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Thursday, June 20, 2024
Dr. Brown: Opinion: Imagine isolation in care homes, especially for those with dementia

Drs. William Brown, Martha Truncale and Timothy Brown
Special to The Lake Report

With this the third surge, Ontario enters yet another lockdown to contain the spread of a far more formidable viral foe – the highly transmissible U.K. variant.

And to no one’s surprise, because of this variant and delays locking down, daily infection rates are climbing steeply, and ICUs and health care staff are stretched to the limit. And for wont of vaccines, some vaccination clinics have often been cancelled. All in all, it's the perfect viral storm and isolation in some form for many.

The second surge, which followed the Christmas period, forced many long-term care facilities in the region to isolate their residents for several weeks.

Throughout this period meals were delivered to their rooms, but residents were confined with little to do and none of the usual social contacts except for occasional meetings with family members using social media.

Isolation was mandated “out of an abundance of caution” as the phrase goes, to protect residents from becoming infected. Unfortunately, many staff members and residents became infected with COVID and some residents died as a result.

Isolation has been and remains a challenge for many during this pandemic. For patients in ICUs, at the point of the crisis, to be truly alone is frightening and final. For their families waiting for news, wishing they could offer their presence and a friendly hand to hold, it must be wrenching.

Some units try their best to maintain some sort of electronic contact but in the same room, holding hands contact is usually strictly verboten. Not so well-known and appreciated was the isolation of residents out of sight in nursing homes, where much of the dying took place early on in this pandemic.

Imagine for a moment what it would be like to be shut in one room for weeks on end with little social interaction except for meals, the comings and goings of staff, with no opportunity to walk the corridors, visit common spaces or perhaps even get outside for a walk in a fenced space.

For those of sound mind, isolation might be tolerable, if only because they might understand the reasons for their confinement.

Imagine then what the impact of isolation might be for those who live in the moment, unable to remember much of the past and struggle to make sense of who’s who and the intentions of others from one minute to the next.

Repeated reminders to stay in their rooms would be promptly forgotten and well beyond the capacity of their brains to grasp what’s going on. That’s what happens with most dementias, especially of the Alzheimer type. Many, like my wife, have no idea what’s going on around them.

Jan was one of the many residents who developed COVID-19 following the post-Christmas surge and that, coupled with the disorienting effect of a long period of isolation, took its toll on her awareness and understanding of the mini-world she inhabits.

Not surprisingly, when for understandable reasons she was moved to another room, she kept returning to her “old” room, sometimes to lie down on what she thought was her bed or use what she thought was her bathroom.

That's how disorienting dementia, isolation and changing routines can be for those without the cognitive wherewithal to make sense of the space and people that surround them and remember mistakes made hours or even minutes before.

That’s what also may lead to misunderstandings with other residents and yet one more reason why isolation – unless there’s a very sound health care reason to impose it – is such a bad idea for those whose social and situational awareness are tenuous at best.

Yet that’s precisely what happened recently, after a staff member tested positive for COVID-19, when again “out of an abundance of caution,” in-room lockdown and hence isolation, was imposed on residents.

But why isolate residents once more? In the NOTL long-term care facility where Jan lives – as I understand matters – she and most residents are now fully vaccinated.

To be fully vaccinated does not mean you can’t become infected. You can, but vaccinated residents are at very low risk of developing clinically significant COVID-19. And balanced against the risk of infection must be the risk of creating even more havoc and confusion for those patients with dementia.

We must examine the balance between how we protect residents from COVID-19 and the harm we create with isolation.

In varying degrees this year, we have all experienced isolation. But the worst impact of isolation has fallen on patients in intensive care units and in long-term care facilities, especially those suffering with dementia.

Isolation may have helped to stem the spread of COVID during the second surge before vaccination was possible but makes little sense once most are fully vaccinated because of the cost in quality of life especially for the cognitively impaired.

This is a discussion that those who shape health care policies need to have in conjunction with the community and concerned families to reach the wisest decisions.

Here, the usual “out of an abundance of caution” no longer makes sense. Life is not just the “breath of life” but the quality of life.

Dr. William Brown is a professor of neurology at McMaster University and co-founder of the Infohealth series at the Niagara-on-the-Lake Public Library. His daughter, Dr. Martha Truncale, is an orthodontist in Alaska and his son, Dr. Timothy Brown is an ear, nose and throat surgeon in Halifax.



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