In the WAM Weekly, we asked superstar Gerontologist and Chief of Geriatric Medicine at UC Irvine, Lisa Gibbs, MD, how the pandemic has impacted the millions of Americans caring for someone with Alzheimer’s or dementia.

WAM: Caregiving is stressful under the best of circumstances, but COVID is adding another layer or complication. What are you hearing from families?

Gibbs: The pandemic is indeed adding numerous stresses to families and caregivers. Social distancing and sheltering in place is easier for some than others. Many caregivers who work outside the home are now working from home. While this may be convenient in some ways, it can present new challenges, such as loss of boundaries between work and home. In addition, the closure of senior centers and adult day healthcare facilities means that seniors have lost outlets for social and mental stimulation which is a necessity for maintaining mental health. Also, caregivers have lost respite time to relax or focus on other responsibilities.

WAM: What are the challenges facing families as they care for loved ones in the middle of a pandemic?

Gibbs: One major challenge is keeping loved ones, especially older adults, safe from COVID. Family caregivers are worried about bringing COVID home to loved ones, and this is even more challenging in multigenerational households, especially for front line workers who don’t have the option to work at home. Also, those families who count on paid caregivers may not have this support now due to COVID illnesses, or concern about letting others into their home. This increases the caregiving responsibilities for the primary caregiver, who may also be working. Employers need to be understanding if employees need increased flexibility due to caregiving at home, especially since caregiving support may be needed at fixed times during the days and nights.

WAM: What are the consequences of isolation on patients and caregivers?

Gibbs: We are seeing increased anxiety and depression in our patients, not only due to the risk of COVID but also because we aren’t able to socialize normally. Holidays may be especially difficult for families who have wisely stayed away from loved ones to be safe. Certainly, daily interactions and support, such as in person support groups, community groups, or church groups are either not occurring or are online. We have many patients who have lost these human connections because they either don’t have a digital device or stable internet or are not comfortable using them. Digital access is such an important link to the world outside.

This is a tough situation, but staying connected to friends and family by phone, or teleconferencing, is critical. Also, rediscovering or finding new hobbies is important for our emotional and mental health. Many of our patients are gardening and enjoying the outdoors, for instance. Exercise is also so important, and customizable to one’s physical abilities. Exercise improves mental health, and improves sleep which in turn improves mental health and reduces stress.

In patients with cognitive impairments, social interaction is critical, and we have seen the effects of depression on memory.  This is true for those living in the community as well as those in assisted living or nursing homes. In many facilities, social distancing also means eating, sleeping and staying in one’s own room by themselves. We have had some families move their loved ones out of facilities, but not everyone has this option. It’s been heartbreaking for seniors and loved ones alike.

WAM: What concerns do you have, if any, about patients postponing necessary health care because of their COVID-19–related concerns?

Gibbs: Patients shouldn’t delay medical care that is considered essential. Ongoing care saves lives, especially for those with chronic conditions such as diabetes, hypertension, heart failure and others.  Keeping up with preventive care, such as vaccines, mammograms and colonoscopies are also important. The pandemic will have lasted over a year at least- it has taken much from us, but we shouldn’t sacrifice self-care.