As the pandemic continues to isolate older adults (as a matter of health and safety) from their families and communities, Sweet Readers is connecting them with trained students through creative virtual visits and interactive programs. Everyone has been displaced somehow because of COVID-19 and, in some ways, this has broadened our common ground, making the timing better than ever to develop meaningful cross-generational relationships.
Due to the pandemic, 22% of U.S. adults moved locations or knew someone that did (Pew Research Center, 2020) and 60% of children around the world are experiencing a form of lockdown (United Nations Policy Brief, 2020). While the elderly are at especially high risk for contracting the coronavirus, children, separated from their friends and schools, also risk the harmful effects of loneliness and isolation. Sweet Readers provides invaluable connection and community, a sense of “normalcy” during turbulent times, which is invaluable for people across all generations.
The pandemic has also upended medicine and healthcare and challenged the very people (doctors, researchers, nurses, medical staff, care providers, etc.) we depend on to restore, improve, and, in some cases, maintain our health. As Sweet Readers Summer Interns, we had the opportunity to interview Dr. Sam Gandy, MD, PhD and Director of Mount Sinai School of Medicine’s Alzheimer’s Disease Research Center. We discussed how the coronavirus pandemic is impacting doctors and patients, especially those with cognitive impairments.
AP (Anna Pitts): How has your “place/location” changed during this pandemic?
SG (Dr. Sam Gandy): Physically, since February, I almost never leave my home except to run essential personal errands and to walk the dog. Yes, this is very different.
SK (Samantha Kritzer): What is your typical day like now? Are you able to conduct research and see patients in your office?
SG: My day consists of queued up appointments for Zoom meetings and phone calls, managing email in between. My research group meets regularly by Zoom, and I see patients by Zoom as well.
SK: Are you able to fully examine a patient over a zoom meeting?
SG: Since most of my patients have memory disorders, reliable information is usually conveyed to me not by the patient but by a collateral informant. Since most of that is conversation rather than exam, I can get a pretty good idea of what’s going on from a good collateral informant.
SK: What have you found to be the benefits and limitations of telemedicine?
SG: The main benefit is the element of safety during a pandemic. The main limitation is that we cannot check vital signs, e.g. There is accumulating evidence that appropriate blood pressure control is key to managing brain function, so I feel more compelled than ever that neurologists should record vital signs. Prior to the pandemic, efforts at installing home computers for research were stymied by the hurdle of having someone on site who was facile with the technology. Having been associated with that failed home computer experiment, I have been surprised at how well the transition to telehealth has gone. “Necessity is the mother of invention” (from The Republic, by Plato).
AP: How do you think COVID-19 has affected the lives of the elderly?
SG: The elderly tend to have smaller circles of friends and family. With COVID-19, they (and we all) are more isolated than ever.
AP: How do you think the lack of visitation in elder care centers has impacted those living with cognitive impairments?
SG: I think that those in care centers must be lonelier and more disoriented than they might be otherwise. My sense is that they must also be more anxious. This must also aggravate paranoia and agitation.
SK: Have you seen a faster progression in Alzheimer’s patients?
SG: I think that that varies with the severity of dementia and the status of the home situation. There now [appears] to more [frequently] be some background of chronic bewilderment which seems different from before, but I am not sure how much impact that has on their health. Most of us alive today had only a superficial understanding of the influenza pandemic of 1918. This “new normal” is like having been teleported to a new planet.
AP: Do you think that a change in place/location can affect one’s mental health? How do you think changes in place have altered the lives of the elderly with cognitive impairments?
SG: For people in good mental health, a change of scenery can be refreshing. For those with memory disorders, the classic situation [of] relocating to a new venue, [often leads them to become] anxious and disoriented, especially if they wake in the middle of the night and do not recognize their environments. In the pre-COVID-19 world, this could be managed by always having a family member or well-known carer close at hand, standing by to reassure the person living with dementia. This can still happen in families that are sheltering together already, but that is not always the case. Otherwise, there is the challenge of how to put the person with dementia together with an out-of-home friend or family member while maintaining safety.
SK: How can we best protect the long term health of people living with dementia?
SG: Diet, exercise, and heart health are the best interventions we have for dementia. So long as those are tended and the situation does not aggravate anxiety or disorientation, I am not sure that long term health is affected [by the pandemic]. The average time from diagnosis to death in a patient with Alzheimer’s is about 10 yrs, maybe 15 yrs if there is extraordinary support. I am not sure dementia is accelerated during the pandemic. There is also the difficult ethical question of the benefit of sustaining life when there is little or no remaining quality of life or the ability to enjoy life. There is no easy answer to these difficult issues. We also confront the same challenges as we develop new drugs and determine which stages of illness to target.
AP: How can people work to improve the lives of the elderly during these troubling times?
SG: Our Center routinely refers caregivers to Sweet Readers, and there is usually great success. There is something about social contact between humans that is good for the human brain. I have [also] been surprised at how well my virtual visits with patients have gone. In many cases, the carers are mostly supervisors, and learning the new technology provides them with stimulation and challenge. Those living with dementia and their peers mostly were raised before technical and computer expertise was as typical as it is for those growing up now, so there are some stars that need to be aligned to optimize virtual encounters. Our Center now has a fulltime telehealth support expert .
Dr. Sam Gandy is an expert in the field of cognitive brain health and we thank him and all of the healthcare workers for being true heroes and supporting the world during this turbulent time. We hope our interview with Dr. Gandy provided insight into how the healthcare system has been affected as well as information about people living with cognitive impairments and how to help them.
Article written by: Samantha Kritzer, a rising junior at Brown University and Anna Pitts, a rising sophomore at Dartmouth College, who have been involved with the Sweet Readers Organization for the past eight and seven years, respectively.