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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 1-3

COVID-19: A crisis for people with dementia


Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission04-Jun-2020
Date of Decision10-Jun-2020
Date of Acceptance19-Jun-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Dr. Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgmh.jgmh_20_20

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How to cite this article:
Mehra A, Grover S. COVID-19: A crisis for people with dementia. J Geriatr Ment Health 2020;7:1-3

How to cite this URL:
Mehra A, Grover S. COVID-19: A crisis for people with dementia. J Geriatr Ment Health [serial online] 2020 [cited 2020 Jul 2];7:1-3. Available from: http://www.jgmh.org/text.asp?2020/7/1/1/288236



COVID-19, a novel virus, emerged as a threat to the community across the world and was declared as a pandemic in March 2020 by the World Health Organization.[1] As of May 25, COVID-19 had affected 213 countries and territories around the world, with more than 55 lakhs confirmed cases with 3,47,293 deaths.[1] The COVID-19 has led to an unprecedented fear and uncertainty, especially among the elderly. There can be several reasons for elderly being at higher risk of developing COVID-19 infection and having an adverse outcome, such as a higher prevalence of chronic illnesses and weak immune system with slow recovery.[2] It is reported that in the United States, 8 out of 10 deaths were in the elderly population. Similarly, it is evident that across the world, the death rate associated with COVID-19 was higher among the elderly population.[3],[4] Among the elderly population, a subgroup, those with cognitive impairment or dementia, are considered to be at high risk of infection. The higher risk of infection is attributed to various factors [Table 1].[5],[6] Hence, significant concerns have been raised about the risk of COVID-19 infection among people living with cognitive impairment. However, to date, no data are available on morbidity and mortality associated with COVID-19 in people with cognitive impairment.
Table 1: Risk factors for COVID-19 in patients with dementia

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More than 60% of cases of dementia are in low- and middle-income countries (LMIC).[7] It is a known fact that the challenges for LMIC are enormous in the form of less developed health-care system and care and protection system. This further increases the risk of infection with COVID-19 among the elderly with dementia. Hence, it is essential to provide support to people with dementia in this crisis of COVID-19. Those with dementia should not be exposed unnecessarily to social gatherings, public transportation, or unnecessary visitors at this risky time. The caregiver or family member should be alert and vigilant to the presence of signs as well as symptoms of COVID-19 (”look beyond the words”).[8]

The family members and caregivers of patients with cognitive impairment and dementia have a big role to play in maintaining the safety of these patients. Further, the role of the caregivers will be defined by the level of cognitive impairment. If the person is suffering from the mild cognitive impairment, has good conversations skills and is able to participate reasonably in the surroundings, having a general discussion about everything related to COVID-19 infection and explaining them about what they are required to do or not to do, such as washing their hands, maintaining social distancing, using a mask, and avoiding social gathering can be beneficial.[9] It is advisable to keep this information accessible and repeatable, which is the key to success in people with dementia.

For patients with more severe deficits, caregivers should devote enough time to the patients with cognitive impairment/dementia to explain to them about hand hygiene measures. The caregivers should attempt to give a simple description as to how to wash hands to stay healthy. The caregivers can demonstrate proper hand-washing techniques, by suggesting “humming part of a favorite tune,” so a person with dementia washes his/her hands for an appropriate amount of time. They can also consider placing signs in the bathroom/elsewhere or written reminders to remind people with cognitive impairment or dementia to wash their hands with soap for at least 20 s. Using pictures and the large bold font may be helpful to use in signage.[10] Alcohol-based sanitizer can be used as an alternative if the person with dementia is not able to wash their hands easily.[9],[10],[11],[12],[13],[14] However, in such a scenario, the risk of exposure to any kind of flames must be kept in mind. This is important because exposure to flames after using alcohol-based sanitizer can lead to burns.

Caregivers should also help patients to understand the important of social distancing to keep oneself safe. The caregivers have to balance between maintaining social distancing and social isolation. People with dementia must not feel isolated. It is difficult for the elderly to maintain social distancing, as they may value the time spent with friends and family members. Hence, reassurance again and again without any threat can be helpful. People staying away from people with dementia should be in touch with them by maintaining contact by voice calls or video calls [Table 2].[10],[14],[15],[16] These can also provide social support, and it is necessary that the older generation feel safe and connected with society. However, it is important to remember that a few individuals with cognitive impairment may have trouble using technology. Hence, they should be provided appropriate instruction and support to use of these tools.
Table 2: How to maintain contact in the time of need of social distancing[10],[14],[15],[16]

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Further, the caregivers need to plan for things to maintain continuity of care. Various measures which can be used include virtual care, alternate care, and availability of medications. Virtual care means getting in touch with the treating team for an online appointment.[14],[16],[17] During the pandemic, there is always a probability that caregiver/family members of people with dementia can get infected with COVID-19 or are not in a position to assist a person due to lockdown. All this should be kept in mind, and alternate care measures need to be planned. The family member should determine who can take care of an individual with dementia in their absence. If possible, close and caring friends/relatives/volunteers need to be identified and shortlisted, and their contact details should be prepared, which can be used readily to help an individual with dementia.[10],[14],[16],[17] It is essential to keep the environment calm and have backup plans to manage challenging situations. It is also important to identify more resources that are available on a local, provincial, and national level. Many credible organizations offer support. There are volunteer community groups, with appropriate expertise, which can provide support for carers and people with dementia, particularly those living alone.[16],[18] There are a few nongovernmental organizations such as Alzheimer's and Related Disorders Society of India (ARDSI), which, in partnership with government institute, are helping in mobilization of support in case a carer is unable to care.[19] ARDSI is providing support and guidance for caregivers via telephone, video conferencing, social media platforms, and off-site distance monitoring.[20] The caregiver should also ensure that the medical supplies are stocked up. In case a person with dementia is staying away, it is vital to send the medications in advance. Further, a reminder must be kept to ensure adherence to the medications.[13],[16]

For elderly living alone, friends, family, government, and nongovernment organization can also lend a helping hand by delivering the groceries from the store and dropping them off directly to their home. In addition, family members, staying away, can order the same for the elderly, to minimize the trips to the grocery shops.[8],[9],[10],[11],[12],[13],[14],[16] If feasible, a family can shift temporarily with the elder one to a place where the required supports can be provided easily.

Clinicians managing patients with dementia should also actively contact the patients and their families to ensure medical care and guide the caregivers and patients in this hour of crisis.

Pandemic is a crisis for all, but more so for vulnerable people, such as those with cognitive impairment and dementia. People with dementia require extra care, support, and precautions to deal with the COVID-19. Community and caregivers should be encouraged to have more frequent contact or spend more time with people suffering from dementia. The recommended preventive guidelines such as wearing a mask and hand hygiene can be taught by repeating the same information again and again. The family members and the clinicians managing these patients have a big role to ensure the safety of this group of people.



 
  References Top

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World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report–51, May 2020. Available from: https://www.who.int/docs/defaultsource/coronaviruse/situation-reports/20200311-sitrep-51-covid-19. [Last accessed on 2020 May 25].  Back to cited text no. 1
    
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Novel Coronavirus (2019-nCoV) Situation Reports. World Health Organization. Available from: http://www.worldometers.inf'coronavirus. [Last accessed on 2020 May 25].  Back to cited text no. 2
    
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Older Adults. Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html. [Last accessed on 2020 May 25].  Back to cited text no. 3
    
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Dementia. World Health Organisation; 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia. [Last accessed on 2020 May 25].  Back to cited text no. 4
    
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Bruns A. COVID-19: Dementia and Cognitive Impairment. Available from: https://www.bgs.org.uk/resources/covid-19-dementia-and-cognitive-impairment. [Last accessed on 2020 May 25].  Back to cited text no. 8
    
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Weiss C. COVID-19: Advice for Caring for People with Alzheimer's Disease, Mild Cognitive Impairment. Available from: https://newsnetwork.mayoclinic.org/discussion/covid-19-advice-for-caring-for-people-with-alzheimers- disease-mild-cognitive-impairment. [Last accessed on 2020 May 25].  Back to cited text no. 9
    
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Ellison JM. Coronavirus and Alzheimer's Disease; 2020. Available from: https://www.brightfocus.org/alzheimers-disease/article/covid-19-and-alzheimers-disease. [Last accessed on 2020 May 25].  Back to cited text no. 11
    
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CDC. Coronavirus Disease 2019 (COVID-19). Situation Summary. Available from: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html. [Last accessed on 2020 May 25].  Back to cited text no. 12
    
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Sundarajan G. Caring for the Elderly during the COVID-19 Pandemic. Available from: https://www.unicef.org/india/stories/caring-elderly-during-covid-19-pandemic. [Last accessed on 2020 May 25].  Back to cited text no. 13
    
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Livingston E, Bucher K. Coronavirus disease 2019 (COVID_19) in Italy. JAMA 2020.  Back to cited text no. 14
    
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Palisoc J. COVID-19: Tips for Supporting People with Dementia. Available from: https://health.sunnybrook.ca/covid-19-coronavirus/tips-for-supporting-people-with-dementia. [Last accessed on 2020 May 25].  Back to cited text no. 16
    
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Comas-Herrera A, Lorenz-Dant K, Ferri C, Govia I, Saini PT, Jacobs R, et al. Supporting People Living with Dementia and their Carers in Low- and Middle-Income Countries During COVID-19. Available from: https://ltccovid.org/2020/04/10/supporting-people-living-with-dementia-and-their- carers-in-low-and-middle-income-countries- during-covid-19/. [Last accessed on 2020 May 25].  Back to cited text no. 19
    
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