Fighting loneliness during COVID19 with dementia study findings
Touch is a basic human need, even during a pandemic
Christmas is less than a month away. In pre-pandemic times, the run-up to this holiday is filled with social events – drinks with friends, family get-togethers, work parties – but the threat of being infected with COVID19 has meant that all these events have been canceled or postponed until 2021. The pre-Christmas shopping frenzy is also a non-event, with the only people feeling the frenzy being online retailers and delivery people. The nostalgia for the smell of mulled wine and roasted chestnuts being sold on busy street corners, or for the sound of Christmas carols on repeat in every department store or supermarket is fooling with our emotions. The prediction of a quiet, dull, and homebound week of festivities is not being celebrated by the majority of us.
Loneliness for you own safety
It has been a long year with few visits to elderly parents, grandparents, friends and neighbors. While we miss their company, nobody wants to be responsible for infecting an older person and reducing their lifespan. Although there is a real reason for the lack of contact, the result has been older people alone and lonely, for almost a year. Shielding them to protect them from the virus is having negative effects on mental health, which in turn, reduces quality of life and longevity.
Many healthcare articles advise people to be active, social, and busy.
In fact, scientist have discovered that an extended period of loneliness can result in depression, in 18% of people over the age of 52, over the subsequent 12 years. Being able to introduce protective factors to protect your mental health as a 52-year-old is a lot easier than when you are 82. Many healthcare articles advise people to be active, social, and busy. Having worked with the over 65 population for a few decades, I know that this advice can be almost impossible to follow, especially if you are depressed, isolated, poor, wheelchair-bound, or cognitively impaired. It can also be difficult if family members live at a distance, or when friend circles are diminished by the illness and death.
Internet connections don’t work for everyone
The COVID19 pandemic has resulted in children being exposed to online school and socializing at a speed and level that most parents feel guilty about. Almost as guilty as the fact that children can’t meet their friends in parks, at birthday parties, or for sporting events. As such, necessary evils like YouTube, TikTok, Facebook, and a multitude on online gaming platforms, like Among Us, have barged into the lives of families. And, we have learned to be somewhat grateful as children experience less isolation by entering this online world to connect with their friends, peers and teachers. In a perfect world, we would all be equally connected to this matrix.
Like many older people, the value placed on social contact comes with a hierarchy of restrictions.
Learning how to use the internet when you are 80 can require a commitment – learning new skills, buying the technology, and installing the internet. While most people can easily identify the benefits of being connected to the online world, there also exists a psychological barrier. The perspective that a real, face-to-face or ear-to-ear conversation is better than an email or WhatsApp call, is holding many older people back. Similarly, learning and remembering how to use the technology is an obvious hindrance, that is apparent in my own older family members. Like many older people, the value placed on social contact comes with a hierarchy of restrictions. These reasons have made life a lonely place for many older people – who long to hug their grandchildren, slap their buddies on the back, and kiss the cheeks of their adult children and friends.
Touch is a basic human need
Much research has been done on the human need for non-sexual physical contact with other people. Touch is a basic human need. Child development psychologists and pediatric specialists continue to push the necessity of touch in developing the bond between mother and newborn child. The work of neuropsychologist, James Prescott Ph.D., revealed that cultures where mothers carried their children on their backs for the first 5 years, were more peaceful cultures than in cultures where this was not the practice. His later work identified a correlation in an increased incidence of emotional disturbances and violent behaviors in individuals who had limited or inadequate physical contact with a maternal figure during the developmental phase of early childhood.
Touch as a safety blanket
The same need continues in adults. Dacher Keltner’s research found that touch is fundamental to human bonding, communication and health. Further, touch signifies trust, security and has the benefit of soothing the individual. How apt for people filled with anxiety caused by not being confident in their own life experiences and environment; people who are sick, old, isolated, or being avoided to reduce the chances of being infected with the COVID19 virus. Touch is the means to communicating love and support with someone who is no longer able to follow and partake in a stimulating conversation. Touch tells them that they are still a valuable part of our lives.
Let’s take this paper to a place where touch has always been hard to come by, but that is now almost non-existent if you exclude essential nursing interventions, like showering and toileting.
Touch is the means to communicating love and support with someone who is no longer able to follow and partake in a stimulating conversation.
If an old person needs to more into an aged care facility, chances are that they will be able to communicate with other residents at mealtimes or during the daily list of required social activities. Many people will be lucky to enjoy an occasional visit from a family member or friend. This is obviously in pre-pandemic times.
But, for someone admitted to a secure unit for people with dementia due to their problematic symptoms – for example, wandering away from the home and being lost; behavioral changes placing the caregiver at risk; anxiety-related to delusional thoughts or being unable to recognize a spouse or family members; or safety risks that can not be minimized by inserting community services, for example trying to cook, and not accepting food delivery services – being the recipient of physical touch, before and now, is unusual.
Tales of touch from locked dementia care units
During my years as a senior social worker specializing in older adult mental health, I worked in 3 secure units based in hospitals and visited many more that belonged to aged care facilities. As a professional, I can confirm that people with dementia do respond to touch and that the need for physical contact does not diminish with their cognitive abilities. Below are 3 examples that have stayed with me.
Let’s begin with an uncomfortable tale. An elderly woman was admitted from an aged care facility to the dementia unit due to her ‘challenging’ behaviors. Specifically, the lady was agitated, intrusive—this usually means that the person goes into other residents’ rooms and touches their things or tries frequently to enter the staff office – and was regularly seen masturbating in the public spaces. Her dementia had progressed to the stage where she made unintelligible sounds and was unable to communicate in words. She liked to approach staff and other residents, offering to shake hands, pulling her hand up out of her skirt waistband and underwear. Many times a day she wore a lovely smile on her face, but this was occasionally replaced by distress and anxiety as she attempted to understand her environment. No one wanted to touch her.
As a professional, I can confirm that people with dementia do respond to touch and that the need for physical contact does not diminish with their cognitive abilities.
A second undesirable situation in dementia care units, occasionally reported by family and staff is that of, physical relationships between residents. It is very distressing for long-term spouses to not be recognized by their partner with dementia. More so, seeing your spouse sitting holding hands with a fellow resident. Yet these residents are generally calmer and happier within the care facility, after establishing these new relationships that generally involve some form of touch, like hand-holding and hugging.
My last story relates a less common dementia scenario, due to the fact that early-onset dementia – in people under 65 – occurs with much lower frequency than other dementias. A 25-year-old woman is upset that her father wants her mother, aged 52, placed into an aged care facility so that he can pursue his new relationship with an old family friend. Her father has been the primary caregiver for his wife for 2 years, having given up both his full-time job and most of his hobbies. The husband indicates that he does not want to continue in this role. He actively talks about his own need for love and support, no longer available from his wife due to her dementia.
Touch has a memory
Dementia robs individuals of the comfort and security that comes from being touched, hugged, stroked, and loved. Often people with dementia are no longer able to initiate the physical connections that are expected by spouses and family members. Often family members think that the lack of response from the person, means that they do not want to be touched. And sometimes, it is the intact memory of a spouse and recollections of the past physical relationship with their now cognitively compromised partner, that reduces the desire to touch and hold the person.
There is a strange disconnect exists between the research on dementia and the provision of dementia care.
All these factors are undeniable contributors to why many people with dementia lack the experience of physical contact that all humans need. There is a strange disconnect exists between the research on dementia and the provision of dementia care. Dementia specialists have known about the need for physical stimulation for decades. In the 1980s, snoezelen or multi-sensory rooms were introduced into dementia care in the Netherlands. The idea behind these rooms is that a person with dementia, autism, or brain injury who is suffering from anxiety, can be calmed by being in an environment that stimulates their senses. These rooms concentrate on lighting, sounds, smells, and textures – which can, not always, reduce anxiety by stimulating a different part of the person’s brain. Undoubtedly, some snoezelen rooms are better designed than others, but the take-home point is that the need for tactile input has been clear for decades in dementia facilities.
Dolls, children and pets as therapy
The use of dolls to soothe older people, generally women, who are distressed further attests to the benefits of human connection through touch. Yes, it can be strangely disturbing to see an older person lovingly talking and cuddling a doll in a dementia facility – but the improved mood of the person makes this practice a worthwhile and medication-free solution.
Similarly, in pandemic-free times, many aged care facilities invited childcare centers and kindergartens to the facility so that children were able to visit with the residents. These inquisitive visitors are not afraid of dementia and will happily connect with the old people who seem to become a little more cognitively aware of the noise and buzz of young children.
Researchers of dog therapy in dementia care, found that a dog can help increase physical activity, communication, and short-term memory.
Finally, pet therapy in aged care facilities, including in secure dementia care units, can brighten the mood of both residents and staff members. Pet therapy has also been used with children and adults with brain injuries, chronic illnesses, and mental health problems. Researchers of dog therapy in dementia care, found that a dog can help increase physical activity, communication, and short-term memory. A reduction in dementia-specific symptoms like wandering, agitation, and delusional thought was noted. Most importantly, feelings of loneliness were lessened. Cat lovers will be happy to hear that similar results have been attributed to these feline creatures. Guidelines on pet therapy for people with dementia are available from the Alzheimer’s Association.
Retro advice to connect
To end, this festive season think about the older people in your family and work out how to connect with them in a way that shows them that you are thinking of them. Remember that isolation brings loneliness that can be exacerbated by expectations and memories of family togetherness at this time of the year. If your family member can use technology, you are lucky and contact should be easy. For other families, think about how contact was made in previous decades and go retro. Make phone calls, send mail and ask neighbors, friends, community members to check in on your older person. If your family member is in aged care, send old photos or music that will mean something to them and possibly trigger their memory and promote a feeling of connectedness.
Klimova, B., Toman, J. & Kuca, K. Effectiveness of the dog therapy for patients with dementia – a systematic review. BMC Psychiatry 19, 276 (2019). https://doi.org/10.1186/s12888-019-2245-x
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Prescott J. (1974). Cross-cultural studies of violence, in aggressive behavior: current progress in pre-clinical and clinical research. Los Angeles, CA: University of California.
Prescott, J. W. (1979b). Deprivation of physical affection as a primary process in the development of physical violence. Child Abuse and Violence (Gil, D. G., Ed). AMS Press. New York pp. 66-137.
University College London. (2020, November 10). Loneliness a leading cause of depression in older adults. ScienceDaily.
Wallace, Sarah & Graham, Christin & Saraceno, Amy. (2013). Older Adults’ Use of Technology. Perspectives on Gerontology. 18. 50-59. 10.1044/gero18.2.50.