ABSTRACT
Introduction: The COVID-19 pandemic has disproportionately affected older adults. Older adults not only have worse coronavirus outcomes but also face significant disruptions in their medical and home care, and social support networks. The pandemic highlights the importance of geriatric and dementia services and the ongoing shortage of health professionals within these fields. We collaborated with Alzheimer's Association Connecticut to develop an e-curriculum to educate caregivers on how best to care for affected seniors during this public health crisis. Methods: We set out to design a novel, blended-learning intervention to improve COVID-19-related geriatric and dementia education. Stakeholder discussions and semi-structured interviews with caregiver support staff and educators were carried out as part of a local needs assessment. Four central themes were identified during these interviews and are now being used to develop an interactive animation-based curriculum on the challenges of administering care for older adults during the pandemic. Results: Our initial focus group with caregiver support staff and educators identified the following key challenges: 1) social isolation, 2) caregiver fatigue, 3) safety issues, and 4) difficulty navigating the healthcare system with COVID-19. We are developing 10 minute educational videos that focus on each of these four themes and incorporate 2-D vector animation and whiteboard style teaching. An additional video will discuss the biology of COVID and why elderly/cognitively impaired adults are at increased risk. Conclusion: Through a local needs assessment, we identified four themes as barriers to providing care for older adults in the COVID-19 era. This information will be used to create an e-curriculum to increase caregivers' confidence and comfort with supporting older adults during the current health crisis. This content may also facilitate important discussions beyond COVID-19 as challenges like caregiver burden and social isolation are not unique to the pandemic.
ABSTRACT
Background Communication with healthcare professionals can be a challenge for non-English-speaking older adults. From differences in culture and caretaking roles, to unique personalities and the presence or absence of non-verbal cues. Although studied in some care settings, such as nursing homes, little has been published about the treatment challenges with hospitalized non-English-speaking older adults, particularly those with dementia. We review a case of a non-English speaking hospitalized older adult and the barriers to communication impacting his care. Case 78-year-old fully dependent male with dementia arrived from Uruguay with his daughter 3 days prior to admission for altered mental status and lethargy. Medical history includes rapid decline in cognition over the past 4 years. Following his retirement and a change in residence, his family noted depressed affect, aggressiveness, hallucinations, and wandering. He was diagnosed with Alzheimer's Disease in Uruguay several months ago. Following some hospitalizations and drug-induced parkinsonism, he was brought to the U.S. to be close to family. In the hospital, the patient remained mostly uncommunicative despite the use of interpreters, and rejected food from providers, leading to concerns for delirium. It was not until an exception was granted for his daughter to assist in his care that the patient began to speak and accept food. Through his daughter, we learned that the patient had always been shy except when with her. Conclusion Communication challenges for hospitalized non-English-speaking older adults with dementia require attention. To comprehensively evaluate and treat “altered mental status” in the hospital, it is imperative to consider cultural and social contributions and to make adaptations to standard communication practices. This should include but is not limited to detailed history from and presence of loved ones at the bedside, presence of familiar objects (photos, blankets, food) and activities (music, activities), and the use of in-person interpreters. The Covid-19 pandemic further complicates communication with this subset of patients by the use of technology, use of personal protective equipment, and visitor restrictions. It is critical to help orient patients by creating as familiar of an environment as possible.