Dementia and Covid study

There will be no doubt, many more studies done regarding coronavirus over the coming years and decades.  Some are happening now, I will discuss the results of one in this blog, that has looked at multiple global studies to ascertain the impact of covid for people living with dementia.

The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia, dementia services and research.  People with dementia have been hugely affected by the virus. People with dementia accounted for 31% of all deaths globally.  A London-based study of nursing home residents, most (57%) of whom had dementia, reported that 40% of COVID test-positive residents were asymptomatic and had a mortality rate of 26%!  There have also been reports of inappropriate ‘blanket’ do not attempt resuscitation (DNAR) decisions and restricted access to healthcare affecting care homes in England.  COVID-19 risk factors in people with dementia included APOE4 homozygosity. Living in a care home and comorbidities increases risk of COVID-19 disease severity, therefore there are biological reasons why people with dementia are more suspectable to the virus and if they get it, that they are more likely to have severe symptoms.

The dominant theme, explored by over 30 publications, was the negative impact of COVID-19-related restrictions on people living with dementia and their carers’ wellbeing, mental health and functioning.   Carers stress levels in normal times are high anyway and to add the social isolation and loneliness of the restrictions of the virus has added a huge addition strain.  Both people with dementia and their carers are having to manage day to day care after the withdrawal of many face to face services that they benefit from.  For those that get the disease and survive, it may increase the risk for or worsen cognitive impairment / dementia.

The negative mental health of workers in care homes and domiciliary care agencies related to the pandemic leading to absences and vacancies, so care homes are often struggling to manage the needs of their residents, especially since many of the visitors to care homes are no longer permitted, which would have provided therapeutic benefits for their residents.  Many entertainers are not permitted into care homes, as well as people such as hairdressers.  Residents are also struggling with the loneliness of being isolated away from their family, who are not permitted to visit, sometimes at all and not as much as before or in the same way.  One UK survey found that most care home managers surveyed reported that GPs were reluctant to visit care homes. In November 2020, the proportion of people living with dementia who received a medication review organised by their GP in the past 12 months decreased to 17.5% from 20.7% in November 2019.  The impact of the pandemic restrictions on care homes was consistently reported in three studies to have diminished overall wellbeing, such as reduced oral intake and increased challenging or distressed behaviours in residents and decreased work satisfaction among staff. Residents’ wellbeing improved after nursing homes were re-opened in a Dutch study.  Studies and reports of home care found that increased levels of carer stress could be mitigated by visiting care workers, although carers were often concerned about staff availability and potential risk of infection, so sometimes did not continue with such services.

Without diagnosis and post-diagnostic care, people affected by dementia may be unable to access important support and treatment or make plans. This will have a huge impact on the trajectory of their disease progression.  Many people living with dementia and their family carers are avoiding contact with primary health services, because of the fear of the disease and believe that this will help them by shielding them from potential risks.  The pandemic is also having a negative impact on the mental and physical wellbeing of home carers, many of whom are unpaid and have experienced changes in care responsibilities (increased care hours) with financial implications, suggesting that financial assistance is a potential source of support, so the study suggests that governments should investigate the benefits of providing financial support to carers.   There is reduced access to and use of social care services, e.g. respite care and face to face day care facilities, which has a huge impact on wellbeing of both people with dementia and their carers.

As the vaccination programme progresses and the worst impacts of the lockdowns locally and globally slowly diminish and a new normal emerges, it will take time before people with dementia and their carers are able to recover the lost ground of care that will have happened to them during the pandemic.