Home-based care strategies amid COVID-19 Pandemic for Dementia Patients

Here are some tips to make it easier for Dementia patients and their caregivers

1 .Control of the infection

• Stay at home to reduce the risk of infection
• Keep home as a clean zone
• Prevent visits from high-risk persons, for example, those with fever or who have had contact with COVID-19 cases
• Have home-members self-sanitize (e.g., wash hands, change clothes, take a bath) and cleanse personal belongings (e.g., cell phones, handbags) upon returning home; clean the bags of delivered goods, etc.; leave footwear outside the house before entering home

2. Care for basic needs

• Maintain home support in personal needs (e.g., bathing) or chores (e.g., preparing meals)
• Nursing care (eg: wound dressing, changing of urinary catheters or feeding tubes) should be continued
• HCP providing home care should be trained in infection control, wear appropriate PPE. and have regular COVID-19 testing
• Make use of online services (e.g. grocery shopping, meals delivery)
• For day care centres that remain open during the outbreak, advice on infection control measures during travels should be given to patients/caregivers or transports should be arranged for them to visit the centres; these centres should implement strict infection control measures

3. Calm down challenging behaviours

• Ask trained HCPs to provide simple tips (e.g., identify potential triggers to avoid) to caregivers in handling behavioural problems, online training videos on management of behavioural problems
• Get consultation via phone or videoconferencing if required
• Video-record the challenging behaviours (e.g., using smartphone) and send it back toHCP for advice
• Dial emergency health-care numbers for tackling more severe behavioural problems (e.g., any form of violent or suicidal behaviour)
• Remember delirium/confusion may be a manifestation of COVID-19 among older people

4. Comprehensive cognitive enhancement

• Replace previous outdoor routines with home-based activities, including maintaining simple exercises (eg, walking, stretching) or cognitive stimulating activities comprising reading, playing card games, or arts and crafts
• Ask to arrange for videoconferencing with individuals or groups of people with dementia/caregivers for activities including exercises, recreational activities, educational talks
• Ask to deliver cognitive and physical rehabilitation programs via videoconferencing which are tailored i according to patients’ disabilities (a.g., balance/gait training or stretching exercise for those with concurrent parkinsonism)
• If outdoor walk/exercise is allowed, avoid crowded areas or maintain physical distancing

5. Managing medical and cognitive problems at home

• Get educated to monitor simple vital signs like B.P., pulse, temperature, blood glucose, and/or oxygen saturation at home; B.P. monitoring may be particularly important in limiting further vascular contributions to dementia; oxygen saturation may detect desaturation due to pneumonia/COVID-19
• Secure arrangement for medical doctors could make home visits if deemed necessary, but they need to follow infection control measures and put on proper PPE for home visits
• Refill and be compliant to prescribed medications: get home delivery of medication if possible
• Discuss in advance patients and caregivers wishes with respect to receiving life-sustaining treatment including hospitalization, resuscitation, and ventilatory support in the event of respiratory failure due to COVID-19

6. Self care for caregivers

• Regularly screen for anxiety, stress and depression and prompt treatment when there is emerging/significant psychopathology
• Have regular home-based exercise, recreational activities, and other ways to relieve stress (e.g., listening to music)
• Ask the trained HCP (e.g., psychologists) to deliver/teach relaxation methods (e.g., mindfulness meditation) via videoconferencing
• Discuss a contingency plan in caring for the patients in case the caregivers become sick