Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective.

OBJECTIVES: Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. METHODS: This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the "cluster of cases" transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. RESULTS: The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = -0.552 [1.993], t58 = -2.109, p = 0.039) and eating disturbances (mean difference [SD] = -1.121 [2.493], t59 = -3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up. CONCLUSION: Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.

"Crisis Within the Walls": Rise of Intimate Partner Violence During the Pandemic, Indian Perspectives.

The ongoing coronavirus disease 2019 pandemic has been a social "un-equalizer," besides being a global health threat. Gender inequality has been globally prominent during the outbreak and the consequent lockdown. Although domestic abuse and intimate partner violence have increased due to chronic entrapment, overcrowding in families, enhanced substance use, distorted relationship dynamics, travel restrictions, and reduced healthcare access, coercive sexual practices have also been on the rise. In low- and middle-income countries, the lack of awareness, societal pressure, administrative apathy, fear of legal hassles, and inadequate knowledge-attitude-practice related to help-seeking lead to underreporting and mismanagement of domestic abuse, which can perpetuate its vicious cycle during the ongoing crisis. India, with its socio-culturally diverse population, has been one of the nations worst hit by the pandemic. With the rise in reports of gender-based violence on the premise of preexisting gender inequality and minority stress, concerns behind "closed doors" are as threatening as the infection itself. With this background, the authors highlight the backdrop of domestic violence as a "hidden pandemic" during the coronavirus disease 2019 crisis, drawing on perspectives from India and briefly reviewing the data from other nations. The role of mental health education and digital literacy as mitigating strategies is subsequently discussed.

Experiences of people with dementia and their caregivers during the COVID-19 pandemic in India: A mixed-methods study.

BACKGROUND: The COVID-19 pandemic has unprecedented consequences for the management of chronic diseases such as dementia. However, limited evidence exists on the condition of persons with dementia and their caregivers during the pandemic in lower-middle-income countries (LMICs). The study aimed to provide insights into the experiences of persons with dementia and their families during the early phases of the pandemic in India. METHODS: This study adopted a mixed-method approach. One hundred and four persons with dementia and their caregivers were evaluated via telephone using validated instruments and a semi-structured interview guide. We used the quantitative data collected to establish a baseline, whereas qualitative data were analysed thematically. RESULTS: The study revealed that persons with dementia and their caregivers experienced difficulties during the pandemic, which included worsening of behaviour, problems in accessing care, disruptions in functional activities and struggles in enforcing infection prevention contributing to caregiver distress. An important finding that emerged was the unchanging reality of caregiving for families. The relative success of the public health response to the COVID-19 pandemic contrasted with the lack of awareness and formal support for dementia. CONCLUSIONS: The COVID-19 pandemic has exposed the vulnerabilities of persons with dementia and their caregivers. This calls for a collaborative reframing of medical care and public health policies to address dementia care.

“The Untold Side of COVID-19”: Struggle and Perspectives of the Sexual Minorities

The coronavirus disease 2019 (COVID-19) pandemic has threatened global public health. Travel has been restricted, economies slashed, borders sealed, and billions quarantined at their residences, in an attempt to contain the outbreak. Social distancing and lockdown measures have disrupted human lives in terms of social relationships and emotional bonds. Every individual is facing unique challenges to cope with these unprecedented times. However, certain sections of the population, like the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) community, are particularly vulnerable to not only the infective risks of the virus, but also the psycho-social offshoots of the global lockdown and the pandemic aftermath. The various factors range from the immunocompromised state, increased comorbidities of sexually transmitted diseases, other chronic medical disorders and substance abuse, as well as reduced access to health care, to stigma and social discrimination, administrative apathy, economic constraints, and uncertainty of social rituals like the Pride Celebrations. These can lead to the underdetection of the viral load, increased physiological risks to COVID-19, decreased help-seeking, and inequality in health and legal care. Their emotional and psychosexual well-being also gets impaired, with increased risks for psychiatric disorders and suicidality.Keeping these factors in the background, this article glances at the disproportionate risk related to the COVID-19 pandemic in the sexual minorities, explores the psycho-social factors behind the same, and highlights specific ways to mitigate these risks for better care. Adopting a rights-based perspective for the LGBTQ community through public health measures during such crises can help reduce stigma and promote their social inclusion.