ABSTRACT
Introduction: Covid-19 disease forced the Spanish government to declare a national state of alarm implementing restrictive measures such as lockdown, social distancing and stay at home measures. These measures can be related to negative consequences on mental health and stress increase in elderly people with mild cognitive impairment or mild dementia. Objectives: The aim of this study was to explore the impact of this strict confinement and to analyze factors associated with perceived stress on community-dwelling older adults with mild cognitive impairment or mild dementia during the start of the COVID-19 pandemic. Methods: This study was conducted in Málaga a Spanish region of Andalucía. In total 143 elderly participants (>55 years old) with mild cognitive impairment or mild dementia, from the SMART 4 MD (n=69) and TV-AssistDem (n=74) randomized clinical trial (RCT), were interviewed by telephone between May 11 and June 25 2020. Participants were contacted by telephone by 5 health professionals (two Neuropsychologists, a Clinical Psychologist, a Psychologist and a Psychiatric and Mental Health Clinical Nurse Specialist). Researchers had previously established relationships with participants during both RCTs. The mean time from the start of the lockdown and home-confinement measures to the interview was 70.93 days (SD=12.36, Range: 52-102). Perceived stress was assessed with the Perceived Stress Scale (PSS-14). Depression (Geriatric Depression Scale), cognition (Mini-Mental State Examination-22), quality of life (Quality of Life-Alzheimer's Disease Scale), health status (EuroQoL-5D-3L) and other variables (specific structured questionary) were also measured. To analyze the factors associated with perceived stress linear regression models were used. R version 4.0.4 program was used for statistical analysis. Results: Of the respondents, 94/143 (65.7%) were women. The mean age was 74.12 years (SD 6.49), and 36/143 (25.2%) lived alone. 66/143 (46.48%) participants were worried and 33/143 (23.24%) were afraid at the time of the evaluation. Perceived stress was negatively associated with change in living arrangement (B=-4.89;p<0.05), feeling well (B=-7.88;p<0.001), feeling calm (B=-3.12;p<0.05), quality of life (B=-1.02;p<0.001) and health status (B=-0.20);p<0.001) and positively associated with feeling sad (B=7.32;p<0.001), feeling worried (B=6.45;p<0.001), feeling afraid (B=7.77;p<0.001), feeling anxious (B=10.44;p<0.001), feeling bored (B=6.77;p<0.001), sleep disturbances (B=5.49;p<0.01) and score of depression (B=1.83;p<0.001). Discussion: Surprisingly, the score of perceived stress was similar to other studies with comparable samples1,2. The strict confinement seems not to have affected this population significantly regarding perceived stress. Less perceived stress was associated with wellbeing and better quality of life. More perceived stress was associated with less mental health and sleep disturbances. A change in living arrangements was negatively correlated with perceived stress, probably due to the increase in family support. More studies are necessary to evaluate the long-term consequences of COVID-19 restricted measures in perceived stress and mental health in this vulnerable population. No conflict of interest
ABSTRACT
Residente que presente;Amanda Vega Núñez;Jessica Marian Goodman Casanova;Elena Durá Pérez. Background: COVID-19 outbreak in Spain has deeply affected the care of elderly people with dementia. The Spanish government decided to declare a national state of alarm implementing restrictive measures like lockdown, home confinement, social distancing and isolation, from the 15th of March 2020 until the 21st of June 2020. These measures also led to a change in health care access (1). Since dementia is a pathology which requires continuous care, the restrictive measures and reduced support availability may have significantly increased caregiver burden. The aim of this study was to explore to what extend mandatory restrictive COVID-19 measures affected the burden in caregivers of people with mild cognitive impairment and mild dementia. Methods: This cohort study was conducted in the Spanish region of Andalucía (Málaga). In total 151 caregivers for people with mild cognitive impairment or mild dementia (PMCI/MD), from the SMART4MD (n=75) (2) and TV-AssistDem (n=76) (3) randomized clinical trials (RCTs), were interviewed by telephone between May 11 and June 26 2020. All participants had undergone between 1-3 assessments (in 6 month-intervals) on burden and quality of life prior to the COVID-19 breakout. The mean time between the last assessment of the RCTs (TO) and the interview during lockdown (T1) was 199.33 days (SD=52.43, Range=67-395). The mean time from the start of the lockdown and home-confinement measures to the interview was 70.36 days (SD=12.40, Range: 52-102). Demographic variables assessed were: patients´ age, sex, marital status, educational level, caregiver relationship with the patient and type of cohabitation. Caregiver burden was measured with the Zarit Caregiver Burden Interview (ZBI-12) (4). Patient´s quality of life was evaluated with Alzheimer Quality of Life-Alzheimer's Disease Scale (QoL-AD) (5). Wilcoxon Signed Rank Test was used to compare ZBI-12 and QoL-AD scores before and during confinement because scores did not have a normal distribution. A linear regression model was built to test variables associated with ZBI-12 scores during confinement. Results: 151 matched pairs were assessed for this study. Mean patient age was 59.24 (SD = 15.39). The majority of the patients were women (68,6%) and were married (64,6%). Educational level was primary or less in 61%. The majority of caregivers were spouses (42%) or children (38.7%). Wilcoxon signed-rank test showed that ZBI-12 scores decreased after COVID19 confinement (mean negative rank = 62.37, mean positive rank = 52.51, Z = -3.69, p < 0,001). Patients´ quality of life decreased with confinement (QoL-AD mean negative rank = 89.75, mean positive rank = 42.88, Z = -5.881, p < 0,001). In the regression model, only ZBI-12 before confinement showed significant association with ZBI-12 score after confinement (Squared R = 0,44), while other variables were not significant. Conclusion: Although quality of life of people with mild cognitive impairment is significantly decreased, Caregiver burden did not increase during COVID19 confinement. No conflict of interest