‘The way I talk has become different’: Isolation taking mental toll on LTC residents

Every Sunday morning at 11 a.m., Cathy Thompson video chats with her family to catch up. Amid the hellos and how-are-yous, she waits for a particularly important face to pop up on her screen: her 93-year-old mother residing in long-term care (LTC) in Cambridge, Ont.

Once an iPad is set up by LTC staff, Thompson’s mother takes a moment to comprehend what’s in front of her. “It always takes a little while for mom to get the sound right and to understand who all is on the screen,” says Thompson. “But it’s a wonderful opportunity for us all to see her and each other.”

Typically, Thompson visits her mother in person on Sunday afternoons as an essential caregiver. However, with only 12 visitations permitted per day at the LTC home, it’s not always possible. But Thompson says it’s important for her to visit as often as she can – her mother’s memory is fading.

“I usually go in a couple of hours after the video chat and mom will have already forgotten about it,” says Thompson. “But it happened, she was very happy, and we just have to enjoy the moment.”

Despite the weekly video chats and sit-downs, Thompson says her mother often feels lonely and spends much of her time sleeping until mealtime. Unfortunately, she isn’t the only one feeling this way.

An October 2020 survey by Altarum found that 76 per cent of American LTC residents felt lonelier under lockdown restrictions – unsurprising considering 64 per cent of respondents said they no longer leave their rooms to socialize with other residents due to personal choice or isolation rules.

Jacques Lee, research chair in geriatric emergency medicine at Schwartz Reisman Emergency Medicine Institution (SREMI), says that this social isolation is a major contributor to memory loss, which recent research in the Netherlands has confirmed: older adults who endure social isolation or loneliness are associated with a 50 per cent increased risk of developing conditions like dementia.

“It worsens quality of life,” says Lee. “We know that physical distancing measures are important and necessary, but we really have no idea how much worse (it’s) making an already extremely serious problem.”

According to the Alzheimer’s Association, Alzheimer’s and dementia-related deaths have increased by 16 per cent during the pandemic.

Stephanie Horner, a licensed practical nurse in Toronto’s LTC system, says that of her patients who eventually died, those experiencing memory loss declined in health much faster.

“They would lose interest in eating and drinking and they would feel very lonely,” says Horner. “Their well-being just went downhill very quickly.”

Thompson says while her mother’s memory was weakening when she first moved into LTC, it has only worsened since lockdowns began. In the last year, she says it “just went sliding downhill.”

“I think she’s deteriorated much faster than she would have otherwise,” says Thompson. “You have to repeat yourself 10 times in an hour versus once or twice in an hour (…) Quality of life be damned.”

Horner says that residents’ personalities have also been impacted by a lack of socialization. In extreme cases, behavioural specialists are required for additional aid.

“They’ve been quite prominent in terms of people we’ve communicated with,” says Horner. “(Many) behaviours are getting so much worse and residents that didn’t even have any issues before (COVID-19) have started having issues.”

For people living with dementia, routines are crucial for preventing agitation and “troublesome behaviors,” as described on WhereYouLiveMatters.org. But lockdown measures and social isolation have upended routines, leading to a deterioration of cognitive function in many with early signs of dementia.

A recent study by the British Geriatrics Society shows that even many older individuals who don’t live in LTC are reporting changes in speech, concentration, memory and balance in the past year. Study participants attribute the decline to a lack of cognitive stimulation due to social isolation and a loss of routine.

“The way I talk has become quite different,” says one anonymous participant. “Probably because I haven’t been talking to as many people, which I sort of preferred but probably didn’t realize how much good it was doing until I wasn’t doing it.”

To alleviate this problem in LTC, at least somewhat, Horner said many homes are scheduling weekly video chats with family like Thompson’s. “That still provides at least a little bit of visual connection,” says Horner. “And that’s really the only alternative right now.”

COVID-19 has inspired recent work at SREMI on an intervention called How Are You? that will refer older patients from geriatric psychiatry units to scheduled phone calls with hospital volunteers. The calls are expected to occur once a week for 12 weeks. At the time of publication, the project is still in development.

“We’re going to take hospital volunteers of the same age as the older patients and we’re going to randomize them to either getting a half-hour telephone call (…) or the same intervention delivered over a video chat,” says Lee.

For video chat, SREMI has partnered with software company Aetonix to install an application named aTouchAway in older patients’ devices.

“They take the app, they press one button, and they’re connected,” Lee says.

The goal is to analyze whether it will improve the health of those most impacted by social isolation. For lonely residents like Thompson’s mother, How Are You? could be life changing.

“She forgets that we’re in a pandemic and is constantly needing to be reminded why she’s isolated,” says Thompson. “It’s sad and mournful every time.”