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The content of this article is developed by Alzheimer’s Indonesia. Translation is financed by Age International through HelpAge International.

What you can do during the COVID-19 outbreak

1. Make sure you have enough food supplies and daily necessities – but do not hoard

Avoid leaving the house unless for urgent matters. Choose work from home / distance learning options if possible. This will also make it easier for you who provide care for older family members at home in monitoring their condition.

It is important to make sure you have enough supply of daily necessities to meet your needs while staying home as much as possible. Do not buy too much and hoard. A stock of unperishables for 2 weeks to maximum 1 month is enough. It is better to buy goods regularly (for example every week or every other week), compared to buying goods in excess (hoarding), which will result in scarcity of goods that cause difficulties for other families who cannot afford to buy in bulk.

2. Avoid the crowds as much as possible

Try to avoid gatherings/crowds. When using public transportation, avoid traveling at peak times. Schedule all your needs to go out at one time; for example, to go to the bank, to refill your prescription at the pharmacy, to shop for necessities all in one day - so you don't need to leave home many times. If you must meet other people, opt for outdoor space instead of indoor, and if it is indoor, ensure the room has good ventilation.

3. Maintain physical distance between yourself and others (2 meters)

When you must go out, try to maintain a 2-metre distance from other people. Droplets from other people will fall to the ground before reaching you with this distance. Wear a mask when you are not feeling well but must go out, to prevent spreading a disease to others.

Author(s): dr. Tara Puspitarini Sani, MD, MSc (Dementia) dr. Saskia Mariska, MPH Virginia Geraldine Hanny Prasetya, S. Psi


Older people are at a higher risk of severe COVID-19 cases

COVID-19 is a respiratory disease caused by a virus. This disease began to spread among humans since December 2019, starting in Wuhan, Hubei Province, China. Most people who experience COVID-19 only experience mild symptoms. However, about 1 in 6 people can experience severe symptoms due to a complication of pneumonia, which causes shortness of breath. The symptoms usually worsen gradually.

Globally, more than 50% of confirmed cases of COVID-19 infection have been declared to show improvements, and the recovery rate continues to increase. Although the mortality rate for this disease is low (around 3%), it is more dangerous for older people and people with pre-existing medical conditions (such as diabetes, hypertension, and heart disease).

For older people, this viral infection can cause symptoms that are more severe than young adults or children. Although most people who are infected only experience mild symptoms, in older people this disease can be fatal. Most deaths occur in patients aged 80 years and over (14.8%). This is because the body's immune system and the organ systems of older people are not as good as when they were young. In addition, diseases often found in the older people such as diabetes or heart disease, can slow down the recovery process or increase the risk of complications from this disease.

Therefore, it is important for the older people as well as people who live in the same house as the older people to be more active in preventing transmission.

How to prevent it?

There are several steps that the older people and their families can take to protect themselves from the transmission of this epidemic virus, including:

x Washing your hands for 20 seconds with soap. You need to wash your hands before touching the face, using / removing a face mask, after touching other people, or the surface of objects that have also been held by others. You also have to wash hands before preparing food or eating, after going to the toilet, after leaving the house, or whenever you feel your hands are not clean.

x If you cannot find a place to wash your hands, you can use a hand sanitizer which ingredients contain at least 60% alcohol.

x Avoid touching your face if you have not washed your hands. The eyes, nose, mouth is the port d’entrée (entrance) of the virus into the body.

x Cover your nose & mouth when coughing / sneezing with a tissue. If there are no tissues, cough / sneeze into the inside of the elbow. Don't use your palm / hand to cover your nose / mouth. Throw the tissue into the trash bin, then wash your hands or use hand sanitizer immediately.

x Avoid shaking hands. You can put your hands together in front of your chest as a substitute.


x Make sure your nutritional intake is sufficient and balanced. Fruits and vegetables that

are rich in vitamins and antioxidants are important to strengthen the body's immune system

x Continue to take regular medications for pre-existing diseases as usual. Postpone unnecessary medical appointments/procedures, but make sure you have enough medications at home until the next appointment.

x Do social distancing to reduce the possibility of contracting or transmitting



Social distancing for older persons during COVID-19

Social distancing is a term to describe efforts to maintain physical distance between people to prevent transmission of this virus.

This includes:

- Staying at home as much as possible – limiting leaving home just for essential necessities

- Avoiding crowded places and public transportation when there is no urgent need

- Using technology such as video calls or broadcast and online learning platforms to work/study/do religious activities at home

If you really must leave the house:

- Make sure you are fit. If you are not feeling well but urgently need to leave the house, use a face mask to prevent transmission to others

- Keep a minimum distance of 2 metres from other people. This is a safe distance not to be exposed to the virus when other people cough/sneeze

- If you really must meet/gather with other people, choose an open place or room with good circulation (open the window) and maintain the 2-metres distance

This is important, even if you are not an older person! Why?

When you meet a person who has the virus, you run the risk of contracting it. If an infected person is in good health, it is possible that he or she does not have any symptoms or only shows mild symptoms (coughing, fatigue – but otherwise still able to do their usual activities).

If you catch the virus, when you go home you will expose people living with you with the virus. If you live with an older person, it is very possible that they will get infected and experience more severe symptoms and complications. This is because individuals aged 60 years and over, especially those above 80 (the oldest old), are very vulnerable to the transmission of this virus.

Social distancing for older people

Older people are more vulnerable to COVID-19 infection, which means it is even more important for the older people to do social distancing.

In social distancing efforts, outside activities and number of visitors to home must be limited. Young adults are certainly more familiar with technology so that they can utilize technology for activities at home without the need to travel. However, older people might not be as familiar


with these, and thus are prone to more severe negative impact of social distancing. There are several things that need to be considered in social distancing for older people so as not to result in loneliness or depression.

Carers or people living with older relatives can take advantage of modern telecommunications modes such as video calls to help the older person maintain communication with the outside world and with other friends, peers, relatives and family members, who usually come and visit them at home.

Communication and social media applications such as WhatsApp, LINE, Skype, Facebook and others are very useful to help older persons stay connected with family and friends who don't live under the same roof. However, it should also be noted that the amount of news or hoaxes sent by people in various chat groups can make older people who are doing social distancing more stressful and anxious. How can we help them to get the most out of technology without experiencing this anxiety?

Use communication applications and social media primarily to strengthen meaningful personal interactions during social distancing. Also pay attention to the schedule and duration of use of the device for this. For example: Grandma would benefit more from half-hour video calls every morning and night with her grandchildren who usually visit the house, compared to reading distressing and anxiety-provoking news and messages exchanged in a group of 30 people. Invite family and other relatives to send a message to Grandma personally and ask for news and activities that day, without always discussing the corona virus outbreak.

Scheduled routine activities are also important to prevent anxiety and to give a sense of control over one’s life. Older persons who usually have social activities outside the home might have no idea what to do when they must stay at home. Plan the daily schedule of family activities who stay at home during social distancing, from morning to night. Social interaction is very possible while maintaining physical distance. Humour and creativity will be very useful in finding ways to do activities together.

In Indonesia, it is common for older people to meet in groups to do physical exercise together. During social distancing it is still important to do physical activities, even though there must be some adjustments. Instead of exercising in groups, taking a short walk around the neighbourhood with a person from the same house can be a good idea. Please remember to refrain from physical interactions with others you might meet and keep a safe 2-metres distance. Instead of giving hugs or shaking hands, it is best to wave and smile or greet them by putting your palms together and hold them up in front of your chest.



Advice to reduce risk of COVID-19 transmission for those living with older people

If you care for or live with an older people person, you must be more vigilant so as not to bring the virus into the house that can cause them to contract COVID-19.

Here is some practical advice:

x Make it a habit to wash your hands before touching older people in helping them do activities of daily living. For example, before helping to wear clothes or move from the bed to the wheelchair.

x Washing hands should also be done before and after you touch your face, after touching a public surface, and before preparing food, other than after using the toilet or when your hands are visibly dirty or feels dirty.

x Limit the need for activities outside. Schedule all errands on one trip in order to minimize

the frequency of traveling.

x If you must use public transportation, try to maintain a distance of at least 1-2 metres from other people.

x Avoid following activities that involve large gathering (more than 20 people) in one place.

This includes seminars, religious activities, etc. Instead, opt to study, work, and worship at home.

x After traveling, wash your hands and change clothes as soon as you get home before

meeting older people.

x Prepare a change of clothes and place it outside the room or near the bathroom before going outside the house. This way, you can just take a bath when you get home without having to open the wardrobe / enter the room again with dirty clothes. This is important to keep in mind, especially if you share a room with older people.




Ideas for Intergenerational Activities with Grandparents at Home During Social Distancing

Do you live with your grandparents or an older person?

Given all that is happening around the COVID-19 pandemic, they might be grumbling all the time now - distressed by the storm of news and text messages on chat apps about COVID-19 and having to stay at home due to social distancing.

Let's get them to forget about those WhatsApp groups for a while and do other activities. But first, don't forget to read our advice to reduce risk of COVID-19 transmission for those living with older people!

Here are some ideas for activities you can do with older family members at home during social distancing:

x Chatting

This activity is very basic, but often forgotten. The full, busy schedule of school, college and work sometimes overwhelm us and reduce our time to sit down and have a nice chat with them.

x Cooking

Try making a dish you’ve never tried or ask your parents/grandparents to teach you their secret recipes. If you live separately, you can have a video call with them to have a step-by-step tutorial!

x Decluttering Sort the items in wardrobes or garage into four groups: 1) those still being used frequently, 2) those they would like to give to friends / family, 3) those they would like to donate, 4) those to be discarded. Who knows, while sorting this together, they can reminisce over items which sparks pleasant memories and tell us stories behind it.

x Learning a foreign language Encourage them to learn a foreign language using an application such as Duolingo. Tell them that learning languages reduces the risk of dementia. Encourage discussion by taking turn with them to share interesting facts about the country which language they choose to learn.

x Learn local dialect If we do not speak or are not fluent in the local dialect used by our extended families, this is an opportunity to learn it from our parents / grandparents. While preserving the heritage, your parents/grandparents can stimulate their brain through teaching.


x Learn specific skills Your grandma is a knitting whiz? Or your grandpa is a painter? If there are skills they have which you’d like to learn, ask them to teach you. Besides giving you new skills, teaching something they like can also lift their spirit.

x Movie marathon In this digital age, the choice of films that can be watched at home is endless and easily accessed online. Watch good films with them during this social distancing time. Let them reminisce about the good ol’ times with classic films if they prefer to do so. Watching films and reminiscing only are not much of a cognitive-stimulating activity. However, it’s a good way to start brain-stimulating conversations. Ask them open-ended questions about their opinion. Which was their favourite scene and why? Let's say there will be a local remake of the film and they get to choose the cast, which Indonesian actors/actresses would they choose to play the characters?

If you do not live with them, no problem! Without any direct meeting, the activities above can be done together through a video call too.

You can also encourage your parents/grandparents to take photos of their #socialdistancing activities at home and send it to their Whatsapp groups. Everyone will thank them with positive contents after days of reading hoaxes and negative news!

Have you got any other ideas for activities with your grandparents during #socialdistancing? Come and share your ideas to us!



Challenges in delivering COVID-19 information to older people As the current COVID-19 pandemic develops, it is not a surprise to see that our government has set some rules and warnings for the citizens to keep them safe from the virus. Not only through raising awareness for a clean and healthy lifestyle as preventative measures, but also through social distancing measures to reduce the spreading of the virus. However, not everyone is following these advices, believing COVID-19 will not affect them - and we can see these issues in every generation, from young adults to older people. A lot of older people also still have some difficulties understanding the information around COVID-19, while those aged 65 and over have been found to be greatly impacted by this disease. In this article, we will discuss some possible challenges in communicating COVID-19 information to older people. Firstly, because COVID-19 is a new disease, the amount of research on this disease is still limited. This leads to information without any reliable sources spreading in public. For example, some broadcast messages spread through instant messaging applications recommend eating a particular type of food to prevent COVID-19 or giving misinformation to self-diagnose COVID-19 at home. This kind of misinformation or hoax will cause confusion. Always cross-check every information we receive with reliable sources and choose which ones are correct and useful, before delivering it to our older family members. Secondly, some older people may be resistant towards the government’s advices, such as social distancing. It is possible that this stems from the fact that they have lived longer than most of us and thus have lived through the good and bad in life. They also might have gone through many difficult circumstances for all their life and thus viewing this not as seriously and underestimating the scale of this outbreak. Some older people might think they have lived long enough and thus not afraid of getting infected or even died from it; while some may believe they are still healthy and strong enough and would only be mildly affected by the virus or not at all. In dealing with this situation, explain to them that their family and friends would be very devastated if they, by any chance, were infected. We would love for them to be healthy and emphasize that it is our needs – their loved ones – instead of theirs. We can also address the issue about how a pandemic of this scale is something that has never happened for the last century, thus it requires our combined efforts to stop it. Thirdly, family dynamics. Sometimes, parents-children dynamics gets in the way of older people receiving information and adopting preventative measures. When their child was still underage and in their care, the parents are the one who have more knowledge and take responsibility in everything. Even when their children are already adults, some older people find it hard to switch the carer roles with their children. If you think this might be one of the reasons why your older


parents refuse to receive information or advice from you, try to ask them for a favour to do the preventative measures for the sake of your wellbeing and peace of mind, not for them. For example, you can say that you are worried about this epidemic and want them to stay healthy so that they could continue to tell bedtime stories for their grandchildren. If you think your family dynamics still prevent you to deliver information to your older parents or family members, consider asking help from someone else whom they trust to convey important information to them. For example, another family member, their close friends, trusted local religious leaders or village officials. Another alternative is to show them some articles or educational videos that are delivered by public figures they respect. Last but not least, cognitive impairment such as dementia. This would affect the older person’s capacity to receive and retain new information. Hence, they might forget to apply preventative measures, for example washing hands regularly. Dementia can also interfere with communication and impair individuals’ ability to understand causal relation, therefore making it harder for them to understand the logical basis of doing preventative measures during this epidemic. If by any chance you have family members who is living with dementia, please read our other article on “How to communicate COVID-19 information to older people with dementia” References:

1. Akers, W. (2020). 5 Tips to Help You Talk to Your Older Parents About Social Distancing. Retrieved from https://www.healthline.com/health-news/talking-to-your-parents-about-the-importance-of-social-distancing#2.-Come-from-a-place-of-love-not-control

2. Alzheimer’s Association. (n.d.) Coronavirus (COVID-19): Tips for Dementia Caregivers. Retrieved from https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care

Author(s): dr. Tara Puspitarini Sani, MD, MSc (Dementia) Virginia Geraldine Hanny Prasetya, S. Psi

https://www.healthline.com/health-news/talking-to-your-parents-about-the-importance-of-social-distancing%232.-Come-from-a-place-of-love-not-control

https://www.healthline.com/health-news/talking-to-your-parents-about-the-importance-of-social-distancing%232.-Come-from-a-place-of-love-not-control

https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care




How to deliver COVID-19 information to a Person with Dementia? There is a higher risk for older people to be affected more severely by COVID-19 and to have a worse outcome, especially those with comorbidities such as diabetes and high blood pressure. However, some people who are infected, especially young and healthy individuals, might show only mild symptoms or even no symptoms at all. Therefore, it is essential for every individual to understand and implement preventative measures, including a person with dementia. Older people living with dementia have an even bigger risk than healthy older people to be infected by COVID-19. Dementia interferes with a person’s cognitive functions, including the ability to store and retain new information, understanding conversation, reasonings or even resulting in changed behaviour and unstable emotion. They may experience difficulties to understand the reasons behind the new habits they have to adopt, such as why they could not go out and meet people, why they must use a mask, etc. Hence, we must adjust our approach so that we can communicate effectively with a person with dementia. If you have a family member who is living with dementia, here are some advice in communicating COVID-19 information to a person with dementia.

1. Use simple words. Give them a clear and simple explanation about the current situation in a language they are most familiar with. We can begin with informing them that there is a new disease, COVID-19, which symptoms are quite similar to common cold, spreading in the community all over the world. Older people can get infected very easily. After that, we can give them some suggestions on how to keep ourselves safe from the virus, such as washing hands regularly, using face mask, avoiding touching face, and keeping physical distance from other people. Use short and simple sentences and give the information one by one. We can also stop occasionally and make sure they fully understand the information so far.

2. Give examples

To help a person with dementia understanding our message regarding preventative measures better, we can also show them directly. For example, we can ask them to wash hands together, so that they could copy your hand motion. It is also important for us to show that the whole family is implementing it in daily routines.

3. Put reminders

You could put some pictures or post-it notes as reminders in various spots within your home. For example, you can put hand-washing reminders on the fridge and near the dining table to remind them to wash hands before eating something, or on the mirror in their bedroom closet so they remember to wash hands before touching their face. You could also put a picture of face mask and a bottle of hand sanitiser near the front door so they remember to wear mask and bring hand sanitisers if they were to go out.


4. Make it fun! Do not use scare tactics to force a person with dementia to adopt the new habits. Help them find these new habits an enjoyable way to stay healthy. For example, we can provide them with a certain hand soap or hand sanitizer with a specific brand or aroma that they love. Prepare a bottle of hand lotion in their favourite aroma which they can put on after washing hands. They would also be happier to wear a mask made or given by their grandchild. Creativity is important to help a person with dementia find enjoyable activities at home. You can also read our other article about intergenerational activity ideas at home.

5. Give them emotional support

It is a difficult time for everyone, including for a person with dementia. Support them in getting through the anxiety and worry that they might have. Acknowledge and validate their feelings and make sure they know that you will always be there for them.

References:


2. Alzheimer’s Disease International. (2020). ADI offers advice and support during COVID-19. Retrieved from https://www.alz.co.uk/news/adi-offers-advice-and-support-during-covid-19

3. Turana, Y. (2020). Help the Elderly: Socially Connected when Social Distancing. Presentation, Indonesia




https://www.alz.co.uk/news/adi-offers-advice-and-support-during-covid-19

https://www.alz.co.uk/news/adi-offers-advice-and-support-during-covid-19


‘Musicking’ for Mental Health Due to the COVID-19 pandemic, people around the world must adopt social distancing as a new habit. These changes can affect our mental health. In this article we will explain how music can help us in maintaining our mental wellbeing. What is ‘Musicking’ for Mental Health? Christopher Small (1998) in his book, Musicking: The Meanings of Performing and Listening, defined the term ‘musicking’ as, “An involvement, in all capacities, in carrying out musical activities; whether as a performer, listener, by practicing, providing material for the performance, or dancing.” In this case, ‘Musicking for mental health’ means a self-involvement in musical activity of any form, as an active or receptive participant with the aim of supporting our mental health. Previous research around the world has shown that musicking gives positive impacts such as increasing motivation and creative engagement, improving mood, attention and communication. Musicking when done in a group also increases social engagement and bonding among the participants. Even though the forms of activity are often similar, musicking for mental health is a different concept with music therapy. In music therapy, sessions are guided by a formally-trained music therapist. In music therapy there are three elements: music therapist as the provider and facilitator of the intervention, music and music activity as the media, and the client as the receiver. Musicking for mental health can be done not only by musicians but also non-musicians. The purpose of this activity is to maintain our mental wellbeing, and not aiming to perform music in a professional setting, therefore, enjoying the activity should be the aim. This activity can be done independently, and therefore is suitable as one of the alternatives of meaningful activities for older people and/or their caregivers during this social distancing period. Read our article on Musicking for Older People and the Caregivers for more ideas and advice on musicking. Author(s): Kezia Putri, MMT, MTA, MT-BC


Musicking for Older People and the Caregivers The current COVID-19 outbreak happening across the world have forced the global citizens to limit activities outside their homes significantly. Music can help people to maintain their mental wellbeing during this period of social distancing. Active engagement of musicking can help older people living with dementia to stay oriented, to facilitate interaction and strengthen relationships with close friends and family and develop meaningful engagement. This, in turn, will lift their mood and increase motivation. Some music activities which can be done by older people and their caregivers are:

1. Listening or singing together memorable songs which the older person love to sing or listen to in the past. These songs can be songs in their mother tongue or a language they are familiar with, such as Mandarin, Dutch, English, Javanese, or other local dialects. Songs from their favourite artists or religious song they sing during worship might also be an option. To ensure significant impact, the caregivers are advised to stimulate discussion about the song or the artist. For example, which part of the lyrics they like? Which of this artist’s song is their favourite? What specific memory does this song remind them of? What is the message from the song that should be applied in daily life?

2. Dancing to the music or creating simple movements to do light stretching while listening to the music. For an older person who can play a musical instrument, practicing lightly with family members or a caregiver can help stimulate their cognitive function and encourage interaction. Musicking or music activity can also be an intergenerational activity. An older person can teach their grandchildren to play an instrument or just dance and sing with their grandchildren and other family members.

For caregivers, it is very important to take care of your own wellbeing while supporting a person with dementia. You can recreationally learn to play an instrument, write song lyrics, sing, or make a purposeful playlist and do a purposeful music listening. A purposeful playlist is a music playlist designed independently and personally by an individual based on their current emotion and the emotion they aim to reach. Purposeful playlist starts with a song which represent the current emotion and ends with a song corresponding to the target emotion. The person should then choose several songs that each represents gradually changing emotions between these two songs. The number of the songs may vary according to the person’s preference and need. If the playlist is too short, then the change of emotions will be too quick and difficult to be followed. On the other hand, if it is too long the listener might lose focus or get bored in the middle of the playlist.


Purposeful music listening is listening to a song in a mindful way, paying attention to the details. While listening to the song, try to pay attention to the changes of the tone, the volume, the tempo and other musical details. You can also intentionally play a relaxing song with a slow tempo and mindfully breathe according to the tempo. We hope that these examples can give you some ideas to maintain your mental health through music. The important thing in ‘musicking’ for older people and the caregivers is that it is done intentionally, allocating our time and focus for this activity, to ensure a significant benefit is achieved.

Author(s): Kezia Putri, MMT, MTA, MT-BC


Breaking bad news to People with Dementia

The COVID-19 outbreak has caused many people to experience serious health conditions requiring hospitalization or even resulting in death. Whether it is the death or illness of a close person, breaking bad news to anyone is never easy, let alone having to deliver it to a person living with dementia.

When a family or close relative must be quarantined or hospitalized, or if someone in the family passed away, the dilemma that often arises is: is it necessary to tell this to a person with dementia? Would they understand it? Would this put more burden on their mind?

Everyone reacts to bad news in different ways. The way it is delivered also has a significant impact on how someone deals with it. Delivering bad news is a difficult task. However, sometimes the benefit outweighs the risk. Trying to hide the fact might result in the person with dementia feeling left or rejected. For example, when a family member who is close to him died and it is hidden from him, he might think that this person no longer cares because they never visit or call again.

There are things to consider when breaking bad news to a person living with dementia:

1) The progression of the dementia

Understand their current stage of dementia. This will affect how to deliver the bad news, including the choice of words and to which extent the information needs to be delivered. It is important to understand that dementia can affect not only the thought process but also how they express emotion. This means their reaction to receiving the bad news may not always be appropriate.

2) Who delivers the news

It is better to appoint one person whom the person with dementia is comfortable to talk to, to be the main person to deliver the news and give updates to the person with dementia. Keeping the messenger consistent may help them connect the information better. If there are several family members present, avoid several people talking at the same time. Let the main person deliver the news first and give sufficient time for the person with dementia to respond or ask questions. The others then can take turn giving verbal or non-verbal support afterwards.

3) Time and place

Make sure you are both not in a rush and have sufficient time to talk, particularly to answer any question that the person with dementia might have. Also make sure the person with dementia have had sufficient rest, which will help them understand and process the information. Avoid noisy place, choose for a quiet and calm room where they can focus on your voice. Try to share the news as soon as possible, especially if it means there will be someone absent from their routine which might make them agitated.


4) Choice of words

Always use the language the person dementia is most fluent in and use words which are easy to understand. Dementia makes it difficult for someone to understand idioms or euphemisms. For example, tell them the person ‘has died’ instead of using euphemisms such as ‘passed away’, ‘no longer with us', ‘at peace now’, or 'in a better place'.

5) Pay attention to their reaction and give the needed support

Validate their feelings and let them express their emotions. Avoid dismissive responses, such as "don’t think about it!" or "you should not let this worry you".

Acknowledge that this news is indeed difficult to process, but that you are there for them and reassure them that you both will be be able to get through this together.

Sometimes, at an advanced stage of dementia, one can forget about the bad news. Sometimes they need to be told several times until they can really retain the information and accept the change. For example, a person might forget that his brother has died. However, he keeps on forgetting it and every time he is reminded he goes through a great deal of shock and sadness all over again as if he just heard the news the first time, it is alright if you might not want to tell them the bad news again.

Researchers Tuffrey-Wijne and Watchman (2015) identified steps in delivering bad news to people with cognitive problems, such as dementia:

1) Consider his current background knowledge

2) Understand what the ‘bad news’ is, and divide it into small chunks of information

3) Gradually provide the chunk of information you have, starting with what the person needs now

4) Check the person’s understanding and reaction, sometimes you need to repeat the information

Case study:

Alisa lived with her father who had been diagnosed with mild-moderate stage of dementia, Mr. Sumarso. Alisa was told that Uncle Sumardi, her father's brother had been suspected to be infected with COVID-19 and had to be hospitalized. All members of Uncle Sumardi’s household were instructed to self-quarantine, including the grandchildren.

Alisa considered Mr. Sumarso's understanding at this time:

x Mr. Sumarso understood that at the moment the COVID-19 outbreak was happening x He knew that his older brother was living with his son and daughter-in-law and two

grandchildren


Alisa divides the information into several sections:

- Uncle Sumardi was hospitalized as a COVID-19 suspect

- He was conscious, but experiencing shortness of breath

- Although he had not been confirmed for COVID-19, everyone in that household had to self-quarantine. This included two grandchildren who usually visit Mr. Sumarso's house every two weeks

- Other family members, including Mr. Sumarso, may not visit Uncle Sumardi

Alisa decided that the information her father needed now was that Uncle Sumardi was hospitalized. She gave the other information step-by-step according to Mr. Sumarso's responses and questions. When Mr. Sumarso expressed his worry and asked when he could come visit, Alisa acknowledged her father’s worry and retold the information that unfortunately no one were allowed to visit yet. Alisa informed him that she would give him daily updates about his brother.

References:

1. Tuffrey-Wijne, I., & Watchman, K. (2015). Breaking bad news to people with a learning disability. Learning Disability Practice, 18(7), 16–23. https://doi.org/10.12968/bjon.1998.7.2.86

2. Crossroads Hospice & Palliative Care. (2018). Breaking bad news to someone with dementia. Retrieved April 21, 2020, from https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/june/26/breaking-bad-news-to-someone-with-dementia/

Author(s): dr. Tara Puspitarini Sani, MD, MSc (Dementia)

https://doi.org/10.12968/bjon.1998.7.2.86

https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/june/26/breaking-bad-news-to-someone-with-dementia/

https://www.crossroadshospice.com/hospice-palliative-care-blog/2018/june/26/breaking-bad-news-to-someone-with-dementia/


Online Activity Ideas for People with Dementia

Social distancing pushes our creativity in finding meaningful activities. As we cannot leave our homes for non-essential matters, the boredom and worries about the current situation can affect anyone, including a person with dementia.

A lot of people use the internet for their leisure activities. Can online activities also be an option for persons living with dementia too?

Here we will share some ideas of online activities which can be enjoyed by persons with dementia, including those who have mobility limitations.

1. Brain training games

Many people find simple brain training games helpful in improving their memory and thinking. A few games examples we can download and play with them are memory games, jigsaw puzzle, crosswords, picture quiz, or general knowledge quiz.

Website/Apps to try: English Crosswords Puzzle, GuessUp – Word Party Charades & Family Game, and Train Your Brain – Memory Games.

2. Physical exercise

It is important to keep exercising while social distancing. Physical exercise for at least 30 minutes per day (or 2.5 hours per week) has been shown to improve cognition and mental health, besides physical health. We can show exercise videos on streaming applications such as Youtube which the person with dementia can follow. Encourage them to get moving while considering their strength and mobility capacity. For example, if they could not stand, encourage them to try following the movements from the waist above while sitting down.

Website/Apps to try: Youtube, with search keywords such as Senam Vitalisasi Otak (Brain Vitalising Exercise), Senam Lansia Taichi (Taichi for Older People), or Maumere and Poco-poco dance.

3. Creative activities

Creative activities has been shown to reduce negative emotion and increase positive ones, reduce stress and anxiety, and even improve medical outcomes in older people. We can choose from various activities available online. For example, apps for drawing or coloring for adults - which have simple yet elegant pictures. We can also invite them to follow a cooking or flower arranging tutorial on YouTube.

Website/Application to try: Coloring for Adults, Easy Drawing: Step by Step, or YouTube videos with search keywords such as Balloon Stamping Dementia Activity, Creative Dementia Activity, etc.


Advice on COVID-19 control for nursing homes In facing this COVID-19 pandemic, nursing homes need to take extra measures to prevent the spread of this virus that might be fatal to the older people living in the facility. Symptoms of COVID-19 varies from being asymptomatic to severe respiratory symptoms that lead to many complications that might end up with death. More severe cases are usually found in older patients (above 60 years old). The higher mortality rate in older people further causes more concerns in the measures nursing homes need to take in order to prevent COVID-19 to spread. Older people who live in nursing homes usually need assistance in their activities of daily living (ADL) such as eating and maintaining hygiene. It makes physical distancing almost impossible. Risk of COVID-19 spread is not just limited to the residents of nursing homes, but also to and from the staff that works in the nursing homes. Procedure to enter the facility Recent development of COVID-19 shows that many cases were asymptomatic, or showing very minimal symptoms, but still capable of transmitting the virus to other people, especially the more vulnerable groups. Visits from family and relatives are currently the biggest risk factor for COVID-19 to spread into the nursing home residents. Total restriction to visits by family and relatives to nursing homes should be imposed, except for end-of-life situation. Decisions to allow end-of-life visit should be made on a case-by-case basis, and this must include symptoms screening on the visitor and use of face mask. The number of visitors and the area the visitor is allowed to visit have to be limited. This restriction might result in a new problem which is the feeling of loneliness that leads to stress which might lower the immune system. Nursing home staff can help to minimise this by actively helping the residents to keep their communication with the outside world by using the help of technologies, such as video calls, of just simple phone calls. Nursing homes staffs also carry the risk of transmitting COVID-19 to the residents. Therefore, it is important to establish and implement fair, non-punitive sick leave regulations complying to public health policies for staff. Staff should be screened for COVID-19 symptoms before entering the facility for their shift and briefed to not come in when having a fever (>37.8o C) or other COVID-19 symptoms. If the staff develop symptoms while at work, they have to keep their face mask on, report to their supervisor, and leave the facility. Personal protective equipments Staff entering the facility are expected to wear masks (cloth masks are allowed) even without showing any symptoms. This will help to avoid any transmission from staff that might be infected but showing no symptoms. Staff and residents are also advised to increase their hygiene, especially by washing their hands more frequently with the right methods, using soap and


running water. Staff have to wash their hands before and after helping residents with their ADLs, or before any physical contact. The cloth face masks should also be provided for the nursing home residents. The residents should be advised to wear a mask when leaving their room. Intra-facility mobility restrictions Preventing nursing home residents to go out of their own rooms will help prevent the spread of COVID-19 between residents. However, to forbid the residents to leave their rooms might affect their health. Bigger scale nursing homes with large numbers of residents can divide the facility into segments of areas where the residents can still use communal spaces but limited to an extent so that they will gather in smaller groups and each person will touch less area - thus reducing transmission risk. It is important to list all the staff, their responsibilities, and map the area inside the facility where they work. Impose restriction to non-essential staff or volunteer to enter the resident area. Information Any procedure implemented, especially restrictions to the residents, would be more effective if we communicate correct, reasonable information and facts to the residents regarding the global crisis and the collective effort needed to lower the spread of this disease. With proper information, we hope that the residents will be more aware and can follow the changes and instructions given although it might disturb their peace. Provide information on how to wash hands or use hand sanitiser properly, how to wear and dispose face masks, and cough etiquette in simple instructions. Put pictures or texts as reminders and/or remind them directly. Monitoring Be aware that the symptoms of COVID-19, especially in older people, are not always respiratory tract related. Gastrointestinal symptoms, such as diarrhea, are often found in elderly COVID-19 patients. It is very important to recognise this and detect the disease early. As fever is also one of the early symptoms of COVID-19, routine temperature check for the residents also need to be done by staff properly using thermometers. If by any chance a resident is showing symptoms suggestive of COVID-19, even if it is mild, direct isolation/quarantine is needed for that resident in a room that is separated from other resident. The resident with symptoms should always wear mask . Staff then need to inform the doctor in charge or any healthcare staff or health authorities about the situation so that further actions can be taken according to the government policy.


References 1. https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes 2. https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html

Author(s): dr. Saskia Mariska, MPH

https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes

https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html


4. Relaxation

Sitting down and relaxing together after a long day of exploring various activities, is a much-needed time for you and your loved ones. There are several simple relaxation methods which can be accessed through apps in our very own gadgets. You can invite them to listen to their favorite oldies songs or to do some meditation together with classical music or nature sounds in the background. A previous study stated that music has the power to reduce stress, anxiety, and pain. Besides that, music can also help improve the quality of sleep as well as improving cognition. You can read our other article about Musicking for Older People and Caregivers here.

Website/Application to try: Breathing Relaxation Exercise or Calm: Meditation, Sleep, Relax 5. Social Interaction

For a person with dementia, a good relationship with their caregiver is a must. However, it is also essential to maintain interactions with other people to prevent feeling disconnected from the outside world. We could connect them with other family members who live in a different household, their peers, or their communities through video call features from various apps. We can also help them join a webinar or online meetings of their choice. Alzheimer Indonesia holds regular online meetings and webinars with various topics during this social distancing period. Please check our website and social media for more info.

Website/Application to try: Whatsapp, Zoom, Skype, etc.

References:

1. Adelayanti, N. (2020). UGM Expert Reveals Reasons Why Elderly Parents Are Susceptible to Covid-19 Transmission. Retrieved from https://ugm.ac.id/en/news/19322-ugm-expert-reveals-reasons-why-elderly-parents-are-susceptible-to-covid-19-transmission


3. Clear, J. (2015). Make More Art: The Health Benefits of Creativity. Retrieved from https://www.huffpost.com/entry/make-more-art-the-health-benefits-of-creativity_b_8868802

4. Daily Caring. (n.d.). 9 Enjoyable Activities for Seniors with Limited Mobility. Retrieved from https://dailycaring.com/9-enjoyable-activities-for-seniors-with-limited-mobility/

5. O’Niel, H. (2019) 5 online activity ideas for people living with dementia [Blog post]. Retrieved from https://www.alzheimers.org.uk/blog/5-online-activity-ideas-people-living-dementia


https://ugm.ac.id/en/news/19322-ugm-expert-reveals-reasons-why-elderly-parents-are-susceptible-to-covid-19-transmission

https://ugm.ac.id/en/news/19322-ugm-expert-reveals-reasons-why-elderly-parents-are-susceptible-to-covid-19-transmission



https://www.huffpost.com/entry/make-more-art-the-health-benefits-of-creativity_b_8868802

https://dailycaring.com/9-enjoyable-activities-for-seniors-with-limited-mobility/

https://www.alzheimers.org.uk/blog/5-online-activity-ideas-people-living-dementia

Documents

What you can do during the COVID-19 outbreak AgeUK Advice.pdf · The c } v e }f hi aicle i deel } ed b Ç Al Ìheime [ I vd } veia Talai } v i fi vaced b Ç Age International through