Guidance on COVID-19 for the care of older people and people living in long-term care facilities, other non-acute care facilities and home care

Session 1 • Eating and drinking: more pleasant mealtimes Use different textures, flavours, smells, tastes, sounds and colours. Encourage older people and their families to increase their protein intake. Play soft music during mealtime. People who remain indoors for various health reasons are at higher risk of vitamin deficiency. Appealing food Pleasant music Soft food Protein intake Consult specialist Prepare soft, easy-to-chew food for persons experien- cing difficulty chewing. Consult with dental and oral care specialists. Choking occurs when a foreign object lodges in the throat or windpipe, blocking the flow of air. Choking hazards for older people include pieces of food, teeth or dentures. Caregivers should remain vigilant for the following symptoms of choking: • Emergency: choking Inability to talk Skin, lips and nails turning blue or dusky Cough, which may either be weak or forceful Difficulty breathing or noisy breathing Skin that is flushed, then turns pale or bluish in colour Squeaky sounds when trying to breathe Loss of consciousness If the older person you care for has toothache, body pain, diarrhoea, losing weight, experiencing side effects of medication or has not had a bowel movement for more than seven days, please consult a doctor. Session 1. Providing everyday care 01 Also, vitamin B12 deficiency may occur in vegetarian older people. Providing everyday care Revised and republished as of 23 March 2022 (Originally published on 1 April 2020) 6-10 Times • First aid for choking: Heimlich manoeuvre Stand behind the person. Make a fist with one hand. Position it slightly above the person’s navel. If the person is able to cough forcefully, the person should keep coughing. Wrap your arms around the person’s waist. Tip the person forward slightly. Place one foot slightly in front of the other for balance. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust, as if trying to lift the person up. Perform between 6 and 10 abdominal thrusts until the blockage is dislodged. STEP 1 STEP 4 STEP 2 STEP 5 STEP 3 STEP 6 STEP 7 If the blockage is not dislodged, transfer the person to a health facility urgently. STEP 8 Session 1. Providing everyday care 02 8-10 Glasses zzz... Please follow the doctor’s guidance regarding the appropriate quantity of fluids – especially if the person you care for has any underlying conditions. • Hydration requirement • Signs of dehydration • Consequences of dehydration Make sure water is fresh and looks palatable. Adding ice cubes and slices of lemon or orange could perhaps make it more appealing. Older people should drink 8-10 glasses (1500- 2000 millilitres) of fluid every day. This includes water, iced lollies, soup and juice but excludes tea or coffee. Identify and overcome barriers to drinking, such as worries about not reaching the toilet in time, physical inability to make or reach drinks. Drowsiness, confusion or disorientation Dry, inelastic skin Sunken eyes Dryness of the mouth, lips and tongue Reduced and more concentrated urine output Dizziness and low blood pressure Disturbed mental performance and a heightened feeling of tiredness Low blood pressure, weakness, dizziness, and an increased risk of falling More likely to develop pressure sores and skin conditions Severe dehydration leads to renal failure Dehydration leads to constipation Session 1. Providing everyday care 03 In general, odourless, pale urine indicates good hydration; dark, strong-smelling urine is a common symptom of dehydration. • Encouragement of physical activity Causes older people to get warmer, breathe much harder and their hearts to beat rapidly, making it more difficult to carry on a conversation. E.g. climbing stairs, running. Causes older people to get warmer, breathe harder and their hearts to beat faster, but they should still be able to carry on a conversation. E.g. brisk walking. Aerobic activity should be performed in bouts of at least 10-minute duration. E.g. Zumba, cycling, and walking. Older people with poor mobility should perform physical activity to enhance balance and prevent falls, on three or more days a week. Muscle-strengthening activities, involving major muscle groups, should be done on two or more days a week. Minimizing sedentary behaviour includes reducing time spent watching TV, taking regular walk breaks around the garden or street, and breaking up sedentary time by walking part of the way, while undertaking a long journey. Older people with normal mobility should do at least 150-300 minutes of moderate-intensity aerobic physical activity, or at least 75-150 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity, throughout the week. Moderate intensity Vigorous intensity AEROBIC ACTIVITY ENHANCE BALANCE MUSCLE-STRENGTHENING ACTIVITY MINIMIZE SEDENTARY BEHAVIOUR Session 1. Providing everyday care 04 E.g. carrying or moving heavy loads of groceries, activities that involve stepping and jumping, such as dancing, chair aerobics. E.g. Yoga, Tai-chi, Nordic walking. minutes /week minutes /week 150-300 75-150 • Tips for older people experiencing difficulties using the toilet • Tips for incontinence care • Tips on assisting with bathing Provide adequate nightlights in the hallway between the bedroom and the toilet. Use the right size and type of pad. Identify the times of day that older people prefer to have a bath/shower. Change the wet pad on time and maintain hygiene around genital area. Switch from a shower/ bath to a sponge bath. (Note: bath tubs are particularly difficult as they may lead to falls) Apply protective creams or lotions that maintain healthy skin. If using the shower or bathtub, use a non-slip bath or shower mat to help prevent falls. Consult a doctor if the person has fever, feels pain or passes strong- smelling urine. Adaptive seating or equipment, such as grab bars and shower chairs, may help. Use contrasting colours for the toilet seat. Consider switching to clothing that are easily removable. For bedridden males, using urinals to collect urine may help. Provide a bedpan. Session 1. Providing everyday care 05 A bedpan is a device used to assist an older person to void or pass stool, when he/she is unable to access the bathroom. Before Sleep 15-30 Minutes Form Routine • Identification of sleeping problems Physical exercise during the day may help sleep at night. Ensure that the person you care for does not drink coffee or too much fluid a few hours before going to bed. A light dinner makes it easier to sleep. Keep in mind that some people may require less sleep. Select a normal sleeping time as much as possible. Generally, 6-8 hours of sleep from 20:00 means night waking between 2:00 and 4:00 in the morning. Find relaxing activities before bed such as music or reading. Too much activity before bed can cause a person to be stimulated and stay awake. Create a bedtime routine, such as lowering the lights, washing face and teeth, and changing into pyjamas. Limit daytime naps to 15-30 minutes. It addresses the need for sleep during the day, but it does not prevent the person you care for from falling asleep later on. • Responses to sleeping difficulties Difficulty falling asleep Waking up in the middle of the night Combination of the above Other (please specify below) : No problems at this point Activity What is the main sleeping problem of the person you care for? Please select all that apply. If sleep issues are significantly affecting daily activities as well as social engagements of the person you care for, assist seeking specialist consultation for further assessment and management. Session 1. Providing everyday care 06 Sleeping problems may be related to depression. If the person you care for has difficulty sleeping, please seek advice from a doctor. 31 2 • Intergenerational engagement through virtual platforms and social support To share their knowledge and skills voluntarily with the community. E.g. teaching younger children in schools, orphanages. To share their experiences or demonstrate arts/skills to younger people. To teach older people the techniques of using mobile phones and social platforms on smartphones. Encourage younger generations Encourage retired people Encourage older people To participate in religious, spiritual and social activities. Session 1. Providing everyday care 07 SHAMPOO CLEANER 3 3 1 1 2 2 Being a caregiver Session 2 Check ability to hear and see. Encourage the person you care for to always put the glasses in the same spot to reduce frustration over having to look for them. Sometimes a neck cord is also helpful. Minimize background noise. Turn off the TV or radio when trying to communicate with them. Use touch, hold hands or do a gentle massage to communicate warmth, connection, safety and love. Get attention in a respectful way. Create contrast. Good contrast within and between objects makes them easier to see, find or avoid. Get the person’s attention before you speak. Let the person see your face when you speak. Try to maintain a sense of humour. This will help reduce frustration and tension. Use simple sentences. Choose household objects with larger type and good contrast. There are products available that use larger letters and numbers or good contrast. If the person you care for is wearing a hearing aid, check whether it is clean, fits snugly in the ear canal, is still comfortable to wear and the batteries are charged. Use music – it is truly a universal language. Play music that older people like and that makes them feel good. Give compliments. Talk with older people about what they like and need – it’s an important conversation to have more than once, as things change over time. Treat the person you care for with respect and dignity. Show interest or give the person you care for a smile or a hug. • Communication: communicate better in the following ways • Factors that impact communication STEPS TO IMPROVE SIGHT WAYS TO STAY CONNECTED STEPS TO IMPROVE HEARING Provide empathetic care. Empathy means putting ourselves in someone else’s situation and making an informed decision. Empathy is seeing through our loved one’s eyes, hearing through his/her ears, feeling his/her emotions and thinking about his/her thoughts. Session 2. Being a caregiver 08 Improve lighting. Good lighting is particularly important for near vision. Use hearing as well as vision assistive tools. Many items in shops now have speech capacity, such as talking watches, thermometers and scales. Consult a doctor if the person has problems with vision. Do not give up speaking to people who have difficulty heairng. This would isolate them and could lead to depression. Speak clearly and more slowly. Do not shout. Consult a doctor if the person cannot hear well anymore. • To prevent falls in older people PREVENTION OF FALL IN IMMOBILE OLDER PEOPLE Encourage older persons to attend a low-intensity aerobic chair exercise class that includes stretching and strengthening exercises. Have older people flex and extend their feet several times after sitting up, then stand up slowly with someone watching; if health professionals have suggested the presence of postural hypotension. Initiate a walking programme in which an older person walks with or without help every day, as part of a daily routine. If an older adult is mainly immobile, provide opportunities for socialization and sensory stimulation (e.g. television and visits). Immobility and a lack of social support and sensory inputs may result in confusion or depression in older people. Session 2. Being a caregiver 09 Assess the home environment for factors that create barriers to physical mobility. Reinforce the need to promote independence in mobility as tolerated, as providing unnecessary assistance with transfers and bathing activities may promote dependence and a loss of mobility. The use of multiple medications and some underlying medical conditions are associated with an increased risk of falls. If the person you care for experiences dizziness or loss of balance, please consult a doctor. 13 2 4 Session 2. Being a caregiver 10 If an older person falls and is discovered on the floor, the following action should be taken: WHAT TO DO IF AN OLDER PERSON FALLS? • Care of older people with or at high risk for pressure sores Redness, abrasion/scrapes, blisters or shallow craters on unbroken skin, lasting 15–30 minutes or more. A grey or black scab. Do not remove the scab. If a bed sore is beneath it, this could cause damage or lead to infection. Texture changes; for example, when the skin feels “mushy” rather than firm to the touch. Do not try to massage or apply anything, unless advised by a health professional. The individual should be quickly assessed for any injury following the fall. Upon recovery, allow the individual to slowly sit up, and then gradually help them to their feet. If the person is sitting up, assist him/her to lie down in a supine position. If symptoms of dizziness and light- headedness continue, the individual should be assisted to lie down again. If unconscious and not injured, the legs of the person should be raised while the person is still lying on the floor; this should speed up recovery. If symptoms continue despite the above, or if there is further loss of consciousness, call for help to promptly transfer the person to a health facility. If recovery is slow, the individual should be placed in the recovery position. If an older person experiences an unexplained syncopal episode more than once, they should see a specialist. For more information on “Guidelines for caregivers to prevent or manage a developed pressure sore”, please refer to WHO’s training package on long-term care in home or institutional settings in the South-East Asia Region. What to look for and do as a caregiver for immobile older people? Psychological well-being Session 3 In case of memory loss, try a memory aid such as a note, pill-box, reminder/alarm, etc. If possible, involve the person you care for to find the best way to support them in case of memory problems. Take a deep breath and think about the best ways to respond that will be the least distressing to you and the person you care for in the case of memory loss. • How to respond to memory loss for the people you care for? • How to deal with a person with depression, anxiety or apathy • Reasons that cause aggression • How to deal with aggression Session 3. Psychological well-being 11 Illnesses such as urinary tract infection Unmet needs Medication combinations or side-effects Take a deep breath and think about the most positive ways. Try to change into a more calming environment. Try to maintain the dignity of the person that you care for; do not force them to engage in activities that they do not wish to do. Try to distract the person you care for; don’t argue. If the person is suddenly behaving aggressively, there may be an underlying cause that should be investigated by a doctor. People with mood problems need extra love and support. It is important to identify ways to stop or reduce mood changes, by comforting and getting the person interested in things that they like to do. Take a deep breath and think about the best ways to respond that will be the least distressing to you and the person you care for in case they have mood problems or experience a loss of interest. It is important to recognize when things get serious. If the person you care for has serious and constant mood changes or you think that they are in danger of harming themselves, it is important to seek medical advice right away. Caring for me Session 4 • Taking care of yourself is important: acknowledge your feelings • How to ask for help • Making time for pleasant activities is important to take care of yourself to keep providing care Session 4. Caring for me 12 Activity Please select at least one activity that you would like to do together more often. If an activity is not listed below, use the "Other" box at the bottom of the list to add the activity that you would like to do. Listen to music Watch birds or animals Play a musical instrument Do handiwork or crafts Take a relaxing walk Look at photos Listen to or read stories, newspaper articles, poems, etc. Watch the clouds or explore nature Recall and discuss happy memories Go out to eat together Cook and prepare snacks Have friends over to visit Other : When caring has become too burdensome or tiring, can another person temporarily supervise and care for the older person? This could be another member of the family or household, or a trained social care worker, whether professional or volunteer. Sharing caregiving responsibilities with other people will help you to continue providing care in the long term. It’s OK to take a break It’s OK to ask for help It’s OK to feel frustrated THINGS THAT WILL HELP YOU TO EFFECTIVELY ASK FOR HELP Describe your problem in one or two sentences. Give detailed information about what kind of help you need. Break it down into smaller parts. It’s usually easier for people to say yes to a little request than to a big one. Think about what you want or need and what your feel- ings are about the current situation. 1 1919 20 • Relaxation activities Session 4. Caring for me 13 Use the scale below of 1-10 and pick the number that describes how tense you are feeling now; 1 is very small amount of tension and 10 is very high amount of tension. Use the scale below of 1-10 and pick the number that describes how tense you are feeling now; 1 is very small amount of tension and 10 is very high amount of tension. Before you try an exercise, ask yourself: “How tense am I feeling?” After the exercise, ask yourself again. This might help you understand whether this type of relaxation helps you feel less tense. Remember • Take some time to relax anywhere and at any time of the day. • Set a goal: try to do a relaxation exercise at least once a day. You can plan a specific time to relax every day. • You will benefit from having renewed energy and better mood after doing the relaxation exercises. Even a brief exercise can make a difference! For more detailed instructions on each relaxation activity, please see iSupport: VERY SMALL VERY SMALL 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 VERY HIGH VERY HIGH Focus on your breathing is relaxing. By doing a breathing exercise, you could reduce tension. Helps you feel calm and reduces stress. You will feel less tension in your neck and increase the blood flow to your brain. Focus your breathing and count back from 20 to 1. Imagine you are in a place or surrounded by people and things you like. Helps you relax by tensing and relaxing your muscles. Stretch your muscles can help to decrease tension. You can do the stretches anywhere and anytime. Ask yourself again, “How tense am I feeling now?” Does this type of relaxation activity help? Basic breathing Mindful breathing Neck movements Number counting Imagery Muscle relaxation Total stretching https://apps.who.int/iris/ handle/10665/324794 Annex 14 Tip! Activity Below are some tips for incontinence care. Problems Health condition Possible causes Changes that you may have observed Recommended solutions Recommended actions you may try Constantly taking the pad off and throwing it on the floor Poor appetite • Feeling uncomfortable with the pad • The pad size is incorrect • The pad is wet and needs to be changed Does not want to eat a meal Eats only small amounts of food Takes a long time to eat a small amount of food • Check whether the pad size is correct • Change the wet pad on time • Consult a doctor regarding the person’s behaviour • Make food appealing: use different textures, flavours, smells, tastes, sounds and colours that the person enjoys • Eat with the family, rather than alone • Play soft music that they like during mealtime • Increase physical activities that they can do during the day Still having wet pants even while using the incontinence pads Toothache Having sore or irritated skin in the genital area Having fever, being in pain, strong-smelling urine • The pad size is incorrect • The schedule for using the toilet has not been maintained Refuses to eat and drink Is restless Has a facial expression indicating pain • Use the right size and type of pad • Maintain scheduled trips to the toilet to minimize the use of pads • Ask whether the person is in pain • Ask them to point out the area of pain • Check whether there are loose teeth, mouth ulcers, etc. • Seek help from a doctor or dentist • Incontinence pads can cause skin breakdown • Unsuitable pad size and delaying changes of soiled pads in a timely manner can cause skin infection • Select a suitable pad size and type • Change the soiled pad on time and maintain hygiene around genital area • Apply protective creams or lotions that maintain healthy skin • Urinary tract infections are triggered by a number of factors, including incontinence and poor genital care • See a doctor • Maintain an intake of 6-8 glasses of water or juice per day, except if the person is under fluid or dietary restriction • Maintain good genital care Common health conditions can affect eating and drinking. The activity below teaches you how to improve these conditions, if they are present. Annex 15 Activity Health condition Changes that you may have observed Recommended actions you may try Memory loss; forgets to eat or drink Asks when the next meal is even if it already happened The person says that they are hungry even if they already ate • Remind the person to eat and drink regularly • Model eating and drinking (i.e. eat and drink with the person) • Provide snacks between mealtimes Depression Weight loss Weight gain Body pain Does not have bowel movement for more than 7 days Diarrhoea Side-effects from medications Refuses to eat or says they are not hungry Eats small amounts of food Has no interest in food • Seek help from a doctor Forgets to eat Eats smaller amounts of food Eats regular amounts of food but still loses weight Eats all the food that is served Eats more snacks than before because they forget that they already ate Is obsessed with food Refuses to eat and drink Is restless Unusual body postures Has a facial expression of pain Hard and dry faeces Difficulty passing faeces/straining Having a feeling of incomplete bowel movements Becomes anxious or agitated Hard stomach Nausea and vomiting Liquid faeces Increased number of bowel movements Incontinency and difficulty controlling bowel movements Nausea, vomiting, liquid faeces or constipation Does not want to have a meal Eats only small amounts of food • Increase the amount of food • Provide foods that they will like • Increase flavourful foods as the person’s taste might be impaired • Seek advice from a doctor • Model eating and drinking (i.e. eat and drink with the person) • Serve smaller portions • Remove the plate when the person indicates that they are full • Provide low-calorie snacks • Ask whether the person is in pain • Ask them to point out the area of pain • Seek help from a doctor • Seek help from a doctor Upon resolution of the problem: - Increase fibre in diet - Increase drinking of fluids - Increase physical activity • Seek help from a doctor • Seek help from a doctor Annex Poorly fitting artificial dentures Refuses to eat and drink Is restless Has a facial expression indicating pain Refuses to wear dentures Throws dentures on the floor • See above for toothache • Check that the dentures are in good condition and fit properly

Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 1 1. Introduction 1.1 Background With coronavirus disease 2019 (COVID-19) being prevalent globally, the World Health Organization (WHO) Regional Office for the Western Pacific has prepared guidance on how best to provide care for older people during the pandemic and to prepare for the transition from acute pandemic response to sustained management of COVID-19. This guidance is for older people, caregivers of older people, and policy-makers responsible for health and long-term care (LTC). Policy-makers may use this guidance to consider recommended actions in planning for the transition to sustained COVID-19 management, and in preparing for the next pandemic or emerging public health threat. Previous outbreaks such as 2009 H1N1 influenza, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that older people are more vulnerable to new and emerging infectious diseases. As of 7 March 2022, the COVID-19 case fatality rate for people over 80 years of age is over 4.4% in Australia, Japan and the Republic of Korea, while the rate for those under 80 is less than 0.2% .1,2,3 In six European countries, over 50% of COVID-19-related deaths were residents of LTC facilities, including older age groups.4 Enhanced precautions among older people and early preparation in LTC facilities are important to protect older people and vulnerable populations. In Asia, approximately 2.2% of older people above 65 in China, 4.1% in the Republic of Korea and 5.9% in Japan live in LTC facilities. The proportions are comparatively smaller in Malaysia (0.4%) and Viet Nam (0.6%).5 In Fiji, as in many other Pacific islands, it is assumed that most older people are cared for by their family members, communities and religious groups.6 The number of older people staying in LTC facilities is expected to grow with increasing life expectancy, smaller family size and cultural changes in many countries.6 Special attention should be paid to older adults with noncommunicable diseases (NCDs) such as cardiovascular disease, chronic respiratory disease, diabetes and cancer, as their prognosis is likely to be worse than those who do not have NCDs if infected with COVID-19.7 While physical distancing is useful in terms of infection prevention and control, social isolation as a result of limited interaction can negatively affect the cognitive, mental and physical functions of older adults.8 Public health and social measures such as physical confinement and lockdown can decrease physical activity levels of affected individuals.9 Closure of sports facilities and limited access to outdoor space and free movement reduce opportunities to exercise. Regular exercise is essential for preventing muscle loss, falls and fall-related injuries in older people.10 Long-lasting public health and social measures may also have an impact on mental health. Reduced social networks, isolation and loneliness may worsen generalized anxiety and depressive disorders among older people.11 The COVID-19 pandemic has given rise to interest in health at individual and community levels and a growing awareness of the need to better support vulnerable populations, including older people.12 Different sectors need to work together to improve health and livelihoods so that people can protect themselves and each other. Everyone is encouraged to adopt protective behaviours and practices now and in the future. 1.2 Target audience Older people, both in their homes and LTC facilities; their caregivers, friends and family; managers, staff, caregivers and health-care professionals at LTC facilities; home-care service providers; and policy-makers to utilize in response to the COVID-19 pandemic, as well as strategies to maintain community health and well-being. Guidance on COVID-19 for the care of older people living in long-term care facilities, other non-acute care facilities and at home Revised and republished as of 23 March 2022 (Interim guidance was originally published on 1 April 2020) Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 2 2. Advice on COVID-19 for older people and caregivers 2.1 Advice for older people (Adapted from the WHO guidance on COVID-19: Risks and safety for older people) 2.1.1 Basic protective measures To prevent infection, there are a seven key actions that you can follow: a. Wash your hands frequently and thoroughly with soap and water and dry them thoroughly. You can also use alcohol-based hand rub if your hands are not visibly dirty. If an alcohol-based hand rub or soap is not available, use local materials such as coffee grounds, ash, salt, sand, coconut husk, bark, leaves and berries.13 b. Cover your mouth and nose with a flexed elbow or tissue when coughing and sneezing. Remember to throw away the used tissue immediately in a bin with a lid and to wash your hands. This way you protect others from any virus released through coughs and sneezes. c. Avoid touching your eyes, nose and mouth. Hands touch many surfaces that could be contaminated with different viruses and other pathogens. If you touch your eyes, nose or mouth with unclean hands, you can transfer them from the surface to yourself. d. Keep a physical distance from others. When you go out, avoid crowded spaces and maintain a distance of at least 1 metre (3 feet or arm’s length) from others. If visits are necessary (e.g. caregiver to support with activities of daily living), ask your visitors to regularly check for symptoms to ensure they are symptom free when visiting you. Ask them to also follow these seven key actions, including washing hands when they first enter your home. People with symptoms must not visit and should follow instructions from local authorities for testing and management. e. Clean and disinfect frequently touched surfaces every day. These include tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, taps and sinks. Use detergent or soap and water to clean surfaces prior to disinfection. f. Wear a mask. In areas where the virus is circulating, masks should be worn when you’re in crowded settings, where you can’t be at least 1 metre from others, and in rooms with poor or unknown ventilation. Make sure the mask covers your nose, mouth and chin. Medical masks are recommended for people aged 60 years or older and people with underlying health conditions, because they are at a higher risk of becoming seriously ill with COVID-19 and dying. For more advice on mask use, please also refer to Q&A: Masks and COVID-19. g. Protect yourself from the flu. During the COVID-19 pandemic, it is more important than ever to protect yourself from the flu. Ask your health-care provider whether a flu vaccine is right for you. 2.1.2 Advice to prepare for COVID-19 in your community Based on local context, older people should consider the following additional measures: a. Older adults are a priority group for COVID-19 vaccination, including booster doses, as are health workers and immunocompromised individuals. b. Inform yourself of the special measures taken in your community as well as the services offered (e.g. home delivery, psychosocial support, alternative access to your pension or social welfare support) and the sources of reliable information (e.g. health ministry website). c. Create a list of the basic supplies that you will need for at least 2 weeks and have these delivered, if possible. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 3 d. Make a list of emergency contact numbers (e.g. COVID-19 local helpline, nearby hospitals and health facilities, domestic abuse helpline, psychosocial support helpline) and contact information of your support network (e.g. family members and friends, main caregiver, community care worker, associations of older persons). e. Discuss with your health-care provider, health-care worker or caregiver how your health needs can be addressed during the COVID-19 pandemic. f. If you rely on support provided by a caregiver, identify with him or her another person that you trust to support your daily living and care needs in case your caregiver is unable to continue to provide care. g. If you are the primary caregiver of another person, identify another person that you and the person that you care for trust to take on your caregiving responsibilities in case you fall sick. h. If multiple people live in your home, if possible, prepare a separate room or space in your home so that anyone with COVID-19 symptoms can be isolated from others. i. Think about what matters most to you regarding care and support, including medical treatment, in case something happens to you and you are unable to make your own decisions. 2.1.3 Advice for those with symptoms related to COVID-19 a. If you have mild symptoms and are otherwise, healthy, you should manage your symptoms at home. Common symptoms include fever, cough, tiredness, and loss of taste or smell. Less common symptoms include sore throat, headache, aches and pains, diarrhoea, skin rash, discolouration of fingers or toes, and red or irritated eyes. b. If you have difficulty breathing, loss of speech or mobility, or confusion, or chest pain, contact emergency medical services immediately. c. If you live with others, isolate yourself as soon as you suspect infection by using the space that you identified in advance. d. For self-isolation, you are advised to: stay in a well-ventilated room, limit movement at home, stay in different rooms from other family members or maintain a distance of at least 1 metre from other family members, and not share bedding, towels, cutlery and kitchen utensils.14 If you are identified as a suspected or confirmed COVID-19 case, refer to the updated WHO guidance on infection prevention and control guidance for long-term care facilities in the context of COVID-19. If you live with others and home care for COVID-19 is advised by your health or social worker, other household members should follow WHO guidance on home care for patients with COVID-19 presenting with mild symptoms and management of their contacts. If you live with others in a setting where physical distancing is difficult, refer to the WHO guidance on actions to be taken for the care and protection of vulnerable groups. 2.2 Advice for caregivers a. Develop in advance – and together with the older person and the household – an alternative plan in case the primary caregiver is unavailable, and identify an alternative caregiver or alternative facility, or both. b. Caregivers (unless the caregivers are older people themselves or have underlying conditions) are at lower risk of becoming seriously ill compared to older people. However, they could unknowingly transmit the virus to older people from possible contact with other people (i.e. from commuting or shopping). It is thus necessary for caregivers to take standard precautions when with older people and to take preventive measures such as self-isolation if they have any symptoms. c. If the caregiver is unwell, arrange for another person to care for the older person. If the older person is unwell, consider restricting visitors, unless for compassionate reasons. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 4 2.3 Self-care for the general well-being of older people 2.3.1 Health promotion There is a concern that some public health and social measures to prevent COVID-19 transmission (e.g. physical distancing, staying at home, refraining from visiting family members/friends) could have an indirect, negative impact on older people’s health and well-being. Follow these 10 steps to stay healthy during the pandemic (adapted from Q&A: Older people and COVID-19): a. Stick to your regular routines as much as possible and maintain a daily schedule for yourself including sleeping, meals and activities. b. Stay socially connected. Speak to loved ones and people you trust every day or as much as possible, through telephone or video calls, messaging, writing letters, and other means of communication. c. Be physically active every day. Reduce long periods of sitting and incorporate at least 30 minutes of exercise in your daily routine. d. Drink water and eat healthy, well-balanced meals. e. Avoid smoking and drinking alcohol. f. Take breaks from news coverage about COVID-19 as prolonged exposure can cause feelings of anxiety and despair. g. Engage in hobbies and activities that you enjoy or learn something new. h. If you have ongoing health conditions, take your prescribed medicines and follow the advice of your health-care worker regarding any health visits or phone consultations. i. If you have an emergency medical condition that is not related to COVID-19, contact emergency health services immediately and ask what you should do next. j. If stress, worry, fear and sadness get in the way of your daily activities for several days in a row, seek psychosocial support from available services in your community. In addition to physical and mental health, oral health is another concern. Evidence from Spain shows that high levels of perceived vulnerability to COVID-19 infection increased dental care avoidance.15 Due to fear of high-risk procedures and limited access to oral health care, oral health may be neglected.16 Older people should maintain good oral hygiene with self-care and regular dental visits. Older people are encouraged to practise self-care to protect their health and well-being, and provide support to others around them. More information on self-care for older people is provided in the Annex. Caregivers and volunteers are encouraged to call older persons (especially those who are feeling depressed and those who live alone) to assist in dealing with stress during the pandemic. 2.3.2 Use of information and communications technology Using information and communications technology (ICT) is a way of staying connected with friends and family. Numerous user-friendly services are available to maintain social connections. People frequently use audio or video calls (telephone, mobile phone or messaging applications) or host online group sessions (e.g. book/movie review, music therapy and exercise clubs). Content for education, entertainment and health promotion that older people can access and benefit from is available online. A friend, family member, caregiver or social worker can assist an older person, so he or she can stay connected using ICT devices and services. For those facing difficulty accessing ICT, alternative social funding or benefit options should be explored, such as free provision of devices and subsidies for purchasing devices and services. 2.4 Advice for home care Home care for older people and other vulnerable populations, such as people with disabilities or mental health concerns, is common in the Western Pacific Region. It is important to carry out safe home care to prevent transmission of COVID-19. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 5 For the home care for older adults and other vulnerable people, basic protective measures (outlined in section 2.1) are the primary method of prevention of COVID-19 infection. In addition, practise the following: 2.4.1 Advice for home care for older people a. Visitors • No one with signs or symptoms of COVID-19 should be allowed to visit older people. Visits need to be carefully planned and informed by a risk assessment. If possible, limit the number of visitors at a time and meet in a well-ventilated room or in an outdoor setting. • Ensure basic preventive measures including mask wearing, hand hygiene and physical distancing are observed. b. Caregiver/resident without any symptoms • Given the possibility of asymptomatic cases, especially in areas of widespread transmission, ensure sufficient space (e.g. at least 1 metre from other family members). • Caregivers/residents should wear a mask when they are in the same room as the patient, whether symptomatic or not. Follow basic precautionary measures. For additional details, please refer to the WHO guidance on home care of patients with suspected COVID-19 infection presenting with mild symptoms. 2.4.2 Advice to caregivers of older people with dementia For a person with dementia, it can be challenging to understand what is happening and to follow precautionary measures such as mask wearing and physical distancing. Bear in mind that people with dementia might not be able to recognize you when you wear a mask. Pay special attention to individuals in this group so that their health conditions do not deteriorate further. • Caring for someone with dementia can be very challenging. If you feel alone, ask someone you can trust, a health-care professional or a support group for help. Describe your problem and what kind of help you need. • Take care of yourself. Having social support is important – stay connected as much as possible. Talk regularly to someone you trust and who understands your situation and feelings. • Plan in advance in case you are no longer able to provide care for the older person with dementia. Ask the person you care for about his or her care preferences, including by whom and where he or she would like the care to be continued. Identify people who can provide support if you can no longer provide care. Plan for costs of future care and discuss preferences for more advanced care and end-of-life decisions, if necessary. For more details, please refer to the Q&A for people caring for someone with dementia. 2.4.3 Advice for self-management post COVID-19 infection Post COVID-19 condition (sometimes called “long COVID”) occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of COVID-19 with symptoms that last for at least two months and cannot be explained by an alternative diagnosis. Common symptoms include, among others, fatigue, shortness of breath, cognitive dysfunction (sometimes called “brain fog”) and generally have an impact on everyday functioning. For more information, please refer to the WHO definition of post COVID-19 condition. If you are experiencing long COVID, consider the following to support your recovery and address residual symptoms: a. Manage breathlessness. Breathlessness is a common symptom among those admitted to hospital with COVID-19. The feeling of breathlessness should improve as you slowly increase your activities and exercise. Breathing techniques (including positions to ease breathlessness) can help to manage this. b. Exercise after being discharged from hospital. Exercising is an important part of recovery after severe illness. Exercising can help improve physical and mental well-being, reduce breathlessness and stress, and enhance mood. c. Manage difficulties using voice. People may have difficulties using their voice after being on a ventilator. If your voice is raspy or weak, it is important to: 1) keep talking, when Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 6 comfortable, 2) not strain your voice, 3) rest, 4) try humming to yourself, 5) use other ways to communicate, and 6) sip water throughout the day. d. Manage eating, drinking and swallowing. If you were ventilated with a breathing tube while hospitalized, you may notice some difficulty with swallowing food and drinks. Eating well and drinking lots of water are important to your recovery. Paying attention to swallowing is important to avoid choking and lung infections. e. Manage problems with attention, memory and thinking clearly. It is very common for people who have been severely unwell to experience difficulties with attention, memory and thinking clearly. It is important for you and your family to recognize these difficulties, as they can impact your relationships, daily activities and return to school or work. f. Manage activities of daily living. It is important to become active again when you are recovering, but this can be hard if you feel very tired, out of breath or weak. The following strategies may be helpful: 1) adjust your expectations for what you can do in a day, 2) save your energy by doing tasks sitting down when you can, 3) pace yourself and try to do light tasks between heavier ones, 4) let others help you with tasks that you may be struggling with, and 5) ease back into activities. g. Manage stress and problems with mood. Being extremely unwell or hospitalized can be a highly stressful experience. Managing stress and feelings of anxiety and depression is an important part of your overall recovery. For more information, refer to Support for rehabilitation self-management after COVID-19- related illness. Please share this information with older people, especially those who might require assistance (e.g. an older adult who lives alone or is housebound) or share it with someone who has a chronic lung, heart, immunological or neurological condition. 3. Guidance for long-term care facilities, other non-acute care facilities and home care This section is based on various national recommendations and relevant WHO guidance.17-21 LTC facilities and other non-acute care facilities, including mental health and disability services, should implement strong infection prevention and control (IPC) practices to prevent transmission between staff, residents and visitors. The three principles of controlling infectious disease in all health-care facilities, including LTC and other non-acute care facilities and for care at home (Fig. 1), are as follows: a. Do not bring in infection. Prevent staff, caregivers and family members from carrying infectious diseases into a facility. b. Do not take infection out. Prevent staff, caregivers and family members from carrying infectious diseases out of a facility to local communities. c. Do not spread infection. Prevent the spread of infectious diseases both within and outside a facility. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 7 Fig 1. Preventing transmission of infection (COVID-19 and non-COVID-19) in long-term care facilities, non-acute care facilities and home care Adapted from: Key principles of infection control and prevention in nursing homes for older people [in Japanese]. Tokyo: Ministry of Health, Labour and Welfare; 2019.22 3.1 Long-term care and other non-acute care facilities General principles for the prevention of infectious disease transmission in LTC and other non-acute care facilities focus on preparation and response. 3.1.1 Preparation Ensure that there is an IPC committee/team within the facility that is multidisciplinary with designated responsibilities. The IPC committee/team should utilize evidence- based guidelines to maintain a high standard of hygiene and sanitation. a. Provide compassionate, respectful, people- centred care consistently, while ensuring adequate protection of residents, visitors and staff from COVID-19. b. Establish and implement routine IPC policies and procedures including: • standard precautions (hand hygiene, mask wearing, respiratory etiquette, environmental cleaning, reprocessing of equipment, etc.) • transmission-based precautions (primarily droplet and contact precautions for COVID-19). c. Provide sufficient supplies and equipment (e.g. hand hygiene products and personal protective equipment) and place them at points of care. d. Provide one or more dedicated people as IPC leaders. e. Train caregivers and employees on IPC. f. Place reminders in the facility (posters, reminders) to assist compliance with IPC. g. Audit IPC practices and give feedback to caregivers and all employees. h. Develop a response manual for when cases of COVID-19 occur. i. Train key personnel on how to isolate confirmed cases of COVID-19. Dedicate medical and residential care equipment (e.g. thermometer, blood pressure cuff and pulse oximeter) to the use of one resident where possible. All equipment should be cleaned and disinfected per routine practices before reuse with another resident, or a single-use device should be used and discarded in an appropriate waste receptacle after use. Personal items such as electronic gadgets should not be shared by residents. A safe facility environment should be established, including general maintenance, plumbing, ventilation, food preparation/storage, laundry collection/cleaning and waste collection/disposal. Facility employees should always follow local jurisdictional guidelines, when available. In areas with high community transmission rates, they are encouraged to wear masks throughout their shift, Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 8 especially in clinical areas, except when eating, drinking and changing masks. Facility employees, residents and other facility users should make sure all their immunizations are current (e.g. seasonal influenza, pertussis, chickenpox, measles, rubella, mumps, and hepatitis B) and undergo regular health check-ups. 3.1.2 Response The facility should respond to COVID-19 infection with triage, early recognition, source control and resident management. Triage and early recognition Prospective surveillance should be established for residents, caregivers and employees: a. Assess the health status of residents prior to admission as well as daily monitoring at a facility. • Identify signs of any infection and report to a physician/nurse (e.g. fever,* vomiting, diarrhoea, respiratory illness). b. Assess the health status of caregivers and other employees. • Identify signs of any infection and report to occupational health at the facility or their own care provider (e.g. fever,* vomiting, diarrhoea, respiratory illness). • Conduct active temperature and symptom checks for all caregivers and employees at the facility entrance. c. Establish and implement a protocol for testing residents with symptoms. • For residents, caregivers and employees, consider alternative causes of acute respiratory infection (e.g. influenza, respiratory syncytial virus). * In people 65 years and above, fever may not be prominent. Resident management Medical care includes regular and increased monitoring for clinical deterioration, with advanced care planning and discussion with the resident/representative about escalation and referral to a health-care facility. Source control a. Reinforce preventive measures by emphasizing well-ventilated rooms, mask wearing, respiratory and hand hygiene to residents, caregivers and employees, as well as environmental, surface and equipment cleaning and disinfection. Follow national guidance on vaccination and routine testing. b. Control potential sources by encouraging residents and accompanying individuals who have signs and symptoms of illness to practise respiratory and hand hygiene and provide medical masks. For areas of widespread transmission, with limited capacity for implementing control measures and especially in settings where physical distancing of at least 1 metre is not possible, visitors should wear masks.23 Spatial separation of residents with acute respiratory symptoms may be required and can be achieved through: • providing care in single rooms; • creating dedicated care areas (cohorting) for residents with acute respiratory symptoms; and • leaving at least 1 metre between residents who have signs and symptoms and those who do not. For LTC facilities management and staff to support with strengthening IPC practices, refer to the WHO preparedness checklist for long-term care facilities and the communication toolkit for long- term care facilities. Care for suspected or confirmed COVID-19 cases When caring for older people with suspected or confirmed COVID-19 infection, practise contact and droplet precautions. Use airborne precautions in addition to contact and eye protection, when performing aerosol-generating procedures or where isolation rooms are poorly ventilated. For details, refer to WHO guidance on IPC precautions. a. Personal protective equipment (PPE) • Perform hand hygiene before putting on PPE. • When caring for any patient with suspected or confirmed COVID-19 infection, practise standard, contact and droplet precautions (by wearing medical Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 9 mask, gloves, gown and eye protection such as goggles or face shield). • During aerosol-generating procedures, practise standard, contact and airborne precautions (by wearing N95 masks or equivalent, gloves, gowns and eye protection such as goggles or face shields). • Carefully, and appropriately, remove all PPE just before leaving a patient’s room and discard in a hands-free (e.g. opening operated by motion sensor or foot pedal) waste receptacle with a cover. • Perform hand hygiene after removing gloves and gowns, before removing face protection, and after leaving the room. b. Resident movement/transport and activities • Restrict residents to their room: o Symptomatic patients: For 10 days after symptom onset, plus at least 3 days without symptoms, including without fever and respiratory symptoms. o For asymptomatic patients: For 10 days after positive test for SARS-CoV-2, the virus causing COVID-19. • Restrict participation in group activities for all symptomatic residents. • Restrict movement/transport of residents with suspected or confirmed infection to essential diagnostic and therapeutic tests. • Avoid transfer within facilities (unless medically indicated). • If transport is necessary, advise transport services and personnel in the receiving area of the required precautions for the resident being transported. • Ensure residents who leave their room for medical reasons (e.g. essential diagnostic and therapeutic tests) wear a mask and adhere to respiratory hygiene. c. Cleaning Hospital-grade cleaning and disinfecting agents are recommended to clean all horizontal and frequently touched surfaces at least twice daily and when soiled. d. Reporting suspected cases Any suspected cases should be reported to relevant authorities such as the local government and/or public health centre as per local requirements. Visitors Symptomatic visitors should be restricted from visiting the facility. If visitors must visit for compassionate reasons, they should be instructed to practise respiratory hygiene, wear a mask, perform hand hygiene, and visit the resident directly and exit directly after the visit. They should limit their movement within the facility and come during non-visiting hours when they are less likely to transmit illness and be provided with the necessary PPE. Technical guidance on COVID-19 is regularly updated as the situation evolves. Please refer to the latest documents published online at: https://www.who.int/emergencies/diseases/novel- coronavirus-2019/technical-guidance For more information on IPC and LTC, please refer to the following WHO guidance: • IPC for health workers of people suspected or confirmed with COVID-19 • IPC for long-term care facilities • Preventing and managing COVID-19 across long-term care services: policy brief • Criteria for releasing COVID-19 patients from isolation. 3.1.3 Daily life When it is difficult to continue group meals and activities within facilities, it is necessary to consider how social interactions (or social connections) can be maintained while lowering the risk of infection in facilities. ICT and other means can be used to maintain relationships between residents and their families. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 10 4. Advice to policy-makers for the “new future” With the progress in vaccination and knowledge gained since the beginning of the pandemic, this is a good time for Member States to reassess their approach towards COVID-19, adjust their response to the changing landscape and develop a vision and plan for sustained management of COVID-19. By implementing a strategy for sustained management of COVID-19 that combines high vaccine coverage with calibrated public health and social measures, including setting- and individual- based measures, Member States can avoid exceeding the capacity of their health-care system while maintaining minimum social restrictions. Member States should shift from a hospital- centred COVID-19 care pathway to a broader care pathway integrating intermediate care facilities and home-based recovery, to optimize health- care utilization, reduce pressure on health-care workers and ensure the right care for the right patients in the right settings. Member States are encouraged to collect, report and analyse data on confirmed COVID-19 cases and deaths that are disaggregated by sex and age, at a minimum, in accordance with WHO’s public health surveillance for COVID-19. For more information, please refer to the information document from the seventy-second session of the WHO Regional Committee for the Western Pacific. The Regional Action Plan on Healthy Ageing for the Western Pacific, endorsed by the WHO Regional Committee for the Western Pacific in 2020, advocates health and social systems transformation towards healthy ageing.24 Member States are encouraged to invest in a whole-of- society transformation to improve national medium- to long-term preparedness for future threats and also support healthy ageing. The heightened interest in the health of ageing populations provides an opportunity for policy- makers to adopt innovative approaches to address the needs of older people during the COVID-19 pandemic. This includes encouraging people to practise self-care, with more frequent health communication, using technologies to improve access to care and enhancing community-based care. These changes will lay the foundation for a “new future”, beyond the “new normal”, where health is recognized as an investment and supportive communities enable older people to stay healthy, thrive and age in place, contributing to the achievement of the Sustainable Development Goals and the vision for WHO’s work with Member States in the Western Pacific, as laid out in For the Future: Towards the Healthiest and Safest Region. 4.1 Encourage self-care and general well-being 4.1.1 Promote self-care among older people It is important that older people are enabled to take care of themselves. WHO has developed a set of self-assessment questions and recommendations for older people to practise self-care and general well-being (Annex). Policy- makers are encouraged to disseminate the checklist through health-care providers, community volunteers, social workers and other channels. 4.1.2 Use communication to encourage behaviour change National and local governments should use strategic communication to encourage behaviours that prevent the spread of the virus and promote general well-being in the context of COVID-19. Insights from behavioural science on practices and factors that influence them can be used to develop and implement targeted “nudges” that provide positive reinforcement and indirectly influence individual decisions and behaviours. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 11 Examples of “nudges” during COVID-19 Footprint markers encouraging physical distancing. (Amagasaki City, Japan) An arrow pointing to a hand sanitizer at the entrance of the store. (Amagasaki City, Japan) Nudge-based approaches have been used worldwide to promote healthy behaviours such as quitting smoking, decreasing consumption of alcohol and increasing uptake of vaccines.25-26 4.2 E ncourage the use of ICT 4.2.1 Continuing social support networks Older people experiencing social isolation are at higher risk of depression and cognitive impairment, and may require LTC sooner.27 Public health measures that can lead to social isolation disproportionately affect older people, especially those relying on voluntary services or social care.27 To mitigate the impact of social isolation, setting up a “buddy system” for lonely or socially isolated older individuals can help them stay connected. Community members can seek out an older “buddy” to regularly check on (while adhering to physical distancing).28 Online technologies can supplement existing social support networks and continue to provide a sense of belonging. Interventions can be as simple as calling significant others, close family and friends, volunteers, health-care professionals or social workers more frequently,29 especially if the person has not been seen in the neighbourhood or been in contact for a few days. Beyond simply reaching out, online cognitive behavioural therapy for loneliness has shown promise.30 Communities should consider forming group social and support activities (such as online courses explaining new technologies and group reminiscence therapy) in which older people can actively participate to reduce social isolation.31 4.2.2 Improving self-care ICT can assist in monitoring the health status of older people and improve self-care and self- management options. WHO’s Integrated Care for Older People (ICOPE) reflects a community-based approach to help reorient health and social services towards a more person-centred and coordinated model of care to optimize physical and mental capacity and functional ability among older people and prevent care dependence. A package of evidence-based tools is available, including mobile applications. Delivery of health information, advice and reminders through mobile phones can encourage healthy behaviours and assist older people with improving and maintaining their intrinsic capacity. WHO’s Mobile Health for Ageing (mAgeing) programme supports routine care offered by health-care professionals with an emphasis on self-care.32 4.2.3 Closing the digital divide When designing policies and interventions, bear in mind the existing inequalities in accessing ICT infrastructure and devices. Those at higher risk for social isolation (people with disabilities, informal migrant workers, people of low socioeconomic status) often have lower access. Build a case for closing the digital divide as part of health-care accessibility, and, if possible, work with service providers to create age-friendly ICT environments for older people. As societies advance digitalization, digital skills training to Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 12 enhance digital literacy for all – and especially among older people – is a policy priority. 4.3 Strengthen community-based support 4.3.1 Community-based integrated care Though COVID-19 has brought many challenges, both to the community and older people themselves, there is an ever-increasing sense of mutual aid and support in communities. This allows for policies to introduce and improve community-integrated care systems to enhance coordinated, community-based support. Starting with social prescribing by training community health workers is one way of introducing community-based integrated care, connecting the health and social care sectors. In areas where COVID-19 is prevalent and access to services, including health and LTC facilities,33 is limited, older people should practise self-care. To ensure the quality of health care and LTC provided within the community is adequate even during the COVID-19 pandemic, the following actions are recommended: a. Prepare in advance a sector-wide plan for continuous provision of community-based integrated care during the pandemic. This plan includes home visits by physicians, nurses and caregivers, including for rehabilitation, as well as daily shopping and transportation. b. Discuss how to maintain essential social services for older people (e.g. social activities, visits by community volunteers) using alternative ways. c. Maintain essential health services. Effective governance and coordination mechanisms and protocols for service prioritization and adaptation can mitigate the risk of outright system failure. For more information, refer to WHO’s operational guidance on maintaining essential health services. d. Consider innovative ways to support essential service delivery. For example, digital applications can be used as part of supportive supervision of health workers, and evidence- based digital tools can be used to support clinical decisions on diagnosis and treatment. e. Increase capacity for early detection of high- risk clusters, for example among persons with certain health conditions, health-care workers and vulnerable groups. High-risk settings for targeted early detection and response may include nursing homes and health-care facilities. 4.3.2 Age-friendly environments National and local governments play an important role in creating an age-friendly environment where older people can maintain their functional ability to the greatest extent possible. a. Identify older people at risk. Through local associations or registries, communities should identify older people experiencing severe outcomes from COVID-19 (e.g. those with underlying health conditions) or at risk of negative consequences from public health measures (e.g. those living alone or who may be at greater risk of loneliness and social isolation) or those at heightened risk due to their home environments (e.g. care homes, settlements). Communities should also consider a system of community sentinels/wardens (such as 1 per 50 households) to help identify and support older people at risk. b. Improve access to information. Communities should consider a mechanism to reach out to high-risk individuals (e.g. helpline, outreach by community volunteers). Disseminate customized messages to explain the risks of COVID-19 for older people and actionable recommendations, based on their health status. Also, identify accessible mechanisms (e.g. peers, community leaders, forums) and formats (e.g. pictures, plain language, sign language, demonstrations) based on cognitive, visual and hearing capacity, as well as technology literacy. c. Support older people to meet their basic needs. During the COVID-19 pandemic and associated movement restrictions, some older people will need additional support to meet their basic needs, including: • accessing money Community agencies responsible for pension, social welfare or cash payments may identify safe mechanisms to ensure timely payments, while reducing waiting Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 13 times and limiting physical contact (e.g. separate queues or specific times for older people). The new payment process (e.g. cash cards, mobile phone-based e- wallets or payments collected at retail merchants) should not create additional barriers for older people. Governments may consider income support schemes for older people who lost income during the COVID-19 pandemic. • shopping for groceries/food, medicines, personal and household items Retail stores should consider safe privileged access for older people. Local administrations and community organizations can identify older people in need of support for shopping and request delivery of food and products with clean packaging. Local transportation initiatives (e.g. Mobility as a Service - MaaS) can support transportation for daily needs. • accessing water, sanitation and hygiene facilities Local governments or those managing settlements should make water and sanitation services accessible to older people (e.g. install rails, provide smaller water containers). d. Combat ageism and prevent and respond to violence. Older people are diverse, in their socioeconomic backgrounds, personal experiences, and physical and mental capacity. Therefore, the policy and support for older people should be based on individual needs, rather than chronological age only. Avoid stereotyping older people as uniformly frail and vulnerable. At the same time, it is important to prevent and respond to violence towards vulnerable older people whose movement is restricted to their home or within facilities. Raise awareness using public campaigns34 and provide support to caregivers and reporting mechanisms (e.g. helplines, collaboration with accessible essential services and community workers). For more information on preventing violence against older people during the COVID-19 pandemic, please refer to: • COVID-19 and violence against older people • Addressing violence against children, women and older people during the COVID-19 pandemic: key actions Appropriate community action to prepare and respond to COVID-19 requires developing local plans with older people, including those most at risk. Older people can be engaged directly, through influential leaders (e.g. community leaders, faith-based leaders, traditional leaders and healers) and existing networks (e.g. older people’s groups, women’s and men’s groups, primary health-care workers, community health volunteers). Policy-makers both at national and community levels are also encouraged to collaborate with health, social welfare, finance, security and other sectors to ensure that older people are supported to participate in society even during COVID-19 outbreaks. Community networks, organizations of older people and businesses should be involved to ensure effectiveness, avoid duplication, and help strengthen the local community’s prevention and response capacity to conduct early and continuous assessments of older people’s knowledge, attitudes and practices, as well as existing barriers to meet their basic needs. The assessment results should be reflected in information, education and communication (IEC) materials, which can contribute to achieving risk communication and community engagement action plans or other emergency preparedness and response action plans in place.35 Please refer to WHO’s general advice on creating age-friendly environments. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 14 5. Guidance development 5.1 Acknowledgements WHO extends its sincere thanks to the Ministry of Health, Labour and Welfare, Japan for providing their manual on IPC at nursing facilities for older people, giving permission to adapt the diagram for this guidance, and reviewing the diagram adapted from it. 5.2 Guidance development methods This document was developed by a guideline development group composed of staff from the WHO Regional Office for the Western Pacific in collaboration with the Unit for Demographic Change and Healthy Ageing and the Unit for Ageing and Health from WHO headquarters. It is based on a review of relevant literature and consensus on the recommendations following group discussion. 5.3 Declaration of interests No conflicts of interest were reported by any of the contributors. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 15 References 1. 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Agency for Healthcare Research and Quality (2017). A unit guide to infection prevention for long-term care staff. Retrieved 23 July 2020, from https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/guides/infection-prevent.html 18. Public Health Agency of Canada (2010). Guidance: infection prevention and control measures for healthcare workers in acute care and long-term care settings – seasonal influenza. https://ipac-canada.org/photos/custom/OldSite/pdf/ 101217newsEN_Final_Seasonal_Influenza-1.pdf 19. Public Health Agency of Canada (2013). Guidance: infection prevention and control measures for healthcare workers in acute care and long-term care settings, and additional resources. https://www.canada.ca/en/public-health/services/infectious- diseases/nosocomial-occupational-infections/guidance-infection-prevention-control-measures-healthcare-workers-acute-care- long-term-care-settings.html 20. Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K (2008). SHEA/APIC guideline: infection prevention and control in the long-term care facility. Infection Control & Hospital Epidemiology, 29(9), 785–814. 21. World Health Organization (2003). Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). https://apps.who.int/iris/handle/10665/70863 Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 16 22. Ministry of Health, Labour and Welfare, Japan (2019). A manual for infection control and prevention at nursing facilities for older people [in Japanese]. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/ninchi/ index_00003.html 23. World Health Organization. (2020, December 1). Q&A: Coronavirus disease (COVID-19): Masks. Retrieved 26 November 2021, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-on-covid- 19-and-masks 24. World Health Organization. (2020). Regional action plan on healthy ageing in the Western Pacific. http://iris.wpro.who.int/handle/10665.1/14714 25. Sunstein, C. R., Reisch, L. A., & Kaiser, M. (2019). Trusting nudges? Lessons from an international survey. Journal of European Public Policy, 26(10), 1417–1443. 26. Reynolds, J. P., Archer, S., Pilling, M., Kenny, M., Hollands, G. J., & Marteau, T. M. (2019). Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment. Social Science & Medicine, 236, 112395. 27. Armitage, R., & Nellums, L. B. (2020). COVID-19 and the consequences of isolating the elderly. The Lancet Public Health, 5(5), e256. 28. Consortium, Age and Disability (2018). Humanitarian inclusion standards for older people and people with disabilities. Retrieved 23 July 2020, from https://reliefweb.int/sites/reliefweb.int/files/resources/Humanitarian_inclusion_standards_for_older_people_and_people_wit h_disabi....pdf 29. Newman, M. G., & Zainal, N. H. (2020). The value of maintaining social connections for mental health in older people. The Lancet Public Health, 5(1), e12–e13. 30. Käll, A., Jägholm, S., Hesser, H., Andersson, F., Mathaldi, A., Norkvist, B. T., ... & Andersson, G. (2020). Internet-based cognitive behavior therapy for loneliness: a pilot randomized controlled trial. Behavior therapy, 51(1), 54-68. 31. Dickens, A. P., Richards, S. H., Greaves, C. J., & Campbell, J. L. (2011). Interventions targeting social isolation in older people: a systematic review. BMC Public Health, 11(1), 647. 32. World Health Organization & International Telecommunication Union. (2018). A handbook on how to implement mAgeing. https://apps.who.int/iris/handle/10665/274576 33. Kretchy, I. A., Asiedu-Danso, M., & Kretchy, J. P. (2020). Medication management and adherence during the COVID-19 pandemic: Perspectives and experiences from low-and middle-income countries. Research in social & administrative pharmacy, 17(1), 2023–2026. 34. Officer, A., & de la Fuente-Núñez, V. (2018). A global campaign to combat ageism. Bulletin of the World Health Organization, 96(4), 295. 35. IFRC, UNICEF, & WHO. (2020). Risk Communication and Community Engagement (RCCE) Action Plan Guidance COVID-19 Preparedness and Response. Retrieved 30 June 2020, from https://www.who.int/publications/i/item/risk-communication-and- community-engagement-(rcce)-action-plan-guidance WPR/DSE/2022/001 © World Health Organization 2022 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence . Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 17 Annex: Screening tests for physical and mental capacity 1,2 Priority conditions associated with declines in intrinsic capacity Tests Cognitive capacity 1. Remember three words: flower, door, rice (example words) 2. What is the full date today? Where are you now (home, clinic, etc.)? Did you get either of the answers wrong? 3. How many words could you recall (e.g. flower, door, rice)? Fewer than three words? Mobility Chair rise test: Rise from chair five times without using your arms. Does it take more than 14 seconds? Nutrition 1. Have you unintentionally lost more than 3 kilograms over the last three months? 2. Have you experienced loss of appetite? Vision Do you have any problems with your eyes: difficulties in seeing far, reading, eye diseases or currently under medical treatment (e.g. diabetes, high blood pressure)? Hearing You can check your hearing with three tests: whisper test, screening with audiometry and automated app-based digits-in-noise test. Did you fail any of these tests? (You couldn’t hear the whispering, audiometry result is 35 decibels or less, app-based test result advises you to seek professional help.) If you have a smartphone or tablet, test your hearing using hearWHO (https://www.who.int/health-topics/hearing- loss/hearwho). Psychological well-being Over the past two weeks, have you been bothered by 1. feeling down, depressed or hopeless? 2. little interest or pleasure in doing things? Oral health 1. Do you have difficulty chewing? 2. Do you have pain in your oral cavity*? Social care and support 1. Do you have difficulty with any of the following daily activities? a. Getting around indoors b. Using the toilet (or commode) c. Dressing yourself d. Using the bath or shower e. Keeping up your personal appearances? f. Feeding yourself? 2. Do you have problems pursuing leisure interests, hobbies, work, volunteering, supporting your family, educational or spiritual activities that are important to you? 3. Do you feel lonely? If you answered “yes” to any of the screening questions (above), you should seek help from a health-care professional or a social worker. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 18 Suggested messages to older people for self-care1,2,3 Mobility Keep to your regular routines and schedule as much as possible including sleep, meals and activities. Be physically active every day. Be active in daily life (gardening, tidying up, cooking in a standing position, farming, etc.) and reduce the amount of time you spend sitting. Do 30 minutes of exercise each day, including four types of training: strength, aerobic exercise, balance and flexibility (stretch). • Strength: Two days a week, use weights, your body weight or resistance bands to make your muscles stronger. Try squats, lunges and sit-to-stand exercises. • Aerobic exercise: Try cycling, walking or online Zumba sessions. Walk for 30 minutes at least five days a week to stay healthy. • Balance: Try walking up one or two flights of stairs, standing on one leg at a time, walking heel to toe in a straight line, radio calisthenics and local government calisthenics. • Flexibility: Stretch your muscles before and after each exercise. Warm up your muscles first with slow movements. Stretch and stay in the same position for at least 10 seconds. Try yoga or Pilates exercises. If possible, ask a professional to help you design an exercise programme. Exercise can be done at home or in your garden. Choose your favourite music and dance to that. Remember to avoid crowding. If you are new to exercise, start with 5–10 minutes and add a minute each day. If you are nervous about falling, try walking or exercising with someone else but avoid crowding. Consider exercises from your bed or chair if walking is hard for you. Talk to your health-care professional to find out more. Stop, rest and talk to your doctor for advice if you feel dizzy, have chest pain, or feel out of breath during or after exercise. Nutrition Go outside in the sun for 30 minutes a day to get your vitamin D, which helps with balance and moving well. Drink sufficient water: 8–10 cups of water every day. Eat healthy: 2 cups of fruit (4 servings), 2.5 cups of vegetables (5 servings), 180 grams of grains, and 160 grams of meat and beans every day (red meat can be eaten 1–2 times a week and poultry 2–3 times a week). Limit your salt intake to 5 grams (equivalent to a teaspoon) a day and limit salt and high-sodium condiments (e.g. soy sauce and fish sauce) when cooking/preparing food. Eat a mix of wholegrains such as wheat, maize and rice, legumes such as lentils and beans, plenty of fresh fruit and vegetables, with some foods from animal sources (e.g. meat, fish, eggs and milk). Consume unsaturated fats (e.g. found in fish, avocado, nuts, olive oil, soy, canola, sunflower and corn oils) rather than saturated fats (e.g. found in fatty meat, butter, palm and coconut oils, cream, cheese, ghee and lard). Avoid industrially produced trans fats (e.g. found in processed food, fast food, snack food, fried food, frozen pizza, pies, cookies, margarines and spreads). Try steaming or boiling instead of frying food when cooking. Eat raw vegetables, fresh fruit and unsalted nuts as snacks, instead of soda, fruit juices, fruit concentrates, flavoured milk, yoghurt drinks, cookies, cakes and chocolate. Write down in a food diary the foods you eat each day. It will help you to see if you met your goals in your care plan. Eat a well-balanced diet without missing three meals a day. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 19 Take nutritional supplements such as vitamin pills or drinks. They can help you meet your daily needs for certain foods. Ask your health-care professional for advice. If you lose weight quickly, have a hard time chewing or swallowing, or have stomach pain or swelling, consult your doctor. Illness should not be ignored. Vison Consider simple changes if your vision causes problems with your daily life. Keep your surroundings bright. Keep things in their right place, such as your keys on a hook or your glasses next to the bed. Good lighting and contrast can help. Ask a friend/family member/caregiver to help you move safely and travel in unfamiliar places if you have problems with your vision. Talk to your health-care professional about a vision check if you have vision problems. If you have trouble seeing to read, glasses may help. Stay up to date with regular visits to get the treatment you need. Hearing Get regular check-ups and use hearing aids to improve your hearing. Many things can affect your hearing, including some medications. Seek a health-care professional’s advice. If you find it hard to hear, ask others to repeat what they are saying or speak slower. Find a quiet place to talk. Moving away from the radio, television or other people talking can help you hear better. If you feel dizzy, your face feels numb or your ears feel full, you may have a problem in your ear. See your health-care professional. Cognitive capacity Exercise your mind. Try playing chess or other games and doing puzzles. Read a newspaper, listen to the radio, do a crossword, or look through photo albums or favourite items to keep your brain active. When you forget a word, try to describe it. Ask your family and friends for support and patience if you are forgetful. Be open to help. Keep a list of important daily tasks or names of people you see often to jog your memory. It may help you feel less nervous when you are on your own. Be around others for a healthy mind. Try social or group activities such as playing cards, attending an exercise class or eating meals with others. If you have trouble doing your regular activities, or are forgetting things more often, see your doctor . It can be frustrating to forget things. Psychological well-being Take breaks from news coverage about COVID-19. Seek updates at specific times of the day from a reliable source such as the WHO website or national or local channels in order to help you distinguish facts from rumours or scams. It is normal to feel sad, stressed, confused, scared or angry during an outbreak. Be aware of negative or unhealthy thoughts. Try thinking three happy thoughts every day. Try repeating a word such as “relax” or “calm” while breathing in and out deeply. Stay socially connected. Speak to loved ones and people you trust every day or as much as possible, using the telephone, video calls or messaging, writing letters, etc. Engage in hobbies and activities that you enjoy or learn something new. Cognitive exercise such as reading a book or doing crosswords/sudoku will keep your mind active and distract you from worrying. A fun activity can get rid of low moods or stressful feelings. You can also use the time at home to keep a well-being diary. Get moving. Exercises like yoga, tai chi, swimming or walking can help cheer you up. Try it if you feel low. If you are feeling down, try helping someone else. Helping others can make you feel good. Avoid using alcohol and drugs as a way of dealing with fear, anxiety, boredom and social isolation. Drinking alcohol not only disturbs your sleep but may also increase your risk of falls, weaken your immune system, and interact with any prescription medicines that you are taking. There is no safe level of alcohol consumption. Seek psychosocial support from available services in your community if stress, worry, fear or sadness get in the way of your daily activities for several days in a row, or if there is a big change in your weight. If you have suicidal thoughts, consult your doctor and talk to others you can trust. Everyone can feel low at times. Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 20 Urinary incontinence** If you have signs of urinary incontinence, talk to your doctor to help identify things you can do to help control your bladder. Ask your physiotherapist about pelvic floor muscle training. It can strengthen muscles to support your bladder. Exercises can be done 2–3 times a week. Start with three sets of 10 contractions. Make sure to relax between each set. Risk of falls Get rid of loose rugs and clutter, clean spills, and install brighter lights and railings in your bathroom and around the home. Changes to your home can lower your risk of falls. Make sure you have form-fitting shoes that do not slip. The right shoes can help lower your risk of falls. If your medication makes you dizzy or sleepy, consult your doctor for possible alternatives. Oral health Practise daily oral hygiene using a toothbrush and fluoride-containing toothpaste if you have teeth. Brush your teeth twice a day. Make sure you brush your teeth before going to bed. If you do not have teeth, use a sponge swab or gauze to clean the oral cavity. If you wear dentures, clean them once a day. Clean your tongue as part of your daily oral hygiene. Lightly brush your tongue or use a tongue scraper (twice a day). Maintain a clean environment in the oral cavity. Improve saliva secretion using proper hydration, increasing the humidity at night, avoiding oral care products that cause irritation, avoiding crunchy/hard foods and eating sugar-free chewing gums/candy. Maintain a healthy diet and avoid sugar-added foods (e.g. fizzy drinks, fruit juices and juice drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready-to-drink tea and coffee and flavoured milk drinks). Maintain the muscles around your mouth by chewing, practising songs alone or saying fast words. Quit smoking. Smoking increases your risk of gum disease. Smokers are also likely to be more vulnerable to COVID-19 because smoking can affect lung capacity. The act of smoking also increases the possibility of transmission of virus from hand to mouth. Social care and support Try rehabilitation (or life support) programmes if you have difficulty dressing, feeding, bathing and grooming, and other activities of daily living. Join online rehabilitation programmes or explore ways to connect with other people online. In addition to a one-way recorded videos, join an interactive online rehabilitation system that allows for conversations with physiotherapists and occupational therapists. Find out what kinds of social support is available in your community. Social support includes support for your living condition, financial security, loneliness, access to community facilities and public services, and support against elder abuse. Talk to your health-care professional or social worker. Talk to your family, friends, social workers, caregivers, health-care professionals about what is important to you by explaining your life, priorities and preferences. Find possible ways to increase your social participation. Think about what matters most to you regarding care and support, including medical treatment, in case something happens to you and you are unable to make your own decisions. If you want to develop an advanced care plan to record your treatment and care wishes, you can talk about it with your health- care worker or someone that you trust. You can write down your wishes and share them with people you trust. If you are a victim of elder abuse, please contact a social work, adult protection or law enforcement systems. Tell someone you trust and report this to the relevant authorities. You can also seek support from dedicated helplines that may be available in your country (including how to access emergency services), or seek out local services for victims. * The oral cavity includes lips, the lining inside the cheeks and lips, the front two thirds of the tongue, the upper and lower gums, the floor of the mouth under the tongue, the bony roof of the mouth, and the small area behind the wisdom teeth. ** Urinary incontinence is the sudden urge to empty your bladder, including accidently emptying your bladder when you cough, sneeze, lift a heavy object, walk or run. There are treatments and strategies available to help control this feeling. The self-care screening tool and recommendations for self-care are based on WHO Integrated Care for Older People (ICOPE): Guidance for person-centred assessment and pathways in primary care,1 Be He@lthy, Be Mobile, a handbook on how to implement mAgeing,2 and consultation with the Division of Preventive Dentistry, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University (WHO Collaborating Centre for Translation of Oral Health Science). Guidance on COVID-19 for the Care of Older People and People Living in Long-term Care Facilities, Other Non-acute Care Facilities and Home Care 21 References 1. World Health Organization. (2019). Integrated care for older people (ICOPE): guidance for person-centred assessment and pathways in primary care. World Health Organization. https://apps.who.int/iris/handle/10665/326843. License: CC BY-NC-SA 3.0 IGO 2. World Health Organization & International Telecommunication Union. (2018). A handbook on how to implement mAgeing. World Health Organization. https://apps.who.int/iris/handle/10665/274576. License: CC BY-NC-SA 3.0 IGO 3. World Health Organization. (2020). Q&A: Older people and COVID-19. Retrieved 29 June 2020, from https://www.who.int/news- room/q-a-detail/q-a-on-on-covid-19-for-older-people

-3kg Flower Door Rice Flower Door Rice 1 1 2 2 3 Yes No Yes No Yes No Yes No Yes No Integrated Care forOlder People Screening tests for physical and mental capacity #HealthyAtHome Stay healthy at home while physical distancing during COVID-19 outbreaks and prepare for healthy ageing in the new normal. • Cognitive capacity Think of any three words. Memorise these three words. Today’s Date: ___Day___Month____Year Current location (home, clinic etc.): _______ Did you get either of the answers wrong? Try recalling the three words you memorised in Question 1. ______, ______, ______ Try rising from your chair Does it take more than 14 seconds? 5 times without using arms. Chair rise test: • Mobility • Nutrition Have you unintention- ally lost more than 3kg over the last three months? Have you experienced loss of appetite? Did you miss any? E OZ DE 3 2 4 P Medical History 1 1 1 2 2 3 Yes NoYes NoYes No Yes No Yes No Yes No 2 Are you currently under any medical treatment? (e.g. any diabetes, high blood pressure) Do you have difficulty in seeing things that are far away or while reading? Do you have any eye disease? You can check your hearing with one of these three tests Were you unable to pass one or more of these tests? www.who.int/health-topics/hearing-loss/hearwho If you have a smart phone or tablet, test your hearing using hearWHO, an ‘Automated app-based digits-in-noise’ test at Contact your healthcare professional if (a) you couldn’t hear whispering in the whisper test, (b) the audiometry result is 35 dB or less or (c) app-based test result advises to seek professional help. *Oral cavity includes lips, the lining inside the cheeks and lips, the front two thirds of the tongue, the upper and lower gums, the floor of the mouth under the tongue, the bony roof of the mouth, and the small area behind the wisdom teeth. Do you have difficulty chewing? Do you have pain in your oral cavity? • Hearing • Oral health Whisper test Screening with audiometry Automatedapp-based digits-in-noise test • Vision 12 Yes No Yes No 1 2 3 Yes No 1 4 2 5 3 6 Yes No Yes No Feeling down, depressed or hopeless? Little interest or pleasure in doing things? Over the past two weeks, have you been bothered by If you have answered “Yes” to any of the screening questions (above), you should seek help from a healthcare professional or a social worker. Do you have problems with pursuing leisure interests, hobbies, work, volunteering, supporting your family, educational or spiritual activities? Getting around indoors Using the bath or shower Using the toilet Keeping up your personal appearance Dressing yourself Feeding yourself Do you have difficulty with any of the following daily activities? You are not able to pursue the activities mentioned above because of Do you feel lonely? If you have answered “Yes” to any of the questions (above), please seek personal assistance from family, friends, or social workers to make changes to your current accommodation, communication tools. Seek necessary social welfare assistance, local community resources or other specialist assistance for additional support. Cost Distance Transport OtherLack of opportunities • Psychological well-being • Social care & support 12 3 Let’s Practice Self-Care! #HealthyAtHome Keep to your regular routines and schedule Be active, reduce time spent sitting Sleep Meal Activities Gardening CookingTidying up STRENGTH TRAINING AEROBIC EXERCISE FLEXIBILITYBALANCE TRAINING Try to do 30 mins of exercise every day Sit to stand Cycling Weights or resistance bands Standing on one leg Calisthenics Climbing stairs Yoga or pilates Body weight (squats, lunges) Stretching Walking OOnline zumba Start with 5-10 minutes and add a minute each day. If you are nervous about falling, try walking or exercising with someone else, but avoid crowds. Exercise on your bed or chair if walking is hard for you. Talk to your healthcare professional to find out more. STOP, rest and talk to your doctor for advice, if you feel dizzy, have chest pain, or feel out of breath during or after exercise. DANCE TO YOUR FAVOURITE MUSIC VITAMIN PROTEIN CHIPS HIPS x • Nutrition Drink plenty of water to get your vitamin D. Vitamin D helps with balance and moving well. Drink 8 -10 cups of water every day. Limit salt intake Eat a balanced diet Each day: - 2.5 cups of vegetables (5 servings) - 2 cups of fruit (4 servings) - 180 g of grains - 160 g of meat & beans to 5 grams (equivalent to a teaspoon) a day and limit salt and high-sodium condiments (like soy sauce and fish sauce) when cooking/preparing food. Go outside in the sun for 30 minutes per day Each week: - Red meat 1-2 times - Poultry 2-3 times Consume unsaturated fatsEat a mix of wholegrains like wheat, maize and rice, legumes like lentils and beans, plenty of fresh fruit and vegetables. found in fish, avocado, nuts, olive oil, soy, canola, sunflower and corn oils rather than saturated fats, found in fatty meat, butter, palm and coconut oils, cream, cheese, ghee and lard. Avoid snacks such as Try steaming or boiling intead of frying your food. soda, fruit juices, fruit concentrates, flavoured milks, yogurt drinks, cookies, cakes and chocolate. Eat raw vegetables, fresh fruit, and unsalted nuts. Prevent malnutrition Avoid industrially produced trans fats such as those found in processed food, fast food, snack food, fried food, frozen pizza, pies, cookies, margarines and spreads. Ask your healthcare professional if you need supplements. Keep a record of what you eat and drink in a diary or on your computer/cellphone and monitor your weight. If you lose weight quickly, have a hard time chewing or swallowing, or have stomach pain or swelling, consult your doctor. Illness should not be ignored. E F TO Z DEPL FD 5 3 2 1 4 8 9 10 11 6 7 CEP CZ PFDE OP ZDLEF PO TE CFED OD PC TFEL LT CE OPDF LO FE TOCDF P Consider simple changes if your vision causes problems with your daily life. Keep things in their right place, like your keys on the hook or glasses next to the bed. Keep your surroundings bright. Use glasses Ask a friend to help you move safely Have a vision check-up IF YOU HAVE TROUBLE WITH YOUR VISION • Hearing Get regular check-ups and use hearing aids. Ask others to repeat what they are saying or speak slower. If you feel dizzy, your face feels numb, or your ears feel full, seek medical advice. TAKE CARE OF YOUR HEARING • Vision CHIPS HIPS 2 1 1 If your medication makes you dizzy or sleepy, consult your doctor for possible alternatives. Get rid of loose rugs and clutter, clean up spills, install brighter lights and railings in your bathroom and around the home. Ensure shoes fit well and do not have slippery soles. Ask your physiotherapist about pelvic floor muscle training. It can strengthen muscles to support your bladder. Exercises can be done 2-3 times per week. Start with 3 sets of 10 contractions. Make sure to relax between each set. If you have signs of urinary incontinence, talk to your doctor. *Urinary incontinence is the sudden urge to empty your bladder, including accidently emptying your bladder when you cough, sneeze, lift a heavy object, walk, or run. There are treatments and strategies available to help control this feeling. such as fizzy drinks, fruit juices and juice drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready-to-drink tea and coffee, and flavoured milk drinks. Prevent dry mouth Maintain a healthy diet & avoid sugar heavy food and drinks Lightly brush your tongue or use a tongue scraper (twice a day). Use toothbrush and “fluoride-containing” toothpaste. Brush teeth twice a day, especially before going to bed. If you don’t have teeth, use a sponge swab or gauze to clean. If you wear dentures, clean them once a day. Clean your tongue as part of your daily oral hygiene Maintain the muscles around your mouth Quit smoking by chewing, singing, or saying words quickly. Smoking increases your risk of gum disease. It also increases likelihood of contracting COVID-19 because smoking can affect lung capacity and because the act of smoking increases the possibility of transmission of virus from hand to mouth. Practice oral hygiene twice daily Drink plenty of water to ensure you have enough saliva. Avoid oral care products that cause irritation and crunchy/hard foods. Choose sugar-free chewing gum/ candy. • Risk of falls • Urinary incontinence • Oral health NEWSNEWSNEWS RADIO NEWSPAPER PHOTO ALBUM PLAYING CARDS FA V O U R IT E P A S T IM E Try social or group activities like playing cards, doing an exercise class, or eating meals with others. Be around others for a healthy mind Ask your family and friends for sup- port and patience if you are forgetful. Keep a list of important daily tasks or names of people you see often to jog your memory. Be open to asking for help If you have trouble doing your regular activities, or are forgetting things more often, see your doctor. • Cognitive capacity It can be helpful to read newspapers, listen to the radio, do crossword puzzles, look through photo albums or favourite items. Exercise your mind M edical H istory 4 6 8 3 1 5 7 2 • Psychological well-being that makes you feel anxious or distressed. Seek the latest information at specific times of the day, once or twice a day if needed. Follow trusted news channels, such as local and national TV and radio, and keep up-to-date with the latest news from @WHO on social media. Try to reduce how much you watch, read or listen to news Try thinking of 3 happy thoughts every day. Try repeating a word such as ‘relax’ or ‘calm’ while breathing in and out deeply. Be aware of negative or unhealthy thoughts Relax Calm Cognitive exercise such as reading a book or doing crosswords/sudoku will keep your mind active and distract you from worrying. You can also use time at home to keep a well-being diary. Engage in hobbies and activities If you’re feeling down, try helping someone else. Help someone else Speak to loved ones and people you trust regularly, using the telephone, video-calls or messaging, through writing letters, etc. Stay socially connected Exercises like yoga, tai chi, swimming, or walking can help cheer you up. Get moving Seek psychosocial support from available services in your community, if stress, worry, fear or sadness get in the way of your daily activities for several days in a row, or if there’s a big change in your weight. Seek psychological support as a way of dealing with fear, anxiety, boredom and social isolation. Drinking alcohol not only disturbs your sleep but may also increase your risk of falls, weaken your immune system, and interact with any prescription medicines that you are taking. Limit the amount of alcohol you drink or don’t drink alcohol at all. Avoid using alcohol and drugs If you have suicidal thoughts, consult your doctor and talk to others you can trust. Everyone can feel low at times. 1 2 43 5 • Social care & support Try rehabilitation (or life support) programmes, if you are experiencing challenges with activities of daily living (ADLs), such as dressing, feeding, bathing and grooming. Try joining an interactive online rehabilitation programme that allow forconversations with physiotherapists and occupational therapists. Social support includes support for your living condition, financial security, loneliness, access to community facilities and public services, and support against elder abuse. This includes thinking about medical treatment, in case something happens to you and you are unable to make your own decisions. If you want to develop an advanced care plan to record your treatment and care wishes, you can talk about it with your health-care worker or someone that you trust. Talk to your family, friends, social workers, caregivers, and healthcare professionals about your life, priorities and pref- erences, as it may be possible to find ways to increase your social participation. Whether you are a victim or have observed the abuse taking place, tell someone you trust and report it to the relevant authorities. You can also seek support from dedicated helplines that may be available in your country (including information on accessing emergency services), or seek out local services for victims. Try rehabilitation programmes Find your community’s social support network Consider what matters most to you regarding care and support Share what is important to you Report elder abuse

Session 1 • Eating and drinking: more pleasant mealtimes Use different textures, flavours, smells, tastes, sounds and colours. Encourage older people and their families to increase their protein intake. Play soft music during mealtime. People who remain indoors for various health reasons are at higher risk of vitamin deficiency. Appealing food Pleasant music Soft food Protein intake Consult specialist Prepare soft, easy-to-chew food for persons experien- cing difficulty chewing. Consult with dental and oral care specialists. Choking occurs when a foreign object lodges in the throat or windpipe, blocking the flow of air. Choking hazards for older people include pieces of food, teeth or dentures. Caregivers should remain vigilant for the following symptoms of choking: • Emergency: choking Inability to talk Skin, lips and nails turning blue or dusky Cough, which may either be weak or forceful Difficulty breathing or noisy breathing Skin that is flushed, then turns pale or bluish in colour Squeaky sounds when trying to breathe Loss of consciousness If the older person you care for has toothache, body pain, diarrhoea, losing weight, experiencing side effects of medication or has not had a bowel movement for more than seven days, please consult a doctor. Session 1. Providing everyday care 01 Also, vitamin B12 deficiency may occur in vegetarian older people. Providing everyday care Published on 23 March 2022 6-10 Times • First aid for choking: Heimlich manoeuvre Stand behind the person. Make a fist with one hand. Position it slightly above the person’s navel. If the person is able to cough forcefully, the person should keep coughing. Wrap your arms around the person’s waist. Tip the person forward slightly. Place one foot slightly in front of the other for balance. Grasp the fist with the other hand. Press hard into the abdomen with a quick, upward thrust, as if trying to lift the person up. Perform between 6 and 10 abdominal thrusts until the blockage is dislodged. STEP 1 STEP 4 STEP 2 STEP 5 STEP 3 STEP 6 STEP 7 If the blockage is not dislodged, transfer the person to a health facility urgently. STEP 8 Session 1. Providing everyday care 02 8-10 Glasses zzz... Please follow the doctor’s guidance regarding the appropriate quantity of fluids – especially if the person you care for has any underlying conditions. • Hydration requirement • Signs of dehydration • Consequences of dehydration Make sure water is fresh and looks palatable. Adding ice cubes and slices of lemon or orange could perhaps make it more appealing. Older people should drink 8-10 glasses (1500- 2000 millilitres) of fluid every day. This includes water, iced lollies, soup and juice but excludes tea or coffee. Identify and overcome barriers to drinking, such as worries about not reaching the toilet in time, physical inability to make or reach drinks. Drowsiness, confusion or disorientation Dry, inelastic skin Sunken eyes Dryness of the mouth, lips and tongue Reduced and more concentrated urine output Dizziness and low blood pressure Disturbed mental performance and a heightened feeling of tiredness Low blood pressure, weakness, dizziness, and an increased risk of falling More likely to develop pressure sores and skin conditions Severe dehydration leads to renal failure Dehydration leads to constipation Session 1. Providing everyday care 03 In general, odourless, pale urine indicates good hydration; dark, strong-smelling urine is a common symptom of dehydration. • Encouragement of physical activity Causes older people to get warmer, breathe much harder and their hearts to beat rapidly, making it more difficult to carry on a conversation. E.g. climbing stairs, running. Causes older people to get warmer, breathe harder and their hearts to beat faster, but they should still be able to carry on a conversation. E.g. brisk walking. Aerobic activity should be performed in bouts of at least 10-minute duration. E.g. Zumba, cycling, and walking. Older people with poor mobility should perform physical activity to enhance balance and prevent falls, on three or more days a week. Muscle-strengthening activities, involving major muscle groups, should be done on two or more days a week. Minimizing sedentary behaviour includes reducing time spent watching TV, taking regular walk breaks around the garden or street, and breaking up sedentary time by walking part of the way, while undertaking a long journey. Older people with normal mobility should do at least 150-300 minutes of moderate-intensity aerobic physical activity, or at least 75-150 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity, throughout the week. Moderate intensity Vigorous intensity AEROBIC ACTIVITY ENHANCE BALANCE MUSCLE-STRENGTHENING ACTIVITY MINIMIZE SEDENTARY BEHAVIOUR Session 1. Providing everyday care 04 E.g. carrying or moving heavy loads of groceries, activities that involve stepping and jumping, such as dancing, chair aerobics. E.g. Yoga, Tai-chi, Nordic walking. minutes /week minutes /week 150-300 75-150 • Tips for older people experiencing difficulties using the toilet • Tips for incontinence care • Tips on assisting with bathing Provide adequate nightlights in the hallway between the bedroom and the toilet. Use the right size and type of pad. Identify the times of day that older people prefer to have a bath/shower. Change the wet pad on time and maintain hygiene around genital area. Switch from a shower/ bath to a sponge bath. (Note: bath tubs are particularly difficult as they may lead to falls) Apply protective creams or lotions that maintain healthy skin. If using the shower or bathtub, use a non-slip bath or shower mat to help prevent falls. Consult a doctor if the person has fever, feels pain or passes strong- smelling urine. Adaptive seating or equipment, such as grab bars and shower chairs, may help. Use contrasting colours for the toilet seat. Consider switching to clothing that are easily removable. For bedridden males, using urinals to collect urine may help. Provide a bedpan. Session 1. Providing everyday care 05 A bedpan is a device used to assist an older person to void or pass stool, when he/she is unable to access the bathroom. Before Sleep 15-30 Minutes Form Routine • Identification of sleeping problems Physical exercise during the day may help sleep at night. Ensure that the person you care for does not drink coffee or too much fluid a few hours before going to bed. A light dinner makes it easier to sleep. Keep in mind that some people may require less sleep. Select a normal sleeping time as much as possible. Generally, 6-8 hours of sleep from 20:00 means night waking between 2:00 and 4:00 in the morning. Find relaxing activities before bed such as music or reading. Too much activity before bed can cause a person to be stimulated and stay awake. Create a bedtime routine, such as lowering the lights, washing face and teeth, and changing into pyjamas. Limit daytime naps to 15-30 minutes. It addresses the need for sleep during the day, but it does not prevent the person you care for from falling asleep later on. • Responses to sleeping difficulties Difficulty falling asleep Waking up in the middle of the night Combination of the above Other (please specify below) : No problems at this point Activity What is the main sleeping problem of the person you care for? Please select all that apply. If sleep issues are significantly affecting daily activities as well as social engagements of the person you care for, assist seeking specialist consultation for further assessment and management. Session 1. Providing everyday care 06 Sleeping problems may be related to depression. If the person you care for has difficulty sleeping, please seek advice from a doctor. 31 2 • Intergenerational engagement through virtual platforms and social support To share their knowledge and skills voluntarily with the community. E.g. teaching younger children in schools, orphanages. To share their experiences or demonstrate arts/skills to younger people. To teach older people the techniques of using mobile phones and social platforms on smartphones. Encourage younger generations Encourage retired people Encourage older people To participate in religious, spiritual and social activities. Session 1. Providing everyday care 07 SHAMPOO CLEANER 3 3 1 1 2 2 Being a caregiver Session 2 Check ability to hear and see. Encourage the person you care for to always put the glasses in the same spot to reduce frustration over having to look for them. Sometimes a neck cord is also helpful. Minimize background noise. Turn off the TV or radio when trying to communicate with them. Use touch, hold hands or do a gentle massage to communicate warmth, connection, safety and love. Get attention in a respectful way. Create contrast. Good contrast within and between objects makes them easier to see, find or avoid. Get the person’s attention before you speak. Let the person see your face when you speak. Try to maintain a sense of humour. This will help reduce frustration and tension. Use simple sentences. Choose household objects with larger type and good contrast. There are products available that use larger letters and numbers or good contrast. If the person you care for is wearing a hearing aid, check whether it is clean, fits snugly in the ear canal, is still comfortable to wear and the batteries are charged. Use music – it is truly a universal language. Play music that older people like and that makes them feel good. Give compliments. Talk with older people about what they like and need – it’s an important conversation to have more than once, as things change over time. Treat the person you care for with respect and dignity. Show interest or give the person you care for a smile or a hug. • Communication: communicate better in the following ways • Factors that impact communication STEPS TO IMPROVE SIGHT WAYS TO STAY CONNECTED STEPS TO IMPROVE HEARING Provide empathetic care. Empathy means putting ourselves in someone else’s situation and making an informed decision. Empathy is seeing through our loved one’s eyes, hearing through his/her ears, feeling his/her emotions and thinking about his/her thoughts. Session 2. Being a caregiver 08 Improve lighting. Good lighting is particularly important for near vision. Use hearing as well as vision assistive tools. Many items in shops now have speech capacity, such as talking watches, thermometers and scales. Consult a doctor if the person has problems with vision. Do not give up speaking to people who have difficulty heairng. This would isolate them and could lead to depression. Speak clearly and more slowly. Do not shout. Consult a doctor if the person cannot hear well anymore. • To prevent falls in older people PREVENTION OF FALL IN IMMOBILE OLDER PEOPLE Encourage older persons to attend a low-intensity aerobic chair exercise class that includes stretching and strengthening exercises. Have older people flex and extend their feet several times after sitting up, then stand up slowly with someone watching; if health professionals have suggested the presence of postural hypotension. Initiate a walking programme in which an older person walks with or without help every day, as part of a daily routine. If an older adult is mainly immobile, provide opportunities for socialization and sensory stimulation (e.g. television and visits). Immobility and a lack of social support and sensory inputs may result in confusion or depression in older people. Session 2. Being a caregiver 09 Assess the home environment for factors that create barriers to physical mobility. Reinforce the need to promote independence in mobility as tolerated, as providing unnecessary assistance with transfers and bathing activities may promote dependence and a loss of mobility. The use of multiple medications and some underlying medical conditions are associated with an increased risk of falls. If the person you care for experiences dizziness or loss of balance, please consult a doctor. 13 2 4 Session 2. Being a caregiver 10 If an older person falls and is discovered on the floor, the following action should be taken: WHAT TO DO IF AN OLDER PERSON FALLS? • Care of older people with or at high risk for pressure sores Redness, abrasion/scrapes, blisters or shallow craters on unbroken skin, lasting 15–30 minutes or more. A grey or black scab. Do not remove the scab. If a bed sore is beneath it, this could cause damage or lead to infection. Texture changes; for example, when the skin feels “mushy” rather than firm to the touch. Do not try to massage or apply anything, unless advised by a health professional. The individual should be quickly assessed for any injury following the fall. Upon recovery, allow the individual to slowly sit up, and then gradually help them to their feet. If the person is sitting up, assist him/her to lie down in a supine position. If symptoms of dizziness and light- headedness continue, the individual should be assisted to lie down again. If unconscious and not injured, the legs of the person should be raised while the person is still lying on the floor; this should speed up recovery. If symptoms continue despite the above, or if there is further loss of consciousness, call for help to promptly transfer the person to a health facility. If recovery is slow, the individual should be placed in the recovery position. If an older person experiences an unexplained syncopal episode more than once, they should see a specialist. For more information on “Guidelines for caregivers to prevent or manage a developed pressure sore”, please refer to WHO’s training package on long-term care in home or institutional settings in the South-East Asia Region. What to look for and do as a caregiver for immobile older people? Psychological well-being Session 3 In case of memory loss, try a memory aid such as a note, pill-box, reminder/alarm, etc. If possible, involve the person you care for to find the best way to support them in case of memory problems. Take a deep breath and think about the best ways to respond that will be the least distressing to you and the person you care for in the case of memory loss. • How to respond to memory loss for the people you care for? • How to deal with a person with depression, anxiety or apathy • Reasons that cause aggression • How to deal with aggression Session 3. Psychological well-being 11 Illnesses such as urinary tract infection Unmet needs Medication combinations or side-effects Take a deep breath and think about the most positive ways. Try to change into a more calming environment. Try to maintain the dignity of the person that you care for; do not force them to engage in activities that they do not wish to do. Try to distract the person you care for; don’t argue. If the person is suddenly behaving aggressively, there may be an underlying cause that should be investigated by a doctor. People with mood problems need extra love and support. It is important to identify ways to stop or reduce mood changes, by comforting and getting the person interested in things that they like to do. Take a deep breath and think about the best ways to respond that will be the least distressing to you and the person you care for in case they have mood problems or experience a loss of interest. It is important to recognize when things get serious. If the person you care for has serious and constant mood changes or you think that they are in danger of harming themselves, it is important to seek medical advice right away. Caring for me Session 4 • Taking care of yourself is important: acknowledge your feelings • How to ask for help • Making time for pleasant activities is important to take care of yourself to keep providing care Session 4. Caring for me 12 Activity Please select at least one activity that you would like to do together more often. If an activity is not listed below, use the "Other" box at the bottom of the list to add the activity that you would like to do. Listen to music Watch birds or animals Play a musical instrument Do handiwork or crafts Take a relaxing walk Look at photos Listen to or read stories, newspaper articles, poems, etc. Watch the clouds or explore nature Recall and discuss happy memories Go out to eat together Cook and prepare snacks Have friends over to visit Other : When caring has become too burdensome or tiring, can another person temporarily supervise and care for the older person? This could be another member of the family or household, or a trained social care worker, whether professional or volunteer. Sharing caregiving responsibilities with other people will help you to continue providing care in the long term. It’s OK to take a break It’s OK to ask for help It’s OK to feel frustrated THINGS THAT WILL HELP YOU TO EFFECTIVELY ASK FOR HELP Describe your problem in one or two sentences. Give detailed information about what kind of help you need. Break it down into smaller parts. It’s usually easier for people to say yes to a little request than to a big one. Think about what you want or need and what your feel- ings are about the current situation. 1 1919 20 • Relaxation activities Session 4. Caring for me 13 Use the scale below of 1-10 and pick the number that describes how tense you are feeling now; 1 is very small amount of tension and 10 is very high amount of tension. Use the scale below of 1-10 and pick the number that describes how tense you are feeling now; 1 is very small amount of tension and 10 is very high amount of tension. Before you try an exercise, ask yourself: “How tense am I feeling?” After the exercise, ask yourself again. This might help you understand whether this type of relaxation helps you feel less tense. Remember • Take some time to relax anywhere and at any time of the day. • Set a goal: try to do a relaxation exercise at least once a day. You can plan a specific time to relax every day. • You will benefit from having renewed energy and better mood after doing the relaxation exercises. Even a brief exercise can make a difference! For more detailed instructions on each relaxation activity, please see iSupport: VERY SMALL VERY SMALL 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 VERY HIGH VERY HIGH Focus on your breathing is relaxing. By doing a breathing exercise, you could reduce tension. Helps you feel calm and reduces stress. You will feel less tension in your neck and increase the blood flow to your brain. Focus your breathing and count back from 20 to 1. Imagine you are in a place or surrounded by people and things you like. Helps you relax by tensing and relaxing your muscles. Stretch your muscles can help to decrease tension. You can do the stretches anywhere and anytime. Ask yourself again, “How tense am I feeling now?” Does this type of relaxation activity help? Basic breathing Mindful breathing Neck movements Number counting Imagery Muscle relaxation Total stretching https://apps.who.int/iris/ handle/10665/324794 Annex 14 Tip! Activity Below are some tips for incontinence care. Problems Health condition Possible causes Changes that you may have observed Recommended solutions Recommended actions you may try Constantly taking the pad off and throwing it on the floor Poor appetite • Feeling uncomfortable with the pad • The pad size is incorrect • The pad is wet and needs to be changed Does not want to eat a meal Eats only small amounts of food Takes a long time to eat a small amount of food • Check whether the pad size is correct • Change the wet pad on time • Consult a doctor regarding the person’s behaviour • Make food appealing: use different textures, flavours, smells, tastes, sounds and colours that the person enjoys • Eat with the family, rather than alone • Play soft music that they like during mealtime • Increase physical activities that they can do during the day Still having wet pants even while using the incontinence pads Toothache Having sore or irritated skin in the genital area Having fever, being in pain, strong-smelling urine • The pad size is incorrect • The schedule for using the toilet has not been maintained Refuses to eat and drink Is restless Has a facial expression indicating pain • Use the right size and type of pad • Maintain scheduled trips to the toilet to minimize the use of pads • Ask whether the person is in pain • Ask them to point out the area of pain • Check whether there are loose teeth, mouth ulcers, etc. • Seek help from a doctor or dentist • Incontinence pads can cause skin breakdown • Unsuitable pad size and delaying changes of soiled pads in a timely manner can cause skin infection • Select a suitable pad size and type • Change the soiled pad on time and maintain hygiene around genital area • Apply protective creams or lotions that maintain healthy skin • Urinary tract infections are triggered by a number of factors, including incontinence and poor genital care • See a doctor • Maintain an intake of 6-8 glasses of water or juice per day, except if the person is under fluid or dietary restriction • Maintain good genital care Common health conditions can affect eating and drinking. The activity below teaches you how to improve these conditions, if they are present. Annex 15 Activity Health condition Changes that you may have observed Recommended actions you may try Memory loss; forgets to eat or drink Asks when the next meal is even if it already happened The person says that they are hungry even if they already ate • Remind the person to eat and drink regularly • Model eating and drinking (i.e. eat and drink with the person) • Provide snacks between mealtimes Depression Weight loss Weight gain Body pain Does not have bowel movement for more than 7 days Diarrhoea Side-effects from medications Refuses to eat or says they are not hungry Eats small amounts of food Has no interest in food • Seek help from a doctor Forgets to eat Eats smaller amounts of food Eats regular amounts of food but still loses weight Eats all the food that is served Eats more snacks than before because they forget that they already ate Is obsessed with food Refuses to eat and drink Is restless Unusual body postures Has a facial expression of pain Hard and dry faeces Difficulty passing faeces/straining Having a feeling of incomplete bowel movements Becomes anxious or agitated Hard stomach Nausea and vomiting Liquid faeces Increased number of bowel movements Incontinency and difficulty controlling bowel movements Nausea, vomiting, liquid faeces or constipation Does not want to have a meal Eats only small amounts of food • Increase the amount of food • Provide foods that they will like • Increase flavourful foods as the person’s taste might be impaired • Seek advice from a doctor • Model eating and drinking (i.e. eat and drink with the person) • Serve smaller portions • Remove the plate when the person indicates that they are full • Provide low-calorie snacks • Ask whether the person is in pain • Ask them to point out the area of pain • Seek help from a doctor • Seek help from a doctor Upon resolution of the problem: - Increase fibre in diet - Increase drinking of fluids - Increase physical activity • Seek help from a doctor • Seek help from a doctor Annex Poorly fitting artificial dentures Refuses to eat and drink Is restless Has a facial expression indicating pain Refuses to wear dentures Throws dentures on the floor • See above for toothache • Check that the dentures are in good condition and fit properly