SALT LAKE CITY — Suna Oz was beginning to exhibit some worrying symptoms.
She was having trouble using the right words, completing regular tasks and understanding basic visuals — and after a time, her family became concerned.
It got even worse once her husband died, as he had often covered for her diminishing capacity, finishing her sentences and helping her function, said her son, Dr. Mehmet Oz from television's "The Dr. Oz Show."
"She would do things that just weren't who she was, and we finally put the pieces together and realized that she had Alzheimer's," he said during a speech at the Utah conference of the Alzheimer's Foundation of America Tuesday. "And physicians who had been trying to tell her and us this for a while without success were able to finally get that message across to us. And that delay was a problem."
Oz was the first speaker at the virtual conference during the Utah stop on the foundation's broader Educating America Tour, which is intended to raise awareness about dementia.
Oz's story was a cautionary tale, describing the opportunities his family missed to receive an early diagnosis for his mother's condition.
While dementia has no cure, Oz believes that changing one's diet, lowering cholesterol, losing belly fat and getting more sleep are all helpful steps in slowing or preventing the disease.
They were steps his family was unable to take because of his mother's belated diagnosis.
"I think I stalled taking care of my mom," Oz said. "The worst lies are the ones we tell ourselves. The biggest challenge is denying our loved ones their wishful thinking, which is what I think ultimately tripped my family up."
He added, "Effectively, like so many have said, I'm going to lose my mom twice. She no longer is the person that I grew up with. She's still with us. There's still a sparkle in her eyes, although, it is, I think, getting duller."
The 'COVID conundrum'
Troy Christian Andersen, an associate professor at the University of Utah; Bruce W. Lee, owner of ComForCare of Northern Utah; and Anne Asman, director of advancement and outreach for the University of Utah's Department of Psychiatry, also spoke at Tuesday's conference.
They discussed the importance of early detection and intervention, family engaged dementia care, living at home with dementia as well as loneliness and social isolation in older populations.
The COVID-19 pandemic has exacerbated the latter issue.
"At this point in time, we really have a growing epidemic of loneliness and social isolation that are now being considered health risks for older adults," Asman said. "And those are especially for the people in rural communities, long-term care facilities, which includes nursing homes, assisted living, memory care."
She emphasized that loneliness and social isolation are distinct phenomena; loneliness is subjective while social isolation is objective.
"Social isolation and loneliness are often not significantly correlated," she said. "Some people choose to be socially isolated. Some people are what we consider to be loners, and those individuals are socially isolated but not necessarily lonely."
Loneliness, however, is a much more insidious emotion — one that health officials are learning more about, including discovering its long-term health consequences.
"Loneliness has been recognized now as a major public health concern, and it is associated very strongly now with the risk of mental and physical illness, cognitive decline, suicidal behavior and general mortality," Asman said.
The question really becomes do we have to choose between protecting the medically fragile, higher-risk, older adults from the coronavirus and cutting them off from outside support and connection which we now know is vital to their overall well-being? That's a really tough question.
–Anne Asman, director of advancement and outreach, University of Utah Department of Psychiatry
Isolation and loneliness are correlated with a 50% increased risk of developing dementia, according to her presentation, and 43% of adults 60 or older in the U.S. report feeling lonely.
The pandemic has presented what she described as the "COVID conundrum," as long-term health facilities were some of the first institutions to close after the pandemic hit.
"The question really becomes do we have to choose between protecting the medically fragile, higher-risk, older adults from the coronavirus and cutting them off from outside support and connection which we now know is vital to their overall well-being?" Asman said. "That's a really tough question."
She said work is ongoing to evaluate residents in rural communities, nursing homes and other facilities for a baseline measure of loneliness, and then the research team plans to conduct further evaluations every three months, after prescribing some form of intervention.
There are several effective resources online for evaluating loneliness, she said, including the UCLA 3-Item Loneliness Scale and the De Jong Gierveld 6-Item Loneliness Scale.
There is also a need for family members and professional caregivers to learn to administer such evaluations and recognize the symptoms of social isolation and loneliness, which include depression, anxiety, fluctuations in weight and issues with sleep.
The evaluations help professionals prescribe useful and timely intervention techniques, Asman said, many of which involve helping the elderly access technology through which they can socialize.
"One of the things we absolutely have to remember is that not all older adults embrace technology," she said. "And I'm finding this to be more and more true."
"Many, many, many research papers show that older adults are very adaptable to technology, and I agree with that if they are schooled and if they are tutored and if there is someone there to help them. Once they're in, they love it."
The trick is finding the technological help that at-risk populations need.
Asman said the key is being patient with them, working through technologies that the elderly know how to use — if face-to-face discussions aren't possible — and being creative in finding solutions.
"If we can get staff and if we can get family members and we can figure out how to get these people tutors and get them online, they probably won't be lonely very long," she said. "Let's be proactive; let's get them connected."