COVID-19 resources on Dementia

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COVID 19 and dementia: experience from six European countries

International Journal of Geriatric Psychiatry

The effects of Covid‐19 have been well documented across the world with an appreciation that older people and in particular those with dementia have been disproportionately and negatively affected by the pandemic. This is both in terms of their health outcomes (mortality and morbidity), care decisions made by health systems and the longer‐term effects such as neurological damage. The International Dementia Alliance (IDEAL) is a group of dementia specialists from six European countries and this paper is a summary of our experience of the effects of COVID‐19 on our populations. Experience from England, France, Germany, the Netherlands, Spain and Switzerland highlight the differential response from health and social care systems and the measures taken to maximise support for older people and those with dementia. The common themes include recognition of the atypical presentation of COVID‐19 in older people (and those with dementia) the need to pay particular attention to the care of people with dementia in care homes; the recognition of the toll that isolation can bring on older people and the complexity of the response by health and social services to minimise the negative impact of the pandemic. Potential new ways of working identified during the pandemic could serve as a positive legacy from the crisis.

Last updated on hub: 03 February 2021

COVID-19 and AgeTech

Quality in Ageing and Older Adults

Purpose: This paper aims to provide an overview of the emerging AgeTech sector and highlight key areas for research and development that have emerged under COVID-19, as well as some of the challenges to real-world implementation. Design/methodology/approach: The paper is a commentary on emerging issues in the AgeTech sector, with particular reference to COVID-19. Information used in this paper is drawn from the Canadian AGE-WELL network. Findings: The COVID-19 pandemic has particularly impacted older adults. Technology has increasingly been seen as a solution to support older adults during this time. AgeTech refers to the use of existing and emerging advanced technologies, such as digital media, information and communication technologies (ICTs), mobile technologies, wearables and smart home systems, to help keep older adults connected and to deliver health and community services. Research limitations/implications: Despite the potential of AgeTech, key challenges remain such as structural barriers to larger-scale implementation, the need to focus on quality of service rather than crisis management and addressing the digital divide. Practical implications: AgeTech helps older adults to stay healthy and active, increases their safety and security, supports independent living and reduces isolation. In particular, technology can support older adults and caregivers in their own homes and communities and meet the desire of most older adults to age in place. Social implications: AgeTech is helpful in assisting older adults to stay connected. The COVID-19 pandemic has shown the importance of the informal social connections and supports within families, communities and voluntary organizations. Originality/value: The last months have seen a huge upsurge in COVID-19-related research and development, as funding organizations, research institutions and companies pivot to meet the challenges thrown up by the pandemic. This paper looks at the potential role of technology to support older adults and caregivers.

Last updated on hub: 29 December 2020

COVID-19 and the care homes of the future

International Long-term Care Policy Network

This webinar, held on the 22nd February 2021, brought together international speakers who have looked at care home models from a variety of perspectives, before and during COVID-19, with the aim of reflecting on what has been learnt from the pandemic and from previous thinking about the role of communal living in the continuum of care. Topics discussed include: typology of personalised care in care homes; re-examining the architectural design models of nursing homes to address both long-standing concerns about the adequacy of these facilities to support quality of life, and the inadequacies highlighted by the COVID-19 pandemic; design for dementia-friendly environments; the Nordic Care Hotel models and other innovative approaches to care from the perspective of the English care sector; modernising the care home sector in Asturias; and dignity, design, dementia – dementia related design and the built environment.

Last updated on hub: 08 March 2021

COVID-19-related social support service closures and mental well-being in older adults and those affected by dementia: a UK longitudinal survey

BMJ Open

Background: The COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and to reduce their well-being. Aims: To explore how social support service use by older adults, carers and PLWD, and their mental well-being changed over the first 3 months since the pandemic outbreak. Methods: Unpaid dementia carers, PLWD and older adults took part in a longitudinal online or telephone survey collected between April and May 2020, and at two subsequent timepoints 6 and 12 weeks after baseline. Participants were asked about their social support service usage in a typical week prior to the pandemic (at baseline), and in the past week at each of the three timepoints. They also completed measures of levels of depression, anxiety and mental well-being. Results: 377 participants had complete data at all three timepoints. Social support service usage dropped shortly after lockdown measures were imposed at timepoint 1 (T1), to then increase again by T3. The access to paid care was least affected by COVID-19. Cases of anxiety dropped significantly across the study period, while cases of depression rose. Well-being increased significantly for older adults and PLWD from T1 to T3. Conclusions: Access to social support services has been significantly affected by the pandemic, which is starting to recover slowly. With mental well-being differently affected across groups, support needs to be put in place to maintain better well-being across those vulnerable groups during the ongoing pandemic.

Last updated on hub: 21 January 2021

Decision-making for receiving paid home care for dementia in the time of COVID-19: a qualitative study

BMC Geriatrics

Background: The lockdown imposed in the UK on the 23rd of March and associated public health measures of social distancing are likely to have had a great impact on care provision. The aim of this study was to explore the decision-making processes of continued paid home care support for dementia in the time of COVID-19. Methods: Unpaid carers caring for a person living with dementia (PLWD) who were accessing paid home care before COVID-19 and residing in the UK were eligible to take part. Participants were interviewed over the phone and asked about their experiences of using paid home care services before and since COVID-19, and their decision-making processes of accessing paid home care since the outbreak and public health restrictions. Results: Fifteen unpaid carers, who were also accessing paid care support for the PLWD before COVID-19, were included in the analysis. Thematic analysis identified three overarching themes: (1) Risk; (2) Making difficult choices and risk management; and (3) Implications for unpaid carers. Many unpaid carers decided to discontinue paid carers entering the home due to the risk of infection, resulting in unpaid carers having to pick up the care hours to support the person living with dementia. Conclusions: This is the first study to report on the impact of COVID-19 on paid home care changes in dementia. Findings raise implications for providing better Personal Protective Equipment for paid carers, and to support unpaid carers better in their roles, with the pandemic likely to stay in place for the foreseeable future.

Last updated on hub: 13 November 2020

Deconditioning in people living with dementia during the COVID-19 pandemic: qualitative study from the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation

BMC Geriatrics

Background: Restrictions introduced in response to the COVID-19 pandemic led to increased risk of deconditioning in the general population. No empirical evidence of this effect however has been gathered in people living with dementia. This study aims to identify the causes and effects of COVID-19-related deconditioning in people living with dementia. Methods: This is a longitudinal phenomenological qualitative study. Participants living with dementia, their caregivers and therapists involved in the Promoting Activity, Independence and Stability in Early Dementia (PrAISED) process evaluation during the COVID-19 pandemic were qualitatively interviewed at two time points: the baseline 2 months after the national lockdown was imposed in England (i.e., May 2020), the follow up 2 months after the first set (i.e. July 2020). The data were analysed through deductive thematic analysis. Results: Twenty-four participants living with dementia, 19 caregivers and 15 therapists took part in the study. Two themes were identified: Causes of deconditioning in people living with dementia during the COVID-19 pandemic and effects of deconditioning in people living with dementia during the COVID-19 pandemic. A self-reinforcing pattern was common, whereby lockdown made the person apathetic, demotivated, socially disengaged, and frailer. This reduced activity levels, which in turn reinforced the effects of deconditioning over time. Without external supporters, most participants lacked the motivation / cognitive abilities to keep active. Provided the proper infrastructure and support, some participants could use tele-rehabilitation to combat deconditioning. Conclusion: The added risks and effects of deconditioning on people with dementia require considerable efforts from policy makers and clinicians to ensure that they initiate and maintain physical activity in prolonged periods of social distancing. Delivering rehabilitation in the same way as before the pandemic might not be feasible or sustainable and innovative approaches must be found. Digital support for this population has shown promising results but remains a challenge.

Last updated on hub: 19 November 2021

Dementia and Covid-19: national action plan to continue to support recovery for people with dementia and their carers

Scottish Government

This plan explains how the Scottish Government is working, and plans to work, with others to strengthen community resilience, support people with dementia and their families to continue to get the right care, treatment and support at the right time as we live with, and come through and recover from, the COVID-19 pandemic. The plan: recognises the huge impact of the pandemic on people with dementia, their families and carers and the wider community; recognises that people living with dementia and their carers often feel alone, vulnerable and anxious about COVID-19; recognises the particular worries families have about what the future holds for their loved ones with dementia; uses what has been learned from the experiences people with dementia and their families have shared about how to respond to their needs during the pandemic; sets out how the government plans to help people with dementia and those that love and care for them to live well with dementia across the whole journey of the illness – and how it plans to reduce the risk of dementia; sets out the actions the government has done so far and actions it continues to do to respond to the pandemic and the things we will keep on doing; reinforces the government shared human-rights based and person-centred approach to supporting people with dementia and their families and carers.

Last updated on hub: 11 January 2021

Dementia and COVID-19: social contact

Alzheimer's Society

This briefing sets out the evidence for action to support social contact for people living with dementia and what the Government need to do next. It covers: the impact of COVID-19 on people with dementia in the UK; the importance of social contact for people living with dementia; maintaining social contact in care homes; supporting the delivery of home care services. The briefing observes that as well as the severe impact of COVID-19 itself, restrictions under lockdown have imposed a lack of social contact and interaction which are known to be contributing factor in the decline of people with dementia. The paper calls on the Government to lead a task force with Local Authorities and expert groups to address how they will support people with dementia as the country emerges from the lockdown over the next 6-12 months, with social contact at the heart of the solution. Specific recommendations for both care homes and home care are included.

Last updated on hub: 10 August 2020

Dementia and the risk of death in elderly patients with COVID‐19 infection: systematic review and meta‐analysis

International Journal of Geriatric Psychiatry

Objectives: The COVID‐19 infection represents a global public health emergency worldwide. Several risk factors have been associated with a poor prognosis among COVID‐19 patients. This study aimed to perform a systemic review and meta‐analysis to evaluate the mortality risk in elderly patients with dementia and COVID‐19 infection. Methods: Literature search was based on Cochrane Library, Embase, PubMed and Google Scholar to locate articles published between December 2019 to July 2020, presenting the number of survived vs deceased patients with dementia and COVID‐19 infection. Results: A total of 233 articles were retrieved; 158 were excluded for not meeting the inclusion criteria, leaving 75 articles to assess for eligibility. After evaluation of the full‐text articles, 8 met the inclusion criteria and were thus included into the final analysis (6493 patients ‐ mean age: 69.6 years). Among COVID‐19 patients, the prevalence of dementia was higher in non survivors compared with survivors (17.5% vs 5.4%, p<0.001). The pooled analysis performed using a random‐effect model showed an increase in the risk of death in COVID‐19 patients with dementia (Odds Ratio3.75; 95% Confidence Interval: 2.54 ‐ 5.54, p<0.0001, I2=49.5%) The Egger's regression test confirmed that there were not statistically evidences of publication bias (t=0.059; p=0.954). Conclusions: The preliminary results suggest that patients with COVID‐19 infection and dementia have a higher mortality risk in the short‐term period compared with infected non‐demented individuals. Due to their intrinsic frailty, dementia patients may require a more aggressive treatment and prompt isolation to improve their short‐term outcome.

Last updated on hub: 07 December 2020

Dementia and the risk of death in elderly patients with COVID‐19 infection: systematic review and meta‐analysis

International Journal of Geriatric Psychiatry

Objectives: The COVID‐19 infection represents a global public health emergency worldwide. Several risk factors have been associated with a poor prognosis among COVID‐19 patients. We aimed to perform a systemic review and meta‐analysis to evaluate the mortality risk in elderly patients with dementia and COVID‐19 infection. Methods: Literature search was based on Cochrane Library, Embase, PubMed, and Google Scholar to locate articles published between December 2019 and July 2020, presenting the number of survived versus deceased patients with dementia and COVID‐19 infection. Results: A total of 233 articles were retrieved: 158 were excluded for not meeting the inclusion criteria, leaving 75 articles to assess for eligibility. After evaluation of the full‐text articles, eight met the inclusion criteria and were thus included into the final analysis (6493 patients – mean age: 69.6 years). Among COVID‐19 patients, the prevalence of dementia was higher in non‐survivors compared with survivors (17.5% vs. 5.4%, p < 0.001). The pooled analysis performed using a random‐effect model showed an increase in the risk of death in COVID‐19 patients with dementia (odds ratio: 3.75; 95% confidence interval: 2.54–5.54, p < 0.0001, I 2 = 49.5%). The Egger's regression test confirmed that there were not statistically evidences of publication bias (t = 0.059; p = 0.954). Conclusions: Our preliminary results suggest that patients with COVID‐19 infection and dementia have a higher mortality risk in the short‐term period compared with infected non‐demented individuals. Due to their intrinsic frailty, dementia patients may require a more aggressive treatment and prompt isolation to improve their short‐term outcome.

Last updated on hub: 08 April 2021

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