Dementia in the era of COVID-19. Some considerations and ethical issues.

Living with dementia at any time brings everyday challenges for the patient and those around him/her. The Covid-19 pandemic is making daily life harder. We aim to describe the problems of people with dementia during the time of such a pandemic and address the issue of their access to intensive care units. A systematic literature search (Cochrane Library (advanced search), and PubMed) was performed (for items up to 19 August 2020) using the following terms: 'COVID-19', 'dementia', and 'intensive care unit'. Studies were independently evaluated and selected for potential analysis. Five of 35 articles initially selected met the inclusion criteria. An additional Google Scholar search identified some striking statements from relevant authorities or scientists about the difficulty of living with dementia in the era of COVID-19, and were also reported. To summarize, dementia-related behaviours, increased age, and comorbid health conditions may increase the risk of contracting the virus. People with dementia in their own homes may already feel isolated, and additional rules for self-isolation may make this worse. As COVID-19 is spreading worldwide, governments and health authorities should devise better criteria for accessing intensive care units and allocating ventilators. If someone is given preference for medical care, it should be because that person has a better short-term prognosis, not simply because that person is younger than someone else.

A complication of coronavirus disease 2019: delirium.

COVID-19 is predominantly a respiratory disease. However, some cases exhibit other features including Central Nervous System symptoms. In the older adult, COVID-19 may present with atypical symptoms, including delirium and its complications. The objective of this study is to describe the relationship between the new type of coronavirus infection and delirium. Systematic research (Cochrane Library and PubMed) was carried out (only upper time limit: April 2020). Publications found through this indexed search were reviewed and manually screened to identify relevant studies. Search terms used included "COVID-19, Delirium, Dementia, Intensive Care Unit". We manually added articles identified through other sources (i.e., key journals). Older people are at the greatest risk from COVID-19. If infected, they may present delirium. Moreover, it is not exclusive to older people. Delirium is not inevitable; rather, it is preventable. Delirium prevention programs are even more crucial in the era of COVID-19 and cannot be allowed to wither despite the challenges of integrating delirium prevention with COVID-19 care. An acute change in condition, behaviour, or mental status should prompt a delirium screen. As regards the treatment, it is advisable to use non-pharmacological interventions first where possible. Medication may be needed for patients with agitation where there is intractable distress or high risk to self/others.