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COVID-19 and the Impact on Individuals with Dementia

Tuesday, June 23rd, 2020

The world has changed since coronavirus became known in late 2019. The way we work, shop, travel and gather has had a huge overhaul. People experiencing dementia have not escaped this change. COVID-19 has implications for people with dementia, both directly in terms of increased vulnerability, and indirectly through effects on social supports and the healthcare system. In a special article, some Canadian-based researchers discussed the current and anticipated impact of the pandemic on individuals with dementia, as well as some possible ways forward to reduce this impact[1].

Increased Risk for COVID-19

The authors argued that people with dementia may be less able to appreciate, remember, or comply with public health recommendations to reduce the transmission of COVID-19.  This places them at higher risk of catching the virus. Individuals with dementia are also more likely to have cardiovascular disease, diabetes and pneumonia compared to individuals of the same age without dementia.  These conditions then place them at further risk of a poorer outcome should they develop COVID-19.

Diversions Away from the Diagnosis and Management of Dementia

Dementia does not simply stop because there is a global pandemic. Yet, the strain on healthcare systems due to the rapid rise in COVID-19 cases, means that resources are being diverted away from patients with dementia. The suspension of elective and non-urgent care in many affected areas were presented as an example.

Disruptions to Community Services

The authors expressed concern that individuals with dementia in the community may be at risk if services that they rely upon, such as “meals on wheels”, are disrupted by the pandemic. People with dementia are also less likely to drive, and a reliance on public transport increases the risk of exposure to COVID-19. The pandemic also threatens to disrupt basic routines that promote mental health.  For example, increased isolation and disruption of group activities may lead to feelings of loneliness.

Reduced social distancing in Residential Care

The typically higher dependence on caregivers in long-term care reduces the feasibility of physical distancing.  Shared communal areas in care homes also increase the risk of COVID-19 transmission.

Increased demands on Caregivers

Family members may have to become carers or find themselves taking on more responsibilities for their loved one with dementia, due the unavailability of established services.

Double Stigma

The authors raised frightening ethical dilemmas in relation to the rationing of health resources. Will older individuals with dementia be able to access intensive care beds? Will ventilators be prioritised for younger, healthier patients?

Threats to the “patients of tomorrow”

The article also presented statistics showing an abrupt interruption to dementia research.  It suggested that this may jeopardise not only the investment society has already made, but also have long-lasting consequences for the field more broadly.

Ways Forward

The authors proposed several ideas to reduce the impact of coronavirus on dementia.

  • Reducing the need for people with dementia to leave home by facilitating deliveries and deferring non-essential travel.
  • Problem solving to maintain the provision of essential services. Contingency planning for potential disruption and considering the temporary relocation of a person with dementia to a place where required supports can be provided.
  • Frequent check-ins on the person with dementia, either by phone or video, or in-person from a physical distance.
  • Coming up with creative ideas to incorporate alternative social and physical activities safely within the home. This will likely involve technology, and need to be accompanied by instruction and support in the use of these tools.
  • The provision of Personal Protective Equipment for healthcare workers.
  • Accelerating the adoption of technologies and tools in research that permit remote assessments. This has the added benefit of allowing the recruitment and follow-up of larger participant samples at reduced costs.
  • Speeding up the development of non-pharmacological interventions that can be delivered in participants’ homes, such as cognitive training or physical exercise.

People with chronic conditions such as dementia are vulnerable during crises – COIVD-19 is no exception.  Despite unprecedented uncertainty, there are many things we can do, and are doing, to reduce the harm of this pandemic.