Maintaining Mental Health During a Pandemic Part 1: Consequences of Isolation & Tips to Prevent Them

COVID-19 Special Series This episode begins our pivot to addressing the important issues facing individuals during the current COVID-19 pandemic. We will speak to researchers and doctors discussing the present and future impact of the pandemic on those with cognitive impairment and those without. We are starting with a two-part series on the psychological and behavioral consequences of the pandemic. Our guest, Art Walaszek, MD, speaks on the effects of social distancing and how individuals or caregivers can stay healthy during this time. Guest: Art Walaszek, MD, Geriatric Psychiatrist, University of Wisconsin School of Medicine and Public Health

Episode Topics:

  • Does social distancing negatively affect you? 5:00
  • How does this affect individuals with cognitive impairment or their caregivers? 11:00
  • What can we all do to prevent any negative effects from social distancing? 15:30

Show Notes:  All of the important issues happening right now cannot be fully covered, so we strongly encourage you to go to trusted sources for specific information, such as the U.S. Centers for Disease Control and Prevention, your state and local health department websites, and the Alzheimer's Association. You can also find resources on our website and that of the Wisconsin Alzheimer's Institute. For other interesting and important stories on the COVID-19 pandemic, I would recommend my colleague at UW Health Jonathan Kohler, MD, of the Surgery Sett podcast who has a special series called "The Frontlines of COVID."

doctor art walaszek
Art Walaszek, MD

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Transcript

Nathaniel Chin: Hello, Dementia Matters podcast listeners. Thank you for returning to the podcast during this COVID-19 pandemic. I know you have a lot on your mind, and despite being at home, I know life is not easy. It's an understatement to say we are living in an extraordinary time. But whatever you want to call this ongoing experience, it is asking extraordinary things of us. And life doesn't just stop because of it, which is why this podcast continues. I want to pivot here on Dementia Matters and address important issues affecting those with cognitive impairment and those without during this COVID-19 coronavirus pandemic. I cannot cover all the issues and frankly shouldn't. I encourage you to go to trusted sources for specific information such as the U.S. Centers for Disease Control and Prevention, your state and local health department websites, and the Alzheimer's Association. You can also find resources on our website at adrc.wisc.edu. That's adrc.wisc.edu. And that of the Wisconsin Alzheimer's Institute, at wai.wisc.edu for other interesting and important stories on the COVID-19 pandemic. I would recommend my colleague at UW Health, Dr. Jonathan Kohler of the Surgery Sett podcast who has a special series called the Frontlines of COVID. We will include these links to all these resources in our Show Notes for those of you affected by Alzheimer's disease or any cause of cognitive impairment, you know better than anyone that it takes a community to care for those affected and to work on the front lines of treatment prevention and cure. What we face with COVID-19 is no different. We all are needed in this fight and I thank you for whatever it is that you're doing. Take care and be safe.

My guest today on Dementia Matters is Dr. Art Walaszek, a geriatric psychiatrist with expertise in the mental health of older adults and the behavioral and psychological symptoms of dementia known as BPSD. His clinical expertise is in mental illness among older adults including depression, anxiety, as well as mental illness in dementia. He sees patients at UW Health Behavioral Health Clinic. In addition to his clinical work, Dr. Walaszek is Vice Chair for Education and Faculty Development and Director of Psychiatry Residency Training at the University of Wisconsin Department of Psychiatry. He is co-leader of the Outreach, Recruitment, and Engagement Core at the Wisconsin Alzheimer's Disease Research Center and directs the Public Health Pillar of the Wisconsin Alzheimer's Institute. Welcome back, Dr. Walaszek, to Dementia Matters.

Art Walaszek: Dr. Chin, thank you very much. Thanks for having me on again.

Nathaniel Chin: I'm excited to be talking with you again, but I must say I wish it were under different circumstances. The COVID-19 pandemic and its consequences are the reason I'm interviewing you today. On today's program, I want to focus on the psychological consequences of isolation and tips for daily behavior to ideally prevent them. Our part two episode will be on anxiety, stress management, and coping in the time of the pandemic. So to begin with, what consequences does isolation have on our psychological health?

Art Walaszek: Well, it's a great question and, more broadly, Nate, thanks very much for covering this really important topic. We worry a lot about the mental health of older adults in all kinds of situations. And this is an especially trying one, especially with all the isolation that goes along with kind of the restrictions associated with the pandemic. So, you know, we're social creatures. We've evolved over millions of years to interact with each other, to work together, to cooperate, to build things together, to have relationships, to have kids, to have families, you know, and, and, and so on. And so being alone is, is an inherently difficult state for human beings. So, you know, isolation, loneliness, contribute to things like, depression to anxiety, in really extreme states. You know, people can have, even problems with hallucinations and kind of testing what's really going on, reality testing. So, you know, we worry a lot about, the effects of isolation and, older adults where they might be at risk — further risk because they already had some loneliness and isolation to begin with. Or they have problems with vision or hearing that make them more isolated or cognitive impairment. Older adults are going to be at higher risk of some of the negative effects of isolation.

Nathaniel Chin: You know what, I'm really glad you're speaking to how important being social is because one of the things that I've come across is it is absolutely critical that we social distance from other people that we do stay inside. But it's not an easy thing. I mean, we speak about it as if it were easy, but at least, you know, we are social, we are meant to be with other people. And because of that, I would like to just say it is hard to be in my house when I would prefer to be outside with my neighbors and friends. I mean, do you feel like that, that there's that dissonance for us?

Art Walaszek: I really appreciate your bringing that up. I think that's right. I think, you know, for sure from an infectious disease point of view, social distancing is the right thing to do, but it's psychologically really tough. You know, you sort of think about all the day-to-day interactions you might have with someone. You know, friends, coworkers, caregivers, say you're an older adult in an assisted living facility, the other residents at mealtime and so on. All of a sudden, really within days, basically all that has shifted around to much more time by yourself. And so it's difficult and it happened rapidly. We were all asked to do it very rapidly. And so that makes it harder as well.

Nathaniel Chin: Yeah. I'm glad you're saying it because frankly for those that are listening, I just want them to know, I understand that it's hard to be in your home and to be isolated. Please continue to be in your home for the sake of our public health. But know that it is difficult. And I was hoping, Dr. Walaszek, you could also comment on this difficulty and the psychological health consequences. Does this differ based upon gender or personality differences? I'm thinking about people who are extroverts versus those that are introverted.

Art Walaszek: Yeah, it's a great question. It basically gets to, you know, can we predict who might be at higher risk of having trouble with isolation? Personality is sort of a complicated structure. It means a lot of different things. I mean kind of most broadly, it's the way we interact with the world and kind of understand what's going on and kind of helps inform our relationships with other people. And one way of thinking about that is introversion versus extroversion. So an introvert does, tends to be kind of a quieter sticking to themselves, more or less interacted with other folks kind of person. And an extrovert is really kind of attuned to what's going on socially, especially, they really pick up on positive social cues and interactions. And so it turns out that people who are introverts, interestingly, do worse in these settings, so when you're lonely and isolated and so on.

So that's a predictor of folks not doing as well. There's another kind of personality construct that may sound a little bit like a blast from the past, but there's a term that we used to use called neurotic. So these were folks who were anxious, worried a lot, fretted over things a lot. It turns out there's still like a version of that in our understanding of personality. It's called neuroticism. It's, how prone you are basically to worry about things essentially. And those folks don't do as well either, in times of isolation. It gets a little complicated because those things are linked together. Like introverts tend to be more on the neurotic side, so it can be a little hard to tease some of those things apart. But it can be helpful. So who should we reach out to in these times? Everybody ideally, but if we really had a focus on who might be at highest risk of struggling with the isolation, it might be the more introverted folks. It might be the folks who are more prone to worry and anxiety to begin with.

Nathaniel Chin: I think another interesting point that I'm hearing from you is really to be understanding of oneself and to in essence be patient, knowing that you might be an introvert or an extrovert or a little bit neurotic, which I think we all are to some degree. But I think about people who are sharing the same space in their home, whether it is partners or siblings or parent versus child, you know, we're going to handle this differently. And a part of that, interestingly enough, is due to personality differences.

Art Walaszek: Absolutely. And you know, all these constructs, you know, there's no value judgment. It's not better to be an introvert or an extrovert. It's just, you know, human beings are distributed in this way. Some are more introverted, some are more extroverted, some are more neurotic, some are more adventure-seeking or novelty-seeking. So, right, so everyone's going to come at this with a different approach. We see this a lot. I mean, this may be a little bit of a tangent, but when we think about caregivers and how they respond to their loved one who say has dementia, their own personality style is going to influence that. So there are folks out there, who are a little more obsessive, a little more detail-oriented, you know, did I do this right and then that and then get the checklist done and so on. So they may have one approach towards caregivers, and the caregiving role. There are other folks that, maybe a little more on the dramatic side and, and so they're going to have a different take in terms of how do they respond to the caregiving role. So that's just a general thing that we see that's likely to be amplified during these times of higher stress. You kind of fall back on some of those baseline personality traits, how you respond to things.

Nathaniel Chin: I'm glad you brought up caregivers because really it segues into my next question of are there unique consequences for those with cognitive impairment and/or the caregivers of those with cognitive impairment?

Art Walaszek: Yeah, great question. I guess I'll start with the caregivers. You know, we know that caregivers to begin with are under stress and caregivers are at higher risk of depression and anxiety than the non-caregivers. So there's already a setup for folks having trouble and then you layer on the stress of the pandemic and the anxiety associated with that. The stress of isolation. The change in routine, the change in all different kinds of other things, you know, worry about, you know, who's going to deliver my groceries or, you know, am I going to have enough money for next and you know, and so on. So, all these added stressors on top of the baseline stress of caregiving means it'll be more challenging and we'll have to pay very careful attention to how caregivers do through this whole situation. I can envision them responding with some guilt, you know, am I doing enough for my loved one? Am I protecting them from this awful virus? What if I get it? What if they get it, you know, sort of guilt and fear and apprehension about all this. So I think those are some of the particular stressors that caregivers are gonna face with all this. People with cognitive impairment, you know, again, one of the challenges that they'll have with all this is there are going to be changes in routine. And we know that routine is really important for folks with cognitive impairment. It helps promote their memory. You know, that kind of, that daily structure really helps them out, both cognitively and emotionally. And so things are going to be different. I mean, maybe their five day a week caregiver who is coming in is not going to be able to come in anymore or, going out for lunch once a week with their spouse is not going to be an option anymore. So, that kind of disruption is going to be stressful for people with cognitive impairment. And they may not remember why are things disrupted? You know, why is it that I can't do our weekly lunch outing or why isn't my sister showing up regularly anymore. So they'll require frequent kind of reminders and reassurance about that.

Nathaniel Chin: One of the things that I've been seeing or talking about in my clinic is that those with cognitive impairment are experiencing more boredom because they're not able to go outside or go to their activity center or see family. And that, that boredom has led to behaviors and agitation and just restlessness. Are those things that you would predict in people who are having any sort of thinking challenge?

Art Walaszek: Yeah, absolutely. I mean, I think a significant part of our interventions for folks with dementia in particular if they're feeling depressed or anxious or getting agitated, is to ensure that they've got adequate structure and activities over the course of the day. Get people engage in activities. There's value socially in those activities. There's value in the cognitive stimulation that you get from those activities. Some of them are physical benefits, you know, like exercise or dance or things like that. And so we've kind of lost a very important tool in our tool kit to help people out. And then the question is how to replace that, you know, what are other activities that folks can be doing that don't rely so much on direct human interactions since those are going to be less possible. So, I think of things like resources that are available on the internet for example, or radio or TV, kind of looking more to some of those things to at least get some of the cognitive stimulation and distraction - diversion from some of the other stressors that are going on. So I think we'll all be tasked with trying to find some alternatives given that the usual activities may not be available for a little while.

Nathaniel Chin: Well, I like the direction you're heading with this. And so I'm wondering what other things can we do all of us to prevent some of these negative consequences of social isolation?

Art Walaszek: Absolutely. I mean, I think I said this is the third time I'm saying structure. So I'm sorry if I sound like a broken record, you know, most of us really do much better with routine and structure and so what does that mean? That means, simple things like what time am I getting up each morning? You know, kind of doing the same thing each morning in my wake up routine. What time do I have breakfast? What time do I flick on the news or whatever. My normal morning routine is: lunch, dinner, medication - sort trying to continue that routine as much as possible. And especially nighttime stuff. I think this is one of the kind of the dangers that all of us can run into, but especially people with cognitive impairment is there's no end of TV or internet or other sources of information late into the night that could potentially A keep us up and B cause fear and worry.

So maintaining like a good nighttime routine ideally as close to what it was in the past. Turning off the TV, turning off the internet, really settling down into a nice nighttime routine and trying to get as much sleep as possible. One other big error that comes to mind is you know, folks under stress may turn to some coping mechanisms that aren't so helpful like alcohol or drugs or things like that. And so trying to avoid, certainly avoid excessive alcohol use and any drug use, but probably best yet just kind of stay away in general because, those ultimately aren't all that helpful coping mechanisms and could cause some other problems as well with sleep, balance, with memory, with mood, and so on.

Nathaniel Chin: Art, I would also add to that list excess sugary, unhealthy food. I'm only speaking personally here, but having been isolated in my home with just my family, I find myself in the evenings having more dessert than I usually would, which I know is impacting my sleeping quality. So drugs, alcohol and sugary food. I guess I would add to that list.

Art Walaszek: It's funny you mentioned that because, while we were recording, my daughter brought up to me a fresh slice of banana bread, which I'm staring at, but I can't eat because we're recording a podcast right now. But it's interesting. So my family has been baking a lot more and that's fantastic. I'm certainly a beneficiary of that. We might be eating a bit more than usual too. And so I have to watch my calories over the course of the pandemic. But I agree. I think when people are depressed or stressed, they turn to carbohydrate rich food. And again, that's sort of a self-soothing kind of thing, but that ultimately can be really problematic, especially if our normal other routines related to walking and exercise and so on are thrown off. So that's another part of routine that I'd mention. You know, actually if people do have more time on their hands, what a great time, especially now that it's spring and the weather's getting nicer to get out for a walk or add in some other exercise, as a coping mechanism and as just a good way to promote physical and cognitive health.

Nathaniel Chin: You know, Art you also mentioned turning off the TV or iPhone, the news, technology in the evenings. But sometimes I wonder if that technology could be helpful to us. And so I'm wondering what you think of as far as social media and things like FaceTime and Skype and video chat as a helpful tool in addressing isolation?

Art Walaszek: Absolutely. I mean like almost everything there, you know, there's good in moderation and there are benefits and there are side effects to all of these things. You know, the advent of things like FaceTime and Skype and Zoom and all those other kind of technologies for connecting people. I think that's been remarkable and it's a fantastic way of people staying in touch with each other, for maintaining other social activities. You know, going to church, for example, virtually through a zoom broadcast, or maintaining other social activities in that way. That I think is amazing. And I think is a great way to maintain social ties. It's different, you know, it's obviously not the same as being in the room with another human being and able being able to hug them or hold their hand or make eye contact - eye contact is really weird on some of these interfaces. It's hard to know where to look and so on. But anyway, but in terms of being able to see someone or just hear someone, hear their voice, I think that can be incredibly reassuring and positive. So I think that part is all very good. Social media can be, I think it's maybe a little more mixed. You know, I'm sort of thinking now about things like Facebook and Twitter and so on. Again, as a way of staying in touch with other people, I think it's great, as a source of news and information that might be a little more...mixed. And it's also, I think it's really easy to get into a kind of rabbit hole of clicking on one thing after another or clicking into really negative stuff on social media. And at some point you just have to turn that off. Otherwise it's just too anxiety-provoking or depression-provoking.

Nathaniel Chin: So you've mentioned a lot of good tips and recommendations for our listeners and so I always like to end these podcasts by asking you personally, what's one thing that you think has been most helpful and most successful in addressing your daily behaviors or just addressing the isolation that you've been feeling?

Art Walaszek: I think, I've tried quite a bit to kind of maintain my social ties with people as much as possible. All of our meetings basically have switched over to some sort of online or video format of some sort. One practice that I've, I think I try to be more mindful of in that setting, is gratitude. You know, as being grateful and appreciative of others. Just kind of thanking other folks for still being able to communicate with me in this way, thanking them for all the work that they're doing, whether it's my colleagues or it's the caregiver of one of my patients, or it's a family member. You know whoever it might be. Really expressing my gratitude because that's also a way of kind of connecting as human beings and reflecting on why we're so important to each other.

Nathaniel Chin: That's wonderful. And with that I would like to thank you Dr. Art Walaszek for joining us on part one of your interview with Dementia Matters and to let our listeners know that shortly we will release part two, which will cover anxiety, stress management, and coping during this time. So thank you Dr. Walaszek.

Art Walaszek: Thank you very much.

Nathaniel Chin: Please subscribe to Dementia Matters on Apple Podcasts, Spotify, Podbean or wherever you get your podcasts, and rate us on your favorite podcast app. It helps other people find our show and lets us know how we're doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health, and the Geriatric Research, Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private universities, states, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Bonnie Nuttkinson and edited by Bashir Aden. Our musical jingle is "Organisms" by Chad Crouch. Check out our website at adrc.wisc.edu. That's adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, please email us at dementiamatters@medicine.wisc.edu. That's dementiamatters@medicine.wisc.edu. Thanks for listening.