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3.
Int J Environ Res Public Health ; 17(24)2020 12 19.
Article in English | MEDLINE | ID: covidwho-1362362

ABSTRACT

Informal caregivers are people providing some type of unpaid, ongoing assistance to a person with a chronic illness or disability. Long-term care measures and policies cannot take place without taking into account the quantitatively crucial role played by informal caregivers. We use the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS), and the Study on Health and Ageing in Europe (SHARE) to measure the prevalence of informal caregivers in the European population, and analyze associated socio-demographic factors. This rate ranges between about 13 percent in Portugal and Spain, and more than 22 percent in Luxembourg, Belgium, and Denmark. It declines in older age groups and, on average, is lower in men than in women in all countries studied, and lower among the poorly educated compared to those with higher levels of education. However, large variance was observed in the average share of informal caregivers for most countries between the three surveys. Our findings, estimated through the three surveys, reveal common trends, but also a series of disparities. Additional research will be needed to enable policy makers to access a richer and more harmonized body of data, allowing them to adopt truly evidence-based and targeted policies and interventions in this field.


Subject(s)
Caregivers/statistics & numerical data , Patient Care/statistics & numerical data , Quality of Life/psychology , Aged , Aged, 80 and over , Caregivers/psychology , Europe , Female , Humans , Male , Patient Care/psychology , Prevalence
4.
MMWR Morb Mortal Wkly Rep ; 70(24): 879-887, 2021 Jun 18.
Article in English | MEDLINE | ID: covidwho-1278792

ABSTRACT

Early during the COVID-19 pandemic, nearly two thirds of unpaid caregivers of adults reported adverse mental or behavioral health symptoms, compared with approximately one third of noncaregivers† (1). In addition, 27% of parents of children aged <18 years reported that their mental health had worsened during the pandemic (2). To examine mental health during the COVID-19 pandemic among U.S. adults on the basis of their classification as having a parenting role (i.e., unpaid persons caring for children and adolescents aged <18 years, referred to as children in this report) or being an unpaid caregiver of adults (i.e., persons caring for adults aged ≥18 years),§ CDC analyzed data from cross-sectional surveys that were administered during December 2020 and February-March 2021 for The COVID-19 Outbreak Public Evaluation (COPE) Initiative.¶ Respondents were categorized as parents only, caregivers of adults only, parents-caregivers (persons in both roles), or nonparents/noncaregivers (persons in neither role). Adjusted odds ratios (aORs) for any adverse mental health symptoms, particularly suicidal ideation, were higher among all respondents who were parents, caregivers of adults, or both compared with respondents who were nonparents/noncaregivers and were highest among persons in both roles (parents-caregivers) (any adverse mental health symptoms: aOR = 5.1, 95% confidence interval [CI] = 4.1-6.2; serious suicidal ideation: aOR = 8.2, 95% CI = 6.5-10.4). These findings highlight that parents and caregivers, especially those balancing roles both as parents and caregivers, experienced higher levels of adverse mental health symptoms during the COVID-19 pandemic than adults without these responsibilities. Caregivers who had someone to rely on for support had lower odds of experiencing any adverse mental health symptoms. Additional measures are needed to improve mental health among parents, caregivers, and parents-caregivers.


Subject(s)
COVID-19/psychology , Caregivers/psychology , Mental Disorders/epidemiology , Parents/psychology , Adolescent , Adult , Aged , COVID-19/epidemiology , Caregivers/economics , Caregivers/statistics & numerical data , Female , Health Surveys , Humans , Male , Middle Aged , United States/epidemiology , Young Adult
5.
J Aging Soc Policy ; 33(4-5): 474-492, 2021.
Article in English | MEDLINE | ID: covidwho-1238101

ABSTRACT

As COVID-19 puts older people in long-term institutional care at the highest risk of infection and death, the need for home-based care has increased. Germany relies largely on migrant caregivers from Poland. Yet the pandemic-related mobility restrictions reveal the deficiencies of this transnational elder care system. This article asks if this system is resilient. In order to answer this question, the research team conducted interviews with 10 experts and randomly selected representatives of brokering and sending agencies in Germany and Poland. We interviewed 13 agencies in Germany and 15 in Poland on the agencies' characteristics, recruitment strategies, challenges of the pandemic, and impact of legal regulations in the sector. The analysis shows that the system could mobilize adaptive capacities and continue to deliver services, but its absorptive capacity is limited. To enhance resilience, policies working toward formalization and legalization of care services across national borders are required.


Subject(s)
COVID-19 , Caregivers/statistics & numerical data , Home Care Services , Resilience, Psychological , Transients and Migrants , Aged , Germany , Humans , Interviews as Topic , Long-Term Care , Poland/ethnology , Transients and Migrants/legislation & jurisprudence
6.
J Child Neurol ; 36(9): 760-767, 2021 08.
Article in English | MEDLINE | ID: covidwho-1172813

ABSTRACT

Because of the COVID-19 pandemic, in-person services for individuals with neurodevelopmental disabilities were disrupted globally, resulting in a transition to remote delivery of services and therapies. For individuals with neurogenetic conditions, reliance on nonclinical caregivers to facilitate all therapies and care was unprecedented. The study aimed to (1) describe caregivers' reported impact on their dependent's services, therapies, medical needs, and impact on themselves as a result of the COVID-19 pandemic and (2) assess the relationship between the extent of disruption of services and the degree of self-reported caregiver burden. Two online questionnaires were completed by caregivers participating in Simons Searchlight in April and May 2020. Surveys were completed by caregivers of children or dependent adults with neurodevelopmental genetic conditions in Simons Searchlight. Caregivers reported that the impact of the COVID-19 pandemic moderately or severely disrupted services, therapies, or medical supports. The majority of caregivers were responsible for providing some aspect of therapy. Caregivers reported "feeling stressed but able to deal with problems as they arise," and reported lower anxiety at follow-up. Caregivers reported that telehealth services were not meeting the needs of those with complex medical needs. Future surveys will assess if and how medical systems, educational programs, therapists, and caregivers adapt to the challenges arising during the COVID-19 pandemic.


Subject(s)
COVID-19/psychology , Caregiver Burden/psychology , Caregivers/psychology , Health Care Surveys/methods , Health Services Accessibility/statistics & numerical data , Neurodevelopmental Disorders/therapy , Adolescent , Adult , Caregivers/statistics & numerical data , Child , Child, Preschool , Female , Health Care Surveys/statistics & numerical data , Humans , Male , Needs Assessment , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
7.
Support Care Cancer ; 29(9): 5463-5473, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1126558

ABSTRACT

PURPOSE: This study aimed to explore the psychosocial impacts of the coronavirus disease (COVID-19) pandemic on cancer patients, survivors, and carers in Australia. METHODS: Using real-time insights from two Cancer Council NSW services-131120 Information and Support Line and Online Community (CCOC) forums-we assessed service demand trends, distress levels (using the distress thermometer), and content from 131120 calls and online posts between 01 December 2019 and 31 May 2020. Emergent themes were identified through an inductive conventional content analysis with 131120 call notes, followed by a deductive directed content analysis on CCOC posts. RESULTS: In total, 688 COVID-19-related 131120 calls (n = 496) and online posts (n = 192) were analysed. Service demand peaked in March 2020 and self-reported distress peaked in May 2020 at an average of 8/10 [Mean = 7.5; SD = 0.9]. Five themes emerged from the qualitative analysis: psychological distress and fear of virus susceptibility, practical issues, cancer service disruptions, information needs, and carer Issues. CONCLUSIONS: The psychosocial impacts of COVID-19 on people affected by cancer are multifaceted and likely to have long-lasting consequences. Our findings drove the development of six recommendations across three domains of support, information, and access. Cancer patients, survivors, and carers already face stressful challenges dealing with a cancer diagnosis or survivorship. The added complexity of restrictions and uncertainty associated with the pandemic may compound this. It is important that healthcare providers are equipped to provide patient-centred care during and after this crisis. Our recommendations provide points of consideration to ensure care is tailored and patient oriented.


Subject(s)
COVID-19/psychology , Cancer Survivors/psychology , Caregivers/psychology , Neoplasms/therapy , Patients/psychology , Adult , Aged , Australia/epidemiology , COVID-19/epidemiology , Cancer Survivors/statistics & numerical data , Caregivers/statistics & numerical data , Female , Humans , Male , Middle Aged , Patients/statistics & numerical data , Social Support
9.
Neurol Sci ; 42(4): 1247-1251, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1064522

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has dramatically stressed the health care system and has provoked changes in population use of digital technologies. Digital divide is any uneven distribution in Information and Communications Technologies between people. AIMS: The purpose of this work was to describe the digital divide of a population of patients with dementia contacted by telemedicine during Italian lockdown for COVID-19 pandemic. METHOD: One hundred eight patients with cognitive impairment were contacted by video call to perform a telemedicine neurological evaluation. Information on patients and caregivers attending the televisit were recorded. RESULTS: Seventy-four patients connected with neurologist (successful televisit, 68.5%) and 34 patients were not able to perform televisit and were contacted by phone (failed televisit, 31.5%). No significant differences were observed among the two groups concerning age, gender, and education, but the prevalence of successful televisit was higher in the presence of younger caregivers: televisits performed in the presence of subjects of younger generation (sons and grandsons) had a successful rate higher (86% successful, 14% failed) than the group without younger generation caregiver (49% successful, 51% failed). This difference is mainly due to the ability of technological use among younger people. DISCUSSION: The most impacting factors on digital divide in our population are the social support networks and the experience with the technology: the presence of a digital native caregiver. The COVID-19 pandemic is unmasking an emerging form of technology-related social inequalities: political and community interventions are needed to support the most socially vulnerable population and prevent social health inequalities.


Subject(s)
COVID-19 , Caregivers/statistics & numerical data , Dementia/therapy , Digital Divide , Pandemics , Telemedicine/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , Caregivers/psychology , Educational Status , Female , Humans , Italy/epidemiology , Male , Middle Aged , Neurologists , Prevalence , Quarantine , Sex Factors , Young Adult
10.
Res Dev Disabil ; 111: 103889, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1051930

ABSTRACT

BACKGROUND: During COVID-19 measures face-to-face contact is limited and professional carers have to find other ways to support people with intellectual disabilities. COVID-19 measures can increase stress in people with intellectual disabilities, although some people may adapt to or grow from these uncertain situations. Resilience is the process of effectively negotiating, adapting to, or managing significant sources of stress and trauma. The current study aims to provide professional carers with new insights into how they can support people with intellectual disabilities. METHOD: An online survey was shared through the social media and organizational newsletters of MEE ZHN (a non-governmental organization for people with disabilities). The resilience framework by Ungar (2019) was adapted to fit to people with intellectual disabilities during COVID-19 measures. Statistical analyses were performed in SPSS statistics version 26. RESULTS: Results show that professional carers applied diverse and distal methods to maintain contact with people with intellectual disabilities during the COVID-19 measures. Professional carers reported a significant decrease in the quality of contact with clients with intellectual disabilities, but overall high levels of resilience in the same clients. IMPLICATIONS: Online methods of communication are possibly insufficient for professionals to cover all needs of people with intellectual disabilities. During this pandemic professionals should be aware of stress but also of resilience in people with intellectual disabilities.


Subject(s)
COVID-19 , Caregivers , Disabled Persons , Intellectual Disability , Psychosocial Support Systems , Resilience, Psychological , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Caregivers/psychology , Caregivers/statistics & numerical data , Disabled Persons/psychology , Disabled Persons/rehabilitation , Female , Humans , Intellectual Disability/epidemiology , Intellectual Disability/psychology , Intellectual Disability/rehabilitation , Male , Netherlands/epidemiology , Professional-Patient Relations , Quality of Health Care , SARS-CoV-2 , Surveys and Questionnaires
11.
J Ment Health ; 30(2): 138-147, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1050046

ABSTRACT

BACKGROUND: People with existing mental health conditions may be particularly vulnerable to the psychological effect of the COVID-19 pandemic. But their positive and negative appraisals, and coping behaviour could prevent or ameliorate future problems. OBJECTIVE: To explore the emotional experiences, thought processes and coping behaviours of people with existing mental health problems and carers living through the pandemic. METHODS: UK participants who identified as a mental health service user (N18), a carer (N5) or both (N8) participated in 30-minute semi-structured remote interviews (31 March 2020 to 9 April 2020). The interviews investigated the effects of social distancing and self-isolation on mental health and the ways in which people were coping. Data were analysed using a framework analysis. Three service user researchers charted data into a framework matrix (consisting of three broad categories: "emotional responses", "thoughts" and "behaviours") and then used an inductive process to capture other contextual themes. RESULTS: Common emotional responses were fear, sadness and anger but despite negative emotions and uncertainty appraisals, participants described efforts to cope and maintain their mental wellbeing. This emphasised an increased reliance on technology, which enabled social contact and occupational or leisure activities. Participants also spoke about the importance of continued and adapted mental health service provision, and the advantages and disadvantages associated with changes in their living environment, life schedule and social interactions. CONCLUSION: This study builds on a growing number of qualitative accounts of how mental health service users and carers experienced and coped with extreme social distancing measures early in the COVID-19 pandemic. Rather than a state of helplessness this study contains a clear message of resourcefulness and resilience in the context of fear and uncertainty.


Subject(s)
Adaptation, Psychological , COVID-19/psychology , Caregivers/psychology , Mental Disorders/psychology , Physical Distancing , Adolescent , Adult , Aged , Caregivers/statistics & numerical data , Female , Humans , Interviews as Topic , Male , Mental Disorders/therapy , Mental Health Services , Middle Aged , Qualitative Research , United Kingdom , Young Adult
12.
Am J Geriatr Psychiatry ; 29(7): 687-697, 2021 07.
Article in English | MEDLINE | ID: covidwho-1036577

ABSTRACT

OBJECTIVE: To investigate mental health status and associated factors among caregivers of older adults during the COVID-19 epidemic in China. METHODS: From March 1 to 31, 2020, 916 caregivers of older adults participated in an online cross-sectional survey on the prevalence of anxiety, depression, and sleep problems. The seven-item Generalized Anxiety Disorder Scale (GAD-7) was administered to measure anxiety symptoms, the two-item Patient Health Questionnaire (PHQ-2) was used to assess depressive symptoms, and a self-developed questionnaire was used to assess sleep quality and duration. Six questions about COVID-19-related experiences were used to assess community-level infection contact and the level of exposure to media information. The prevalence rates of anxiety, depression and sleep problems were computed. The Wald χ2 were applied to compare the differences between subgroups. Multiple logistic regression analyses were performed to investigate factors associated with anxiety, depression, sleep problems, and multimorbidity. RESULTS: The prevalence rates of anxiety, depression, and sleep problems were 46.8%, 29.8%, and 10.8%, respectively. Approximately 263 participants (28.7%) presented with two or more mental health problems. Being female (OR, 2.254; 95% CI, 1.510-3.363), having community-level COVID-19 contact (OR, 1.856; 95% CI, 1.189-2.898), and having a mental disorder (OR, 3.610; 95% CI, 1.644-7.930) were associated with increased risk of multimorbidity among caregivers. Caregivers who preferred positive information (OR, 0.652; 95% CI, 0.472-0.899) had reduced risk of multimorbidity. CONCLUSION: Anxiety and depression were common among caregivers of older adults during the COVID-19 epidemic. Being female and having community-level COVID-19 contact were independent risk factors for experiencing multiple mental health problems. Preexisting mental disorders increased the risk of multimorbidity among caregivers, while enhanced access to positive media information decreased the risk of multimorbidity.


Subject(s)
COVID-19/epidemiology , Caregivers/psychology , Caregivers/statistics & numerical data , Mental Health/statistics & numerical data , Multimorbidity , Anxiety/epidemiology , China/epidemiology , Depression/epidemiology , Female , Humans , Male , Middle Aged , Sleep Wake Disorders/epidemiology
14.
Medicina (Kaunas) ; 56(12)2020 Nov 26.
Article in English | MEDLINE | ID: covidwho-1024603

ABSTRACT

Background and objectives: The COVID-19 pandemic has had an unprecedented reliance on informal caregivers as one of the pillars of healthcare systems. The aim of this study was to assess the quality of life of informal caregivers during the COVID-19 epidemic in Serbia. Materials and Methods: A cross-sectional study was conducted among informal caregivers during the COVID-19 epidemic in Serbia. Physical and mental quality of life was measured by the 36-Item Short-Form Health Survey. Additional data included sociodemographic characteristics, caregiver and care recipient characteristics, and COVID-19 related concerns. The qualitative component was performed using focus groups and individual in-depth interviews. Results: Out of 112 informal caregivers enrolled, most were female (80%), and the average age was 51.1 ± 12.3 years. The majority was delivering care to one person, who was a family member, on a daily basis (86.4%, 92%, and 91.1%, respectively). In multiple regression models, significant predictors of caregivers' physical health were delivering care to a family member and a higher level of care complexity, while significant predictors of caregivers' mental health were a higher level of care complexity and increased concerns about self-health and the health of the person being cared for due to the COVID-19 epidemic. Conclusions: Informal caregivers are experiencing negative physical and mental health outcomes during the COVID-19 epidemic in Serbia.


Subject(s)
COVID-19 , Caregiver Burden , Caregivers , Health Status Disparities , Mental Health , Quality of Life , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Caregiver Burden/epidemiology , Caregiver Burden/prevention & control , Caregiver Burden/psychology , Caregivers/psychology , Caregivers/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Serbia/epidemiology
15.
Clin Ther ; 42(11): 2124-2133, 2020 11.
Article in English | MEDLINE | ID: covidwho-1023514

ABSTRACT

PURPOSE: This study determined the predictors of caregivers' willingness to accept an accelerated regulatory process for the development of vaccines against coronavirus disease 2019 (COVID-19). METHODS: An international cross-sectional survey was administered to 2557 caregivers of children in 17 pediatric emergency departments (EDs) across 6 countries from March 26, 2020, to June 30, 2020. Caregivers were asked to select 1 of 4 choices with which they most agreed regarding a proposed COVID-19 vaccine-approval process, in addition to questions regarding demographic characteristics, the ED visit, and attitudes about COVID-19. Univariate analyses were conducted using the Mann-Whitney U test for comparing non-normally distributed continuous variables, an independent t test for comparing normally distributed continuous variables, and a χ2 or Fisher exact test for categorical variables. Multivariate logistic regression analysis was used for determining independent factors associated with caregivers' willingness to accept abridged development of a COVID-19 vaccine. A P value of <0.05 was considered significant. FINDINGS: Almost half (1101/2557; 43%) of caregivers reported that they were willing to accept less rigorous testing and postresearch approval of a new COVID-19 vaccine. Independent factors associated with caregivers' willingness to accept expedited COVID-19 vaccine research included having children who were up to date on the vaccination schedule (odds ratio [OR] = 1.72; 95% CI, 1.29-2.31), caregivers' concern about having had COVID-19 themselves at the time of survey completion in the ED (OR = 1.1; 95% CI, 1.05-1.16), and caregivers' intent to have their children vaccinated against COVID-19 if a vaccine were to become available (OR = 1.84; 95% CI, 1.54-2.21). Compared with fathers, mothers completing the survey were less likely to approve of changes in the vaccine-development process (OR = 0.641; 95% CI, 0.529-0.775). IMPLICATIONS: Less than half of caregivers in this worldwide sample were willing to accept abbreviated COVID-19 vaccine testing. As a part of an effort to increase acceptance and uptake of a new vaccine, especially in order to protect children, public health strategies and individual providers should understand caregivers' attitudes toward the approval of a vaccine and consult them appropriately.


Subject(s)
COVID-19 Vaccines , COVID-19 , Caregivers , Health Knowledge, Attitudes, Practice , Patient Acceptance of Health Care/statistics & numerical data , Biomedical Research/standards , COVID-19/prevention & control , COVID-19/therapy , Caregivers/psychology , Caregivers/statistics & numerical data , Cross-Sectional Studies , Humans , SARS-CoV-2 , Time Factors
16.
Support Care Cancer ; 29(7): 4137-4146, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1009140

ABSTRACT

PURPOSE: Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers' emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. METHODS: We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers' emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables. RESULTS: A total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of "1: Much lower" to "5: Much higher", the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1-5) for financial strain, 3.61 (SD: 0.86; range: 1-5) for physical strain, and 3.88 (SD: 0.89; range: 1-5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19. CONCLUSION: These findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.


Subject(s)
COVID-19/epidemiology , Caregivers , Financial Stress/ethnology , Neoplasms/therapy , Pain/ethnology , Stress, Psychological/ethnology , Adult , Aged , Aged, 80 and over , Burnout, Professional/economics , Burnout, Professional/epidemiology , Burnout, Professional/ethnology , Burnout, Professional/psychology , COVID-19/psychology , Caregivers/economics , Caregivers/psychology , Caregivers/statistics & numerical data , Cross-Sectional Studies , /statistics & numerical data , Female , Financial Stress/epidemiology , Financial Stress/psychology , Humans , Male , Middle Aged , Neoplasms/economics , Neoplasms/epidemiology , Neoplasms/ethnology , Pain/economics , Pain/epidemiology , Pandemics , Psychological Distress , /statistics & numerical data , Stress, Psychological/economics , Stress, Psychological/epidemiology , Surveys and Questionnaires , United States/epidemiology , Young Adult
17.
Eur Eat Disord Rev ; 28(6): 826-835, 2020 11.
Article in English | MEDLINE | ID: covidwho-995934

ABSTRACT

OBJECTIVE: This qualitative study explores the ways in which the coronavirus disease 2019 (COVID-19) pandemic and associated lockdown measures have affected the lives of adult patients with anorexia nervosa (AN) and their carers. METHOD: Semi-structured interviews were conducted with patients with AN (n = 21) and carers (n = 28) from the start of UK Government imposed lockdown. Data related directly to the impact of lockdown and COVID-19 were analysed using thematic analysis. RESULTS: Four broad themes were identified for patients and carers separately. Patients experienced: 1. reduced access to eating disorder (ED) services; 2. disruption to routine and activities in the community; 3. heightened psychological distress and ED symptoms; 4. increased attempts at self-management in recovery. Carer themes included: 1. concern over provision of professional support for patients; 2. increased practical demands placed on carers in lockdown; 3. managing new challenges around patient wellbeing; 4. new opportunities. CONCLUSIONS: Reduced access to ED services, loss of routine and heightened anxieties and ED symptoms resulting from COVID-19 and lockdown measures presented challenges for patients and carers. Increased remote support by ED services enabled the continuation of treatment and self-management resources and strategies promoted self-efficacy in both groups.


Subject(s)
Anorexia Nervosa/therapy , COVID-19/epidemiology , COVID-19/prevention & control , Caregivers/psychology , Pandemics , Quarantine , Adult , Anorexia Nervosa/epidemiology , Anxiety/epidemiology , COVID-19/psychology , Caregivers/statistics & numerical data , Female , Health Services Accessibility/statistics & numerical data , Humans , Male , Middle Aged , Qualitative Research , Self-Management/psychology , United Kingdom/epidemiology , Young Adult
19.
Am J Manag Care ; 26(11): 465-466, 2020 11.
Article in English | MEDLINE | ID: covidwho-946631

ABSTRACT

Elderly, homebound individuals comprise a vulnerable segment of society who have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic through a myriad of unique challenges. There is a significant amount of fear of acquiring COVID-19 by seeking health care services, which has adversely affected patients by worsening fixable situations. Another challenge is the decrease in diagnostic support for evaluating patients compared with a pre-COVID-19 world. Agencies providing at-home phlebotomy, portable radiology, and support services have had to limit their home visits due to an inability to access personal protective equipment. This loss of diagnostic and therapeutic support has had an emotional toll on patients and their caregivers. COVID-19 has had a tremendous impact on the health and finances of home health aides and their patients. Loss of long-term home health aides has adversely affected younger patients with ailments like Down syndrome as well as older patients with dementia. COVID-19 has also increased pressure on end-of-life decision making. Patients and their families are increasingly opting for palliative care and hospice programming to avoid separation. Families are being forced to consider advance directives under an increased emotional strain as patients become "persons under investigation" for COVID-19. Technology has allowed for the provision of services through telehealth, and changes to policy by CMS have aided widespread implementation of telemedicine. We anticipate continuing to be nimble in the face of challenge and to provide timely and meaningful care for those who depend on our efforts.


Subject(s)
Betacoronavirus , Caregivers/statistics & numerical data , Coronavirus Infections/therapy , House Calls/trends , Pneumonia, Viral/therapy , Telemedicine/trends , Aged , Ambulatory Care/methods , COVID-19 , Caregivers/psychology , Coronavirus Infections/psychology , Humans , Palliative Care , Pandemics , Pneumonia, Viral/psychology , SARS-CoV-2 , Social Isolation
20.
Cancer Med ; 9(24): 9193-9204, 2020 12.
Article in English | MEDLINE | ID: covidwho-938402

ABSTRACT

Since the COVID-19 outbreak started, it has been affecting mainly older individuals. Among the most vulnerable older individuals are those with cancer. Many published guidelines and consensus papers deal with prioritizing cancer care. Given the lack of high-quality evidence for management of cancer in older patients also in normal times, it is even more stringent to provide some resources on how to avoid both undertreatment and overtreatment in this population, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated. We hereby discuss some general recommendations (implement triage procedures; perform geriatric assessment; carefully assess comorbidity; promote early integration of palliative care in oncology; acknowledge the role of caregivers; maintain active take in charge to avoid feeling of abandonment; mandate seasonal flu vaccination) and discuss practical suggestions for specific disease settings (early-stage and advanced-stage disease for solid tumors, and hematological malignancies). The manuscript provides resources on how to avoid both undertreatment and overtreatment in older patients with cancer, who as of now is twice challenged to death, due to both a greater risk of getting infected with COVID-19 as well as from cancer not adequately addressed and treated.


Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , Neoplasms/therapy , SARS-CoV-2/isolation & purification , Aged , COVID-19/epidemiology , COVID-19/virology , Caregivers/standards , Caregivers/statistics & numerical data , Disease Outbreaks , Geriatric Assessment/methods , Geriatric Assessment/statistics & numerical data , Humans , Medical Oncology/standards , Medical Oncology/statistics & numerical data , Neoplasms/diagnosis , Palliative Care/methods , Palliative Care/standards , Palliative Care/statistics & numerical data , SARS-CoV-2/physiology
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