ABSTRACT
Resumen Introducción y Objetivo: En Argentina, la calidad del cuidado que los adultos mayores con cuadros crónicos de deterioro cognitivo reciben esta siendo afectada por la pandemia de COVID-19. Nuestro objetivo fue estudiar en qué medida la cuarentena afectó el bienestar y los síntomas conductuales de sujetos con demencia que viven en la comunidad y sus cuidadores luego de las 8 semanas iniciales de aislamiento obligatorio. Métodos: Familiares de 119 pacientes con Demencia tipo Alzheimer (DTA) o trastornos relacionados que viven en la comunidad fueron invitados a participar de forma anónima y voluntaria de una encuesta exploratoria, de tipo transversal o sincrónica, y con formato electrónico. Se utilizó estadística descriptiva y el test de chi cuadrado con un valor de significancia de p<0.05 para analizar las diferencias según la severidad de la demencia. Resultados: La edad media de los sujetos con demencia fue 81.16 (± 7.03), 35% tenían >85. El 67% tenía DTA y el 26% demencia mixta. El 34.5% tenían demencia leve, 32% moderada, 33% severa. En el 67 % de los casos, el cuidador principal era familiar. Se observó un aumento de ansiedad (43%), insomnio (28%), depresión (29%), empeoramiento de la marcha (41%) y aumento del uso de psicofármacos. La frecuencia de síntomas conductuales fue mayor en sujetos con demencia leve (p<0.05). En casi todos los casos la rehabilitación fue suspendida durante la cuarentena. Hubo un aumento significativo de la sobrecarga del cuidador durante la pandemia (t= -8.657, p<0.001). Conclusiones: Tanto los sujetos con demencia que viven en la comunidad como sus cuidadores mostraron un empeoramiento de su bienestar y estado de salud durante la pandemia de COVID-19, debido a una combinación multifactorial de aislamiento social, ausencia de rehabilitación, aumento del estrés del cuidador, miedo de contraer la enfermedad entre otras causas. Es necesario desarrollar un plan de acción coordinado y urgente que involucre a las familias de los pacientes, las autoridades sanitarias y el personal de salud que habitualmente atiende a estos pacientes para mitigar el impacto negativo de la cuarentena y epidemia en la salud de los sujetos con demencia que viven en la comunidad. Introduction: In Argentina, the quality of care that elderly subjects with dementia living in the community received has been deeply affected by COVID-19 epidemic. Our objective was to study to what extend mandatory quarantine imposed due to COVID-19 had affected behavioral symptoms in subjects with dementia after the first 8 weeks of quarantine. Methods: Relatives of 119 patients with Alzheimer-type Dementia or related disorders living in the community were invited to participate anonymously and voluntarily in an exploratory, cross-sectional and synchronous survey. Characteristics of people with dementia and their caregivers were analyzed with descriptive statistics using the chi-square tests, p < 0.05 was considered significant. Results: Mean age: 81.16 (±7.03), 35% of the subjects had more than 85 years of age. Diagnosis were 67% Alzheimer´s dementia and 26% mixed Alzheimer´s disease. Stages were 34.5% mild cases, 32% intermediate stage, and 33% severe cases as per Clinical dementia Rating score. In 67% of the sample, a family member was the main caregiver. Important findings were increased anxiety (43% of the sample), insomnia (28% of the subjects), depression (29%), worsening gait disturbance (41%), and increase use of psychotropics to control behavioral symptoms. Behavioral symptoms were more prevalent in subjects with mild dementia compared to subjects with severe dementia. Rehabilitation services had been discontinued in most subjects due to the quarantine. COVID-19 confinement increased stress caregiver (t= -8.657, p<0.001). Conclusion: We concluded from our analysis that during COVID-19 epidemic there was a deterioration of behavioral symptoms in our population of elderly dementia subjects living in the community. Perhaps, our findings are related to a combination of social isolation, lack of outpatient rehabilitation services, and increased stress of family caregivers. It is necessary to develop a plan of action to help dementia subjects deal with the increased stress that this epidemic imposed on them.
ABSTRACT
In Argentina, the quality of care that elderly subjects with dementia living in the community received has been deeply affected by COVID-19 epidemic. Our objective was to study to what extend mandatory quarantine imposed due to COVID-19 had affected behavioral symptoms in subjects with dementia after the first 8 weeks of quarantine. We invited family members to participate in a questionnaire survey. The sample consisted of family caregivers (n = 119) of persons with AD or related dementia living at home. We designed a visual analog scale to test the level of the burden of care of family members. Items inquired in the survey included type and setting (home or day care center) of rehabilitation services (physical/occupational/cognitive rehabilitation) and change in psychotropic medication and in behavioral symptoms that subjects with dementia experienced before and during the epidemic. Characteristics of people with dementia and their caregivers were analyzed with descriptive statistics using the chi-square tests, p < 0.01 was considered significant. Results: The sample included older adults with dementia. Mean age: 81.16 (±7.03), 35% of the subjects had more than 85 years of age. Diagnosess were 67% Alzheimer´s dementia and 26% mixed Alzheimer´s disease (AD). Stages were 34.5% mild cases, 32% intermediate stage, and 33% severe cases as per Clinical dementia Rating score. In 67% of the sample, a family member was the main caregiver. Important findings were increased anxiety (43% of the sample), insomnia (28% of the subjects), depression (29%), worsening gait disturbance (41%), and increase use of psychotropics to control behavioral symptoms. When we compared the frequency of behavioral symptoms within each dementia group category, we found that anxiety, depression, and insomnia were more prevalent in subjects with mild dementia compared to subjects with severe dementia. We analyzed the type and pattern of use of rehabilitation services before and during the isolation period, and we observed that, as a rule, rehabilitation services had been discontinued in most subjects due to the quarantine. We concluded from our analysis that during COVID-19 epidemic there was a deterioration of behavioral symptoms in our population of elderly dementia subjects living in the community. Perhaps, our findings are related to a combination of social isolation, lack of outpatient rehabilitation services, and increased stress of family caregivers. It is necessary to develop a plan of action to help dementia subjects deal with the increased stress that this epidemic imposed on them.
ABSTRACT
COVID-19 pandemic in Argentina has affected the care of older adults with dementia deeply. Our objective was to study how the obligatory social isolation affected stress caregiver and burden of care of family members of subjects living with dementia in the community after the initial 4 weeks of quarantine in our setting. We did a questionnaire survey among 80 family caregivers of persons with Alzheimer's disease (AD) or related dementia collected on April 2020. We designed a visual analog scale to test the level of the burden of care. Characteristics of people with dementia and their caregivers were analyzed with descriptive (mean, standard deviation, frequency and percent) and inferential statistics (chi-square test). The sample included older adults (mean age: 80.51 ± 7.65) with different stages of dementia. Family was the primary provider of care in 65%. Overall, COVID-19 confinement increased stress caregiver independently of the dementia stage, but those caring for severe cases had more stress compared to milder forms of the disease. Other findings were that half of the subjects with dementia experienced increased anxiety and that most family members discontinued all sort of cognitive and physical therapies. Family members' main concerns were for severe dementia cases, fear of absence of the paid caregiver during the epidemic, and for mild cases fear of spreading the disease while assisting patients with instrumental activities. A partnership between departments of public health, care workers and families must be planned to guarantee continuity of care during these unique COVID-19 times.