What activities can we do with our loved ones and residents with COVID and staying safe, and what can you as a care partner do to take care of yourself as well?
Evan Plys, joins us to talk about Geriatric Psychology and Care Partner Health in Ep. 9 of Caring Counts Live! What is Geriatric Psychology, what activities can we do with our loved ones and residents with COVID and staying safe, and how can you as a care partner do to take care of yourself as well? Evan is from the University of Colorado School of Medicine.
Ep. 9 Caring Counts What is Geriatric Psychology – Audio Transcripts
With Taylor Hulett and Evan Plys
Taylor
All right. Hello everyone, and welcome to another Caring Counts Live. My name is Taylor Hewlett. I’m from Applewood Our House. Our goal with these is to connect people in memory care because we believe the more connections you have, the more support you have, both with your challenges and your successes, because I think we need to celebrate those, too. Caring Counts is brought to you by Applewood Our House.
Taylor
Today, I am super excited to have Evan Plys from the Psychiatry Department at the University of Colorado School of Medicine. Evan, thanks for being here, and welcome.
Evan
Thank you so much. Thanks for having me. And also, thanks for having these presentations like this. It is such a cool opportunity and such a neat thing that you’re doing for the community. So thank you.
Taylor
Yeah, of course, we enjoy it. As I said, we want to connect to people in memory care, and in the industry, for lack of a better word as a whole. So I think it’s awesome. So, with that being said, you’re from the Psychiatry Department at the University of Colorado School of Medicine. Can you tell us a little bit about yourself and your background?
Evan
Yeah, so I’m a junior psychologist in a psychiatry department. I do research and also clinical work. So, a lot of counseling and psychotherapy, specifically with older adults. I’m excited about UC Health. We have a new outpatient, specialized geriatric psychiatry clinic. And so it’s me and my partner, who’s a geriatric psychiatrist. And we’re committed to providing these specialty services for older adults and their families at UC Health, so we are excited to be launching that shortly.
Taylor
That sounds so exciting. So my first question for you when you start talking about geriatric psychology. My brain goes, What is that? I’ve never heard of that. And I’m wondering if someone in our audience or some people in our audience feel the same way. If you do, please feel free to comment if you have any questions about this field. I would love to learn more. So what is it? Can you tell me a little bit more about it?
Evan
Yeah, it’s a good question. So we’re clinical psychologists, and we have that framework of and practice of clinical psychology. But if you think about the lifespan, there are these major developmental milestones that happen, and they’re unique at each phase of life. And so we get a lot of training in later life. Just like there are child psychologists who spend a lot of time building expertise in the physical changes and cognitive and emotional changes that happen in adolescence, we get a lot of training on normal aging. So, physically, what are the normal changes? What are the not normal changes, cognitively, emotionally, and socially? One of the neat things about psychology is we do a lot of work and thinking about how people’s roles change, not just in the family but also within society. And what that means, it is a basis for understanding the normative events in older adulthood? And what is not normative? And how do we on the psychological side of things assess and treat some of those non-normative life events?
Taylor
I love it when you talk about looking at how people age, and there’s, I think, a lot to unpack there, especially around meeting people where they are. That seems to be a theme that I found in doing these Caring Counts Live that to care for someone (I’m going to bring in memory care and assisted living here with this) is meeting them where they are. It sounds to me like that’s a fascinating thing to do. Let’s jump right into the memory care part of things. How does geriatric psychology translate into dementia and caring for someone with dementia?
Evan
Yeah, so obviously, dementia would be categorized in that non-normative aging experience. And, you know, it’s an illness that not all older adults get.
So, but what we do when we’re treating psychological issues that occur in the context of somebody living with dementia or, or their family members, we take all of those components and really try to build a complete picture of the individual in their environment, both socially and their physical environment. So you want to think of, you know, what are the physical limitations? What are the other physical illnesses, cognitively, where the person’s strengths and weaknesses?
Psychologically, what are the relationships like? What are the person’s values that they’ve built over this lifespan? So we’re getting a noticeable image from many different sources and getting a really clear history of the individual. We see a lot of it, I think. In memory care, we do a lot of work with staff to support residents and manage problematic behaviors.
And we also do a lot of support for families in that setting, around coping with changes, adjustments, grief. Furthermore, just putting together plans to really support a high quality of life, particularly later on in the advanced dementia stages.
Taylor
Yeah, I like that. Something that popped into my head that one of our health managers said was when you said bad behaviors. Bad behavior is the person with dementia showing the caregiver, showing us that we’re not meeting one of their needs? What do you think about that? What comes to your mind when that when I say that?
Evan
Yeah, no, I think that’s spot on. And I like the framing of that because it makes us evaluate ourselves and also the environment. So I think, when it’s a shift, right, in how we’re caring, because when somebody is in that advanced stage of illness, we might go directly to them and say, “Okay, like, what, what’s going on here?” Let’s have a conversation about that. That actually can still work in some situations. In thinking about particularly in the memory care unit, where we see more severe dementia, we want to think about, okay, what am I bringing to the situation? Is it something interpersonal? Is it something that as a community or as in this person’s living space that we’re not providing? We need to either change the environment (i.e., putting the blinds up or down) or something more complex, like food preferences. I like that framework because it is a lot of problem-solving. And if you don’t have a clear picture of who the person is and all those other factors, it’s challenging to do that. And so I think that that’s one of the nice things about this work is that you do like your livelihood as a caregiver, whether it’s professional or as a family member. Your livelihood relies on really understanding the individual. And that’s pretty great to be able to build those types of relationships.
Taylor
Yeah, it sounds like it’s almost crucial to building that relationship. Having that one-on-one time and that one-on-one care is super important to meet that person where they are.
Evan
Definitely, yeah.
Taylor
So, I have a question, and it could be kind of an affiliate question here. But in your field of geriatric psychology (We’ll throw the umbrella of memory care over this whole kind of thing because that’s kind of what we’re talking about today), do you primarily work with the caregiver or the person with dementia? Or is it both?
Evan
One of the nice things is that we work with all of the systems in a memory care community. We work with residents and do things like planning pleasant activities and engaging people, whether with arts and music or helping construct an environment or behavioral plan with that resident. We also do a lot of work with staff around training problem solving and also support. You know that it’s a challenging setting to work. And I think mostly, during COVID, you add a significant trauma and in the form of a pandemic that increases stress. So, you know, we’re providing support there. And then also the family members and thinking about not just one singular, family caregiver, but the whole family system. We can be involved in that care as well. And so, we’re pretty multi-dimensional, in that sense.
Taylor
Yeah, I think that’s great. And I think if you were in our audience, and you’re watching this right now. Suppose you want to get a hold of Evan or learn more about geriatric psychology. In that case, I think that’s something that you could do and talk about individualized. I mean, it’s all going to be different for everyone, isn’t it?
Evan
Oh, absolutely. Yeah. So, as I said, it’s, it’s not just about understanding what’s going on in an individual’s world that you could see. But particularly when we’re thinking about older adulthood, there’s so much history of an individual, of the family, that if you don’t understand that, then you’re only getting a small component of the picture to know how to do something like increase pleasant activities or manage stress or depression. You know, the family, the history of individuals do influence that stuff. So, it’s very individualized.
Taylor
So let’s jump into this. I think there are two topics I would like to focus on the many that we could. But today, you talked about activities, and specifically during a pandemic, and what that looks like staying safe, right? Because we’ve seen that one of the more vulnerable populations is the older adults during this pandemic, so staying safe but still doing activities that can engage a person with dementia. What are your thoughts on that?
Evan
Yeah, I think you’re bringing up even a broader question around like safety and autonomy; that is like a conversation with every family member or caregiver that I work with; we always have that conversation about thinking of this safety autonomy spectrum, where do you fall? And where do you kind of default? And I believe that during a pandemic, that’s important to know because there are obvious consequences of where you sort of fall in that continuum. Still, it also does affect activity planning, around how much support are you going to provide? How much structure are you going to provide? And how much autonomy are you going to deliver in these types of activities?
I think right now, people are thinking about where they fall on that balance. Since we’re still very much in this pandemic, I think that I wouldn’t fault anyone for leaning more on the safety side of things. But as far as you know, how to engage individuals, particularly people living with dementia, I’ve done a lot of work in my research around activities. And one of the theories that I read that I usually come back to a lot is this concept of flow. And it’s a positive psychology theory. And some books on it are accessible and not super academic like I would read in my leisure time. And it moves away from just thinking about the individual and evaluating the types of activities individuals are engaging in.
With that in mind, some tasks and activities exist, and there are these people who exist. We want to match them in the best way possible. This theory lays out several things in picking tasks and activities that provide this sense of fulfillment in the past. There has to be some challenge or engaging component of it. And I think with certain types of neurocognitive disorders, there are attentional limitations.
But you know, really picking something that is going to provide a little bit of challenge, but enough, you know, support that somebody can actively engage fully in the task, but it’s not so easy that they’re going to lose interest. Also, something that’s providing them feedback. So I think of trivia as an example. It’s something that you can maybe answer questions like, that’s pretty available to most people, and it’s challenging. And you’re going to see that you’re going to get some right, you’re going to get some wrong, but you get that feedback, whether it’s positive or negative, you know when you
answer something correctly, you know, when you answer something wrong, and it’s also challenging you. So I think that’s a great activity.
So that’s on the activity side of things. But the other component is the individual. And I think that that’s one thing that we probably don’t do as good a job sometimes in thinking about, beyond just reducing boredom, beyond only increasing entertainment or something like that. Really, what are the individual’s goals and values?
And how can we use these engaging activities to promote those goals? So I think one of my critiques is that some organizations don’t do activity programming well (and I say this with the caveat that many communities do an excellent job at activity programming). One of my reviews of communities I’ve worked with is the framework of activity programs, or engaging people living with dementia and activities to reduce boredom. This engagement helps reduce symptoms, such as agitated behaviors, etc. When activities are there, that’s an excellent component of activities, but they’re there to promote growth.
And they’re there to add something. And I think a lot of times; we’re losing what the activities can add? And asking people what their goals are? What are their values? What are the things that they want to accomplish at any stage of life at any stage of illness, and then you’re reframing the types of activities that we’re choosing to help that person actualize those goals or that growth. And I think that that’s something that, even during a pandemic when we have those two things in mind, we can kind of problem solve around what’s available and realistic and safe to do. And how can we frame this as a way of, we’re not just doing this to do it, we’re engaging with life in a meaningful way.
Taylor
I think that there’s a lot to unpack there, too. We have a question that popped in, and I’ll pop it up on the screen here in just a few minutes from Malou. But before I do that, what you said about meeting someone where they are. The individualized activity to help them grow, and especially during a time with COVID. Where we do have to do our best to be physically distant, still socially connected, but physically distant. I think it can get very challenging, but also what a cool opportunity to be creative with the types of engagement and activities you do. So that’ll lead me right into a question that Malou posed. And that is, do you have any specific activities that can be super successful, especially during COVID for people living with dementia?
Evan
Yeah. One of the things that I think is cool, and I believe they are still doing it. But there was an initiative where many museums had live streaming like tours that you could for free. People can log on and take a tour of the museum. And I thought that that was cool because it opened up opportunities where you know, even before COVID, you may not be able to make it to a museum to see an exhibit. There have been a lot of creative free platforms online like that. The other resources, I think it’s Mather Way in Chicago, an aging organization, put out weekly activities and links for dyads to do together. I enjoy traveling and seeing new things. I have missed that so much during COVID. There are a lot of creative options online today. It is not only about watching or doing a virtual museum tour; it also prompts seniors and caregivers to start meaningful conversations. And I think that to answer the question of what’s been successful, something that’s enjoyable and then can lead to a conversation that maybe moves from the typical conversation of how awful The world is right now.
Taylor
I like that. I want to shine a little light on the growth piece. Not only are you taking, for example, a virtual tour of the museum, and maybe that tour lasts all of two or three minutes for someone with dementia, depending on where they are within that spectrum. But then the conversation that it might lead to with them could be a form of growth that’s individualized for that person.
Evan
Absolutely, yeah. One thing that is also nice is we never feel like there’s never something that we can learn from another individual.
And not only meaningful conversations about life and self-growth but in that moderate stage of dementia can be an excellent prompt for reminiscence of, oh, like, how nice was that? And why don’t you tell me about a time that you went to a museum? Or did you know anyone who did this, and can you still learn new things from these activities, which extends the engagement? We see that reminiscence is a great tool, particularly in that middle stage of the dementia process.
Taylor
Thank you so much, Malou, for that question. If you have another question specifically around activities or anything that we’ve talked about geriatric psychology, and all of these fun things to be entertaining topics, please feel free to post them in the comments here. The other point that we talked about a little bit before was supporting the caregivers. Whether you are a professional caregiver in a facility in a community and a home, or you’re a family caregiver, and you’re caring for your loved one, and you know them super well with the pandemic, the umbrella of COVID. There can be lots of stress on these people caring for their loved ones or caring for residents. Can you talk a little bit about some of the things you’ve learned? And some of the strategies of ways they can cope during this time?
Evan
Yeah, this is an essential point. Since COVID, I’ve been focusing a lot on some of the stressors that family members face in communities. And, you know, in residential care communities particularly. From my perspective, where that’s coming from is, we have seen the images of assisted living and nursing homes in the news as really being ground zero for this pandemic.
There’s been a significant response from residents, staff, and the frontline workers experiencing this trauma. And, I say that not to say that everyone’s going to have PTSD. But, you know, not everyone who experiences trauma gets PTSD. It’s a very high-stress prolonged situation that is affecting the residents and the staff. I’ve seen a lot of activity, thoughts, and articles for those populations.
People who had been in assisted living know that this community runs through the residents or includes the residents, the staff, and the family members of those residents. And that is really with some other community members as well. That’s how you would define an assisted living community, for example.
And I was, I guess, surprised at how little attention the distress of family members was receiving in the conversations around the significant impact to assisted living during COVID.
It seems like, here’s this big part of the community, a community that is experiencing trauma, a highly significant, stressful event. And this section is not receiving as much attention in the mainstream media, at least. And, so in thinking about the stressors associated with being a family member of a loved one in a community during COVID, I believe that there’s a lot of practical challenges and emotional challenges. And the practical challenges are seeking information and staying connected to the community.
As we prepare for a potential second wave and potentially moving, hopefully, this doesn’t happen, but if we move back towards restrictions, what are the roles of family members in the community when visiting isn’t an option? And I think that families play such a vital role that we had clearly defined before this. And then, we have these safety guidelines, and public health officials will lean on that autonomy support spectrum to the side of safety as they should.
But, what are we doing? Like, how are we defining roles for families? We can’t just leave this vital component of the community out of a community. We need to shift how we think about those roles. That’s a very individualized thing that has to happen based on the individual, the community needs, feasibility, and staying connected to the community.
You know, if you think about it, albeit an extreme example, the one that I see a lot is drawing comparisons to 911. And, you know, if you think about it, New York City, being a resident of New York City during 911, you don’t have to be at Ground Zero. You don’t have to be a firefighter or police officer to have that impacted your life.
This is your community. And you know, I think family members are feeling that to a certain extent. And so how are they staying connected to the community? How are they receiving information? How are they supporting and contributing to the growth and the changes that will happen to communities? And, what’s the level of involvement there?
So those are the practical things. I think the other side is just the challenging emotions that we see around fear and anxiety. Obviously, who’s not anxious now? What about grief and loss? You’re grieving, and you’re worried about what the future holds. But then you’re also grieving that you had this routine and relationship that’s been disrupted and has changed in some way.
The research that I’ve been doing is that I’ve been going on a lot of Facebook groups and reading comments from family members. And I see a theme of guilt and shame that is coming up during COVID, around, is my family member safe? And did I do something wrong? When you have the family member as a liaison between this community of assisted living and care, that’s separate from the assisted living who’s invested in the resident. They get it from both sides. And so I can see where these feelings of guilt and heightened anxiety and stress might surface even more on top of the grief. So there’s just a lot going on for family members right now. We need to think about how we’re addressing that and how we especially involve them in any healing process as a community and rebuild.
Taylor
This has been an opportunity for us to redefine that family role in the care team and bring them closer and closer to those things. When the restrictions were, they’re not physically but emotionally and socially, for sure.
And Malou just made another comment, too. We had some suggestions come in from family members
to include the names of other residents, their friends in the photos that we send out so that when they do call, or when they do an outside visit right now, that’s what we’re doing. Or, a FaceTime visit, whatever that might look like, they have a point of conversation to discuss.
Oh, tell me about your friend. What did you do today? Did you enjoy your coffee today together, and things like that. So, I think just finding ways to redefine that role and still have them be part of the care is super important.
Evan
I love that. And I think, especially in memory care, it’s hard to think about how much we use the environment to engage our loved ones. During visits, you know, say, “Oh, I saw the activities director on my way in, and they said this…” Or, pick something up in their room and say, “Oh, like this is new, tell me about this.” And when you’re on the telephone, you don’t have those cues. And it takes a lot more effort on the family member to engage someone, particularly someone living with more advanced dementia stages. I think it’s great that you’re providing those prompts and guidance for that because that’s another thing that is practically lost in this shift to virtual visits.
Taylor
Yeah, I thank you for saying that, too. It’s an opportunity none of us saw coming, but here we are. And we all have to do our very, very best to provide the best care we can for our residents.
Evan
Yeah, absolutely. Yeah.
Taylor
You talked about the practical and emotional stressors of COVID of kind of shining a light on our family members in our communities. What are some things that they can do to – now I might say the wrong language here – deal with those or work through those stressors?
Evan
Yeah, so I think it takes a lot of problem-solving on the practical side of things. And, thinking about what have I tried, what works, and what doesn’t? What are all the possible solutions to help me navigate this extra barrier in this relationship? I think on the emotional side of things, and it’s a little bit more challenging. Because you think about the emotions that I mentioned, anxiety, grief, and guilt are all genuinely natural. And I think it would be kind of odd to not feel them during this, and especially going through a major transition and change and not having a ton of information.
You know, I think that this is going to bring up those negative emotions. You know, I think what’s challenging is some of the advice I have is around acceptance. You know, if we don’t want to change, I don’t think we’re going to be able to change those feelings. Sometimes, when we try to change negative emotions or not experience negative emotions, we can do more harm than good. And so, you know, I think that it starts with really recognizing what’s going on and what you’re feeling.
One of the things that I think has been helpful, particularly around grief, is naming what you’re feeling as grief. And a step further is this term called disenfranchised grief, which I think people feel right now. Disenfranchised grief is essentially you’re feeling the loss, you’re feeling this grieving process. But it’s tied to something that maybe society doesn’t traditionally recognize as a grievable event.
During this pandemic, we’ve seen images over and over of family members who have lost a loved one who never got to say goodbye and staff who have lost numerous friends in a day. And those are the people we interview, like on the news, and those are the stories that we get. It’s almost a way of society saying that’s what you should grieve, like, those are the feelings you’re allowed to have during COVID.
And someone who is struggling about how do I transition to phone visits? They’re not going well, I’m not sure what to do, and I am very busy. I’m not visiting as much. I don’t know what to tell my brother, who lives three states over, and I’m extremely sad about that. That’s challenging!
That’s not like the appropriate society when those people aren’t on the news as much. You know, really naming it and saying it’s okay to have this response, and other people have this response. You know, grief isn’t like we can’t control when we grieve. And you know, all of those things I mentioned, there are losses. One of the things that I said in something I wrote for UC Health was just the time before and after a visit.
When I’m driving to an assisted living to visit my family member, there’s this kind of buffer period of me driving there, maybe thinking about what I’m going to say, leaving work stress behind, going to visit a loved one. And then, when I leave, there might be 10 to 15 minutes of processing, how challenging that was, and how difficult that was. And maybe even crying, before I go home to my family that’s lost. It’s okay to grieve that. Or, if there’s a way to implement that, that’s fine.
But, like those little things of having that time to drive, or not having to repeat yourself on the phone because you have a bad connection. You can feel sad about those. It’s entirely appropriate to grieve those things, even if society is saying that.
The face of grief is the person who lost their loved one, who they weren’t able to say goodbye to; that’s the benchmark that we’ve set. But that shouldn’t discount all of the other losses and grief that people are experiencing. And so kind of leaning into that and saying, you know, I’m feeling this way. I understand why I’m feeling this way. It’s okay that I think this way that doesn’t negate other people’s experiences. Then, just practicing good self-care around social support, staying healthy, sleep, exercise, and engaging in enjoyable activities would be my best guess of a recommendation.
Taylor
Right. Right. And the recommendation past identifying what you’re feeling as the emotion, whether it be grief, sadness, what have you. And then, really, just naming it is what I’m hearing you say is my first step. After that, having that time to process that, while engaging in good self-care, the things that I know are going to help me.
Evan
Exactly, yeah. And naming it is so essential and a multi-step process of not just saying, oh, yeah, I’m feeling sadness and grief. It’s like, when I feel sorrow and grief, what is that? What happens physically? Do I tense up? What thoughts run through my mind? And, do I go back to a particular memory or a certain thing about myself?
I feel guilty because I think I’m a bad son or something like that. And notice when you feel these things, where does your mind go? What happens to your body? And, as I said, it okay to feel these things. Now, you know, the thing to monitor is how you respond to those feelings. So when I’m feeling guilty, do I go to the liquor store and drink a six-pack of beer and get drunk? Or do I pick up the phone and leave an angry voicemail for somebody because I’m trying to get rid of this guilt feeling?
Those are the things to monitor and try to seek help around if it’s getting to that point. You know, really, the more that we approach our emotions with curiosity and try to understand what’s going on and why. And how it’s investing in ourselves. A lot of times, that can be enough there to make it bearable. The goal is not to feel negative emotions, and I think that will be very challenging.
Taylor
To bring it full circle back up to geriatric psychology, I think the clinic you are launching soon sounds like such an excellent resource for people who feel this way that can identify. This is what I’m doing. And yeah, I do need some extra help. I do need some additional support. I mean, that’s why we’re doing these Caring Counts to connect people, especially during this time of COVID.
Evan
Absolutely, yeah. And we fully expect that a lot when we’re often in a cup. Hopefully, in a couple of weeks, we’re going to be seeing a lot of the effects of physical distancing, both in older adults, who might feel more isolated, or in family members who are feeling isolated and also feeling like they are without a guide, without a map. I think that particularly for the care partners, this event has, in my mind, made it clear that enough has been disrupted. Maybe we need to go back and read, redraw the map, redefine what those roles are, and redefine the positives or negatives? What are my coping strategies? Because it’s not pathological. It’s not that people are, like, depressed or can’t cope or not resilient. It’s that we’ve been thrown a very challenging curveball. Take the time to reset and connect with what was working before because many people are doing that now.
Taylor
Coming from a place of curiosity right there. I love that! Yeah. It’s great. Evan, thank you so much for joining us for this episode of our Caring Counts Live. I so appreciate your time and your insight. I have a question to ask you. Do you have a website up yet, or how can people learn more about the clinic you’re launching?
Evan
Yeah. So we are still very much in the developmental process. So I would love to give you that information later. I said we’re trying to meet the needs soon. And mostly, we want to be up and running before the holidays, because I think that’s going to be a time where our services will be beneficial. As soon as that happens, I would love to send you that information and see if we can share it. But it’s going to be through UC Health and the Department of Psychiatry. That department also has a website of resources for coping during COVID. Which, if you haven’t been to, I would recommend it. It’s vetted by our team there. Yeah, I would love to share more information on our clinic when we get that up and running soon.
Taylor
That is so exciting! So what we’ll do is we can share some of these resources in our comments section here on our Facebook Live episode. And then when your clinic is up and ready, and you’re prepared to give out that resource, we’ll start doing that as well. Because like I said, our goal is to connect people in this field and memory care. So with that, Evan, thank you so much for being here. We so appreciate it. I also wanted to let everyone know; we have our annual Caring Counts event coming in October. This year’s event will be all online, and it’s all complimentary, Monday through Friday, in October at noon. The dates for that Monday through Friday are each day at 12 pm, October 12th, 13th, 14th, 15th, and 16th. Our Caring Counts, Alzheimer’s and Dementia Conference. You can register for that conference via our Facebook events or online. I can also post the link here in the comments. Evan, thank you again.
Evan
Thank you so much again for having me. And this is such an awesome resource. And I’m honored to be part of it.
Taylor
Well, we’re glad you’re here, too. We’re so excited to share what you’re doing with our network and share these resources out. We’ll see everyone in two Wednesdays. Thank you for being here with us, and we’ll see you later.
