The COVID-19 pandemic has been devastating for residents of long-term care facilities—especially for those with dementia, says geriatric psychiatrist Nick Schor.
“If someone’s telling you to stay in your room, and you don’t understand why, you’re going to try and get out of your room, and you’re going to get agitated,” says Schor, 48, the founder of Olney Geriatric Psychiatry. “It just was a nightmare.”
Schor specializes in treating people with dementias, including Alzheimer’s disease, and other neurodegenerative conditions such as Parkinson’s. About 20% of his patients died during the first year of the pandemic—mostly of COVID-19. After providing remote care for several months, he returned to his regular rounds at about 40 area nursing homes, assisted living facilities and small group homes in January 2021. Schor says he saw the toll that isolation had taken on many of his patients—in some cases hastening the progression of their diseases.
Most often, Schor and the two nurse practitioners in his practice are called by caregivers when someone is having a problem such as trouble sleeping, loss of appetite, hallucinations, restlessness, aggression, anxiety or paranoia. About 90% of people with dementia experience behavioral or psychiatric issues at some point in their illness, according to Schor, who is president of the Metropolitan Washington, D.C., chapter of the American Geriatrics Society.
“While a good portion of what we do to help our patients is medicating them, we are not in the zombie-making business,” Schor says. He looks at an individual’s environment and life story to suggest changes. For instance, if a patient who is refusing to take a shower had been in the military, Schor might suggest an approach saying, “Soldier, it’s 0700 hours. Let’s go.” A Holocaust survivor may have a different association with a shower, so instead he recommends a warm towel bath in bed. “We look at their strengths and their vulnerabilities. We focus on what they can do and try to make accommodations,” says Schor, who typically sees each of his patients about once a month.
Educating family members is also part of his approach. A common piece of advice: “It’s more important to be kind than to be right,” he says. If someone with dementia asks where their husband is, for example, it’s much kinder to say that the spouse is working late rather than reminding them that he died. If a person is repetitively asking the same question, Schor encourages understanding. “If you keep telling them, ‘I just told you that,’ that is not going to help them remember,” Schor says. “I think a lot of difficulties and frustrations that people have with individuals with dementia is that they feel like it’s ‘they won’t’ rather than ‘they can’t.’ The issue is they can’t remember, and no amount of telling them is going to fix it.”
Despite the challenges and the heartache, Schor, who grew up in Silver Spring and graduated from Howard University College of Medicine in 2000, says he finds it meaningful to work with people in their twilight years.
“All of our patients have an incurable disease,” he says. “We are helpless to cure the disease, but our goals are maximizing their safety, comfort and dignity.”
In his own words…
Tell me a story
“The way dementia works is our most recent experiences are the ones that we tend not to be able to recall. But people can recall quite a bit from their earlier life. People have a lot of wisdom that they can still share. Engaging with the person, asking them questions, asking them to tell stories can be a beautiful way for families to connect with their loved ones—even if they aren’t going to remember the next day that they had that conversation.”
“Unfortunately, there is still a prominence of anti-psychiatry mindset. I’m very proud to be a psychiatrist. A lot of times I have to hide that. Families will say, ‘Don’t tell my mother you’re a psychiatrist,’ which I agree with because with this [older] generation: ‘only crazy people see psychiatrists.’ There are times when family members just don’t understand and can be very opposed to the interventions and can be very closed-minded.”
Observing family dynamics
“We can see a lot of intergenerational pain. People who don’t have good relationships with their parents. Perhaps they are put in this difficult position to have to care for them, and it’s hard for them to dig deep and have empathy and take the time to really understand. It’s painful to see—not only because it makes it harder for me to do my job and help the person, but also to see these sad dynamics.”
Living in the moment
“I view patients with dementia as ‘unintentional Buddhists.’ They are truly in the moment. If they are in a moment that is uncomfortable or difficult, we try to use distraction. If they are panicking and say, ‘Oh my God, I’m late for an appointment. I have to go to work. Where are my car keys?’ and you say, ‘No, Mom, you’re retired. You’re not working anymore,’ a lot of times that doesn’t work. But if you say, ‘Mom, come here. Let me show you these pictures of your grandkids,’ it moves them into a different moment.”