress hormones and anything that fills your heart and mind with calm focus is an antidote.
While the technologies of today give us unprecedented access to this information overload which is, in my opinion, unhealthy, it also gives us unprecedented access to each other, and while we may not be able to spend time with those we care for professionally, as well as those we care about personally, we can harness the power of this technology to remain connected even as we isolate. Most of us have computers and cell phones with cameras so we can call, email, and video chat. We humans are a social species, and while our large cerebral cortex and all of the wonderful gifts it has imparted have made our modern lives what they are today, we would never have made it to this point individually. We evolved and became the dominant life form on this planet as social creatures, relying upon each other, and the group for a survival. Perhaps with modern technology doing so much for us we have moved away from that, but I think we are now in the midst of a big reminder that again, our survival depends upon each other. Use these tools to reach out to one another to offer practical information/problem solving but also comfort and hope.
AGS has always been committed to the goal of support for the seniors in our community and those who care for them, and we will continue to do so, even in the face of this challenge. As this crisis evolves opportunities will arise for us to be of service to those already under our care, but our communities as well.
I wish you all resilience of spirit and calmness of mind.
Nicholas Schor, MD
President, Metropolitan Washington Affiliate
American Geriatrics Society