Covid-19 & Senior Adults: The Aftermath

Beth Cardillo, M.Ed., LSW, CDPArmbrook Village Senior Living

WHY ARE WE HERE?

Symptoms of Covid-19

● Cough● Sore throat● Fever● Difficulty breathing

WHAT WE KNEW THEN

http://www.youtube.com/watch?v=QH5zpa8xbic

Symptoms of Covid-19

● Fever or chills● Cough● Shortness of breath or

difficulty breathing● Fatigue● Muscle or body aches● Headache● New loss of taste or smell● Sore throat● Congestion or runny nose● Nausea or vomiting● Diarrhea● Decreased oxygen levels

ACCORDING TO GUIDANCE FROM THE CDC

● Encephalopathy● Confusion/memory loss● Hallucinations● Swelling and inflammation ● Strokes, blood clots● Seizures● Vertigo● Malaise/extreme fatigue● Myocarditis● Long term loss of taste and

smell● Severe gastrointestinal

upset

In Our ExperienceNEW SYMPTOMS EXPERIENCED BY OLDER ADULTS

?

Possible Long-Term Symptoms & Complications

● Memory loss/cognitive impairment

● Diminished respiratory capacity

● Increased risk for vascular and cardiovascular complications

● Potential increase for risk of Parkinson’s Disease in future*

● Clinical Depression

● Anxiety

● PTSD

WE DON’T KNOW WHAT WE DON’T KNOW

Real Stories

“We can’t transport without a fever.”

Early on, we had a resident with a symptom pattern that didn’t match the CDC guidelines.

He knew something wasn’t right but EMTs couldn’t transport for non-Covid symptoms and the hospital wouldn’t admit him.

His daughter took him to a drive-up testing site where his Covid diagnosis was confirmed and he was quickly taken to the hospital with Covid and double pneumonia, staying almost a month.

Asking for Help

Another resident had severe gastrointestinal upset, intense vomiting, and dehydration but no fever. Her family tried to get her admitted to the local hospital 3 times, where she would be treated for dehydration and discharged.

Her condition worsened and she became confused and began hallucinating. She was finally admitted to a larger hospital and was there for over three weeks.

Armbrook Village requested that the Board of Health and Emergency Response for the City of Westfield and Baystate Medical Center at Noble Hospital send in an emergency team to see our residents. It was then determined by the hospital’s infectious disease and disaster medical team that we had a cluster of cases displaying symptoms that were not compatible with CDC guidance up to that point.

Senior adults were losing time because their numerous symptoms weren’t considered to be Covid-related.

GROUP DISCUSSION

● What happens when we lose time in diagnosing a Covid case?

● What signs and symptoms can we be more aware of in older adults?

● How can we advocate for senior adults in our lives to ensure they have access to care and resources?

The Many Effects of Covid-19

Effects on Mental Health

In Both Residents &

Staff

● Situational & Clinical Depression

● Stress● Anxiety● Fear

Effects on Senior Adults’

Physical Health

● Higher risk for mortality● Higher risk for severe

complications● Deconditioning &

increased fall risk due to isolation

● Dehydration and decreased appetite/malnutrition

Effects on Senior Adults’

Emotional Health

● Loneliness● Confusion● Frustration● Sadness● Hopelessness & despair

Effects on Those

Experiencing Memory Loss

● More rapid decline in cognition● Increased difficulty with word

finding, processing, and retrieving● Backsliding in ability to perform

ADLs and other independent activities

● Malnutrition and dehydration, unwillingness to eat or drink

Our Stories, Struggles, & Successes

Holistic Treatment

We had a 99 year old Assisted Living resident who was diagnosed with Covid and treated at the hospital before being released to a rehab. While this resident had many comorbidities, she did not have dementia or other cognitive impairments.

During her rehab stay, she was experiencing extreme confusion, difficulty walking, and had lost much of her language skills. We made the choice to discharge her to our Memory Care neighborhood, where she could be closely monitored due to safety concerns.

Both the resident and her family wanted her to return to Assisted Living, and made that their goal. After a month of PT, OT, Speech Therapy, and therapeutic programming here, she was able to return to her apartment with only minor word finding issues.

Therapeutic Intervention

We had a resident living with us who did not have Covid, but was struggling with being quarantined to his apartment for many weeks. We noticed that he had started to lose a considerable amount of weight, and after further investigation, discovered he was flushing his meals down the toilet.

This resident, who typically ate 3 meals a day with his peers in our dining room, had completely forgotten how to eat independently. We began a very small therapeutic dining program for residents who needed verbal, visual or social cues to eat, and saw tremendous progress with this resident and others.

GROUP DISCUSSION

● What are some traditional therapies we can offer for those struggling after prolonged isolation?

● What are some non-traditional therapies or treatments we can offer for those struggling after prolonged isolation?

● What struggles have you seen in the older adults in your life that were indirectly caused by Covid-19?

Long-Term Effects of a Public Health Pandemic

Short-Term & Prolonged Effects of IsolationWHAT DID WE SEE THIS SUMMER?

● Lack of resources to address isolation in senior population

● Deconditioning among older adults, even those who were very independent

● Increased confusion, cognitive decline

● Failure to thrive

Short-Term & Prolonged Effects of Isolation

● We’ve made progress - can it continue?● Apprehension about “second wave”● Lasting effects of isolation

○ Lasting cognitive decline○ Lingering fatigue, weakness○ More rapid deconditioning leading to

the need for advanced careWHAT ARE WE SEEING GOING INTO THE FALL & WINTER?

Short-Term & Prolonged Effects of Isolation

● Increased anxiety about living situation, both communal and alone

● Desire for frequent, transparent communication

● Need for safe, meaningful visiting opportunities

WHAT ARE WE SEEING IN FAMILIES & CAREGIVERS?

How to Stay Connected

Connecting with families in meaningful

ways

● Calling to see how they were doing

● Sending handwritten cards and notes

● Virtual Alzheimer’s & Dementia Caregiver Support Group

● Zoom Family Town Halls

● Text message updates

● Weekly letters

How to Combat Isolation

● Outdoor exercise and relaxation (awe walks)

● Safe, one-on-one and small (2 or 3 people) group socialization

● Therapeutic activities and interventions (ConnectedLIFE Programming concepts)

● Cognitive stimulation through programming

● Connection to loved ones

● Utilizing technology, such as dedicated community-wide TV channel for live and specialized programs, Facetime, Skype, Zoom etc.

AT ASSISTED LIVING COMMUNITIES & OTHER GROUP SETTINGS

How to Combat IsolationIN OUR GREATER COMMUNITIES

WHAT WE’VE SEEN OUR AMAZING SENIOR CENTERS DO

● Drive-through and/or home delivered bagged lunches

● Community Access Channels for Activities

● Personal Phone Calls● Wellness Checks w/ the Dept. of

Health● Small Group Programs

Recognizing What We’ve Been Through

● Recapping with Staff● Family Member Forums, to ensure

they understand challenges and all we’ve done to combat them

● Memorials to recognize those we loved that passed, not necessarily from Covid, but during stay-at-homeAND WHAT WE

MAY HAVE TO GO THROUGH AGAIN

Question & Answer

Thank you!FOR MORE INFORMATION, PLEASE VISIT SENIORLIVINGRESIDENCES.COM

http://www.seniorlivingresidences.comhttp://www.seniorlivingresidences.comhttp://www.seniorlivingresidences.comhttp://www.seniorlivingresidences.comhttp://www.seniorlivingresidences.comhttp://www.seniorlivingresidences.comhttp://www.seniorlivingresidences.com

References

Rabin, Roni Caryn. “Some Coronavirus Patients Show Signs of Brain Ailments.” New York Times, 1 Apr. 2020. https://www.nytimes.com/2020/04/01/health/coronavirus-stroke-seizures-confusion.html?referringSource=articleShare

Helms, Julie, et al. “Neurologic Features in Severe SARS-CoV-2 Infection.” New England Journal of Medicine, vol. 382, no. 23, 2020, pp. 2268–2270., doi:10.1056/nejmc2008597. https://www.nejm.org/doi/full/10.1056/NEJMc2008597

Fotuhi, Majida; Mian, Alic; Meysami, Somayehd; Raji, Cyrus. “Neurobiology of COVID-19.” Journal of Alzheimer's Disease, 8 June 2020. https://www.j-alz.com/content/three-stages-covid-19-brain-damage-identified-top-neurologists-journal-alzheimer-disease

Li, Yan‐Chao, et al. “The Neuroinvasive Potential of SARS‐CoV2 May Play a Role in the Respiratory Failure of COVID‐19 Patients.” Journal of Medical Virology, vol. 92, no. 6, 2020, pp. 552–555., doi:10.1002/jmv.25728. https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25728

Scott, Sophie, et al. “Experts Warn Parkinson's Disease May 'Explode' after COVID-19.” ABC News, ABC News, 23 Sept. 2020, www.abc.net.au/news/2020-09-23/covid-19-may-cause-parkinsons-disease-research-finds/12688384.

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