South Africans — and the world — are now months into “shelter at home” decrees, as the novel coronavirus (COVID-19) continues to make its devastating mark on the world. For carers of people living with dementia, isolating at home means being the primary (or sole) caregiver around the clock — piling stressor on top of existing stressors, and making burnout an ever more imminent threat.

Social distancing measures are aimed at bolstering efforts to slow the infection rate (or #flattenthecurve), but many people are struggling with other effects of the lockdown, including isolation, depression, and anxiety. This is a pre-existing pandemic, of which carers were already a significant proportion of those affected.

The “silent killer”

The South African Depression and Anxiety Group (SADAG) calls depression the silent killer and reports that around 20% of South Africans will experience a depressive disorder at least once in their lifetime, and that women are twice as likely to suffer from depression than men. Incidentally, women also form the majority of caregivers.

The last defence

Clinical psychologist, Louis Awerbuck, a speaker at the Livewell Wellness Talks, says caregivers are especially vulnerable because of the emotional burden they shoulder, and that they are keenly aware that there are very few aspects of human behaviour that we can control.

“We try our best to soften the anxiety of others, knowing very well that we do not have any answers or the ability to provide certainties in others’ lives. More than often, we are the last barrier between life’s random onslaughts and a patients’ inability to adequately cope with the anxiety caused by these onslaughts.

Watch for the signs

Awerbuck says there are often early signs of burnout apparent in the way you deal with those in your care. “If you are mentally fatigued, chances are that your own anticipatory anxiety is filtering into your caregiving.”

Four indicators that your mental reserves are running in the red:

1. Struggling to maintain concentration while working;
2. Getting irritated with patients;
3. Secretly wishing that the day would pass as quickly as possible;
4. And not being able to remain in the moment with patients.

Caregivers, he adds, “have to guard against psychological burnout, and we have to monitor ourselves. Nobody else will do it for us.”

Walk the talk

Awerbuck points out that caregivers, already know some of the ways of managing stress and anxiety of patients or loved ones, but the difficulty is implementing it for oneself.

The tried and tested basics of managing stress:

1. Sticking to a routine;
2. Staying physically active;
3. Maintaining regular sleeping patterns; and
4. Focusing on areas that we can control and what is needed to be done.

Change your language

The idea of looking for silver linings is well established but can seem impossible in the face of such adversity. One approach is to actively change the narrative: instead of saying ‘I’m stuck inside’, try ‘I am safe inside’. 

Awerbuck says “Being stuck in lockdown due to the coronavirus definitely holds a myriad of disadvantages, but the situation also provides opportunities”, such as:

• opportunity for families to communicate;
• extra time to personally indulge in activities you previously never had time for;
• and most importantly, to seriously reconsider the way we manage ourselves and the planet.

Ask for help

Finally, reach out, early and often.

“Caregivers often feel understood by other caregivers,” he says, “so I suggest staying in regular contact with other carers.” 

• If you are a family member or spouse of a dementia patient, there are support groups to help you connect with others. Livewell runs a free dementia Facebook support group where like-minded people can connect with Livewell experts and other families experiencing the same struggles. You can join the Livewell support group here: https://www.facebook.com/groups/livewellvillages/.
• For resources and help relating to depression and anxiety, visit www.sadag.org.

Finally, with lockdown in place, many therapists and counsellors have taken to providing online sessions through tools like Skype, Zoom or YouTube. Livewell is hosting free Wellness Talks on a variety of health & wellness topics. You can keep abreast on upcoming topics via the Livewell YouTube Channel. 

Whatever steps you take, give yourself permission to focus on yourself. This is the mental health equivalent of ‘securing your own oxygen mask first’ or acknowledging that you cannot pour from an empty cup. 

To keep up to date on Livewell’s free wellness talks and support groups visit www.livewell.care