This is part of a series of stories profiling members of the Niagara Health team and the work they are doing as part of our response to the COVID-19 pandemic. Meet Annie Lam, a Geriatric Assessment Nurse. June is Seniors Month.
Communicating with seniors who have memory loss and dementia can be challenging in general. But it’s even more difficult when there are restrictions like the ones in place during the pandemic, says Annie Lam, a Geriatric Assessment Nurse at Niagara Health.
Annie is a member of our Geriatric Assessment Program, which supports older adults – hospital patients and those living in the community -- with geriatric syndromes like memory problems, dementia, delirium, depression and mobility issues. The team is made up of Geriatric Assessment Nurses and Geriatricians, physicians who specialize in the care of older adults.
They provide physical, cognitive, psycho-social and environmental assessments to optimize the health and wellbeing of people, in addition to offering support to the patients’ caregivers who are often family members or other loved ones.
During the pandemic, in-person visits to the Geriatric Assessment outpatient program have been postponed to keep everyone safe. The team is using the telephone to support and stay in contact with patients and their caregivers.
What has changed about your work on the outpatient side of the program during the pandemic?
Part of our role involves case management over the phone with older patients and caregivers. However, conducting standardized testing over the phone, like memory tests, is something new that we’ve had to adjust to and learn about. Normally we would conduct those tests in person. We’ve been gathering the best evidence-based tools to be able to conduct the tests over the phone. Older adults sometimes have hearing impairment and it’s difficult for them to hear over the phone. So when you’re trying to conduct tests and get a good history, it can be challenging for them. The Regional Geriatric Program of Ontario has also released several evidenced-based resources since the pandemic started on how to properly conduct the cognitive testing and other geriatric assessments over the phone.
Have you used video conferencing with patients in the community?
The challenge with video conferencing is that a lot of our patients don’t have computers or a cellphone. Usually we rely on family caregivers to be there to assist with technology, but because of physical distancing not all caregivers are living in the same home as the older adults, so there is no one there to help them set it up. We’re hoping to move toward video conferencing, but for now we’ve been using telephone because that has been working well. People are comfortable with the phone.
What tips do you have for patients and caregivers during the pandemic?
It’s important to re-establish that sense of routine. It’s important for everyone to have routine, but especially for older adults. Use your technology, whether it be FaceTime, Skype or calling them, or visiting through a window or visiting on a driveway from a distance. Continue to visit your family members and encourage social interaction. Now that the weather is nice, we encourage older adults and caregivers to get outside and be active, in their gardens and walking through their neighbourhood while respecting physical distancing. We encourage physical activity because evidence shows that physical activity helps to maintain and improve your mental and cognitive health. Also, be sure to reach out for help if you need it. Organizations like the Alzheimer Society of Niagara and Behavioural Supports Ontario have great counsellors to support people throughout this.
How does the Geriatric Assessment Program team support patients in the hospital?
If a patient is having geriatric-related issues, like dementia or delirium (confusion), our team assesses them and provides recommendations to support the patient and interprofessional team. We work with other members of the healthcare team to support older adults and to better understand and manage responsive behaviours through person-centred approaches and medication adjustments. We collaborate with patients and their families to improve their quality of life.
What has been the most challenging part supporting hospital patients during the pandemic?
There have been two main challenges. The first is having to wear personal protective equipment, like masks and face shields. It has become more challenging to communicate with older adults. One of the things that people living with dementia sometimes lose is the ability to use language, so they rely on non-verbal cues. They’re really looking to your facial expressions to provide them with reassurance. Our eyes are still exposed so we try to be as animated as we can. I feel like I’m using body language more to express myself. The use of therapeutic, human touch is also important, like holding their hand or patting their shoulder to provide reassurance to our patients. The second most challenging part is supporting our family caregivers. Given that many resources and services have been put on hold due to the pandemic, we are looking for more creative ways to provide respite and encourage self-care among our caregivers.
What has the impact of a No Visitor Policy had on the patients you care for in the hospital?
A lot of our patients we see have some level of cognitive impairment, and they find a lot of comfort in their loved ones visiting. As a team, we try to figure out how to best support them, and how to reassure the patients if they are anxious, feeling down or responding with behaviours. It has required collaboration by all healthcare team members to help support patients and their caregivers. Everyone is working really hard on creative plans to provide the best care possible.
What is the most challenging part for you personally during the pandemic?
It has been difficult not being able to see my grandparents and be with them in person. You are social distancing to protect them, but you also feel guilty not being able to be there with them. I’m constantly thinking about how they are coping and their physical, mental and emotional health. We talk to them over the phone and we see them through the window, but it’s not the same as that human touch. Even just to give them a hug. It’s all you want to do.
How do you unwind after work?
I’m so grateful the weather is nicer now because I’ve been hiking and spending a lot more time in nature. Yoga also helps to ground me and put everything into perspective. Frequent communication with family and friends also helps me to unwind. It makes you feel like you are not alone through all of this.
Learn more about the Niagara Health Geriatric Assessment Program here. The team can also be reached by calling 905-378-4647, ext 53013.
COVID-19 resources for patients and families.
Read more In It Together stories about our team here.