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Activities at Home to Avoid COVID-19

Seniors over the age of 65 are more at risk from serious complications from COVID-19, such as pneumonia, respiratory arrest, intubation, prolonged hospital stays, and death. These illness often result in the progression of their cognitive impairment.

It is best to avoid contact with anyone not part of the immediate family or circle of friends unless they are wearing a (brand new) mask and gloves. I would recommend that the person avoid going out of the house unless absolutely necessary. The CDC recently acknowledged that there are asymptomatic carriers without signs of illness who can transmit the disease to people over the age of 65 or with dementia, with devastating consequences.

It can be very difficult* and time-consuming to come up with activities to do with your loved one at home. Activities such as watching TV or reading are not very stimulating for the brain, because they are passive and do not require frontal lobe participation on the part of the patient in forms of movement or decisive action.

However, if done successfully, the more active activities described below usually reduce fear about the future, anxiety, depression, a feeling of lost purpose in life, help maintain a routine, and improve sleep quality in people with cognitive impairment. They also improve quality of life for both the patient and the family member or friends.

You can see my other post on activities for memory loss patients here, but there have been new special recommendations from the Alzheimer's Foundation of America in times of COVD-19 that I find particularly innovative.

*Please note that it is normal for a patient who is asked whether they would like to any activity to answer, "No," but if a family member or friend starts doing it next to them on their own or asks later as if they need help (even if they may not), the person is more likely to join. I recommend saying, "I need help with this. I can't do this on my own. Can you help me with [insert person's name]?" This gives the person a sense of purpose and usefulness to the patient which may have been lacking for some time, in fact if they have been criticized before for "doing nothing" or "having memory problems," or told not to do things at home because of errors or safety concerns. Participation with a well-known loved one or friend is ESSENTIAL for a person with cognitive impairment to benefit and persist the most in these activities. Especially if it is incorporated as part of a daily routine. Cognitive and social activities (both of which fit into these categories) are as important as medications in slowing down the progression of memory loss. They must be done TOGETHER.

During future visits with me, I would like you (my patients or family members/friends) to show me on a calendar, or text me their DAILY ROUTINE on OhMD so we make sure they are getting the brain stimulation they need on a daily basis during these times of COVID-19, with perhaps Saturdays and Sundays with breaks. As you may have heard me say several times, aerobic exercise in combination with social and cognitive activity more than doubles the effect of medicine in slowing down cognitive impairment and reducing the risk of dementia, as well as reducing the risk of cognitive impairment in family members and improving quality of life! So please send me these daily routines.

These include:

Aerobic Exercise

This is by far the most brain-activating activity that can be done. Starting slow (up to 5 minutes per day for 4-5 times per week and working up to 20-30 minutes per day) is the best way to avoid physical injury. It is very common to sprain muscles or injure tendons when aerobic exercise is suddenly done vigorously with no escalation period.

Almost 100% of the time this MUST be done in participation with a loved one. Usually people with cognitive impairment like to continue their previous routines, or have apathy due to brain degeneration. They need someone who cares about them to say, "I'm going to do this, and it would be so fun if you would join me for a few minutes," instead of saying, "You should do your exercise now."

I usually recommend purchasing 2 stationary bikes to use at the same time together, or getting in the pool and walking together for at least 20 minutes 4-5 times per week. The person may start slow (only 2-5 minutes) and then work up to the point they are at their aerobic heart rate. To learn to calculate aerobic heart rate, please click here.

Verbal creativity (Left-brained)

-Looking through family photos with a loved one. I recommend asking them what it was like at that time, what they were thinking in the photo, or what they thought of the fashions, and writing them down on the back of the photo or under the photo in the album so you can review this later with them, and read back what they said. This often produces very entertaining and funny results. I have started doing this with my mom and it has been a great experience for both of us, and resulted in a treasure I will keep forever and am planning to upload digitally.

-Writing physical letters or emails to family members, TOGETHER. A person may not be able to write more than a few words at a time, but if you ask them what they want to write about and read to them a list of potential topics or words when they get stuck, they can refer to them as a reminder. Again, they usually need participation of their loved one or trusted friend or family member to sit with them and help do this. Then you can sit down and help edit the letter or email and send it if needed. You may want to trigger the letter or email by showing them a recent photo of something they have done and want to tell them about.

-Reading a book aloud together, the topic of which the patient is interested in. I would stop every 1-4 sentences and ask him/her a question about what they thought about what happened, such as, "What do you think that person is thinking? Or why do you think they are doing that? Or what do you think is going to happen next?" This way they don't tend to zone out and stay engaged in the topic. Depending on the stage of their cognitive impairment, you may need to look in the young adults or even children's sections of the book store. In general, patients with a Alzheimer's disease of cognitive impairment have trouble registering sentences of just a few words in length, usually 4-7 words. So you may need to look in the children's section to see the length of the sentences in words, even in mild Alzheimer's Disease. But purchase a book that may not look overtly like a children's book not to offend the person. You can bring these books to me on future appointments we can review them together to come up with the best points to stop and ask them questions. I would recommend writing down their responses so you can review this again with them later, and even see what they thought of their responses.

-Trivia Games such as Trivial Pursuit, but to get versions in keeping with the patient's prior interests. Don't have a scolding or negative tone when they're wrong. I recommend saying, even if they are wrong, "Wow! You're right, but it also". Below is a version of Trivial pursuit from the 1960's era. I would not recommend keeping points to compete against each other, but perhaps keeping track of how many questions correct compared to the last time he/she played the game. This may show their progress, and make them feel very good about how their brain is doing.

Visual stimulation (Right brained)

-Playing with highly tactile objects, such as flowers. Flower arranging can be particularly stimulating for people who used to enjoy doing this before. Gardening and providing a seated environment for it has been described in my previous post here.

-Creating a collage by cutting out colored forms ahead of times or pictures has been described here.

-For moderate to severe stages, matching socks, folding towels, and putting them in their appropriate locations. This provides tactile information, can be somewhat relaxing, and make them feel like they have a purpose in the household. This can be very helpful for moderate to severe stages, especially if they used to do this previously in life.

The Alzheimer's Foundation of America has regular visual therapeutic programs that I highly recommend. Please check out their calendar, which has activities for both patients and caregivers to relieve stress. These include Art, Earth Day Crafts, Dog Therapy, and Caregiver Stress Reduction Sundays.

Please contact me for an appointment during which I can recommend personalized activities to do with your loved on based on their cognitive abilities. Telemedicine or a phone call is always available as well.


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