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1.
Int J Environ Res Public Health ; 19(10)2022 05 16.
Article in English | MEDLINE | ID: covidwho-1875629

ABSTRACT

(1) Background: A United States national policy advisory group (PAG) was convened to identify barriers and facilitators to expand formal long-term services and support (LTSS) for people living alone with cognitive impairment (PLACI), with a focus on equitable access among diverse older adults. The PAG's insights will inform the research activities of the Living Alone with Cognitive Impairment Project, which is aimed at ensuring the equitable treatment of PLACI. (2) Methods: The PAG identified barriers and facilitators of providing effective and culturally relevant LTSS to PLACI via one-on-one meetings with researchers, followed by professionally facilitated discussions among themselves. (3) Results: The PAG identified three factors that were relevant to providing effective and culturally relevant LTSS to PLACI: (i) better characterization of PLACI, (ii) leveraging the diagnosis of cognitive impairment, and (iii) expanding and enhancing services. For each factor, the PAG identified barriers and facilitators, as well as directions for future research. (4) Conclusions: The barriers and facilitators the PAG identified inform an equity research agenda that will help inform policy change.


Subject(s)
Cognitive Dysfunction , Aged , Cognitive Dysfunction/therapy , Humans , Policy , United States
2.
BMJ Open ; 12(4): e055038, 2022 04 11.
Article in English | MEDLINE | ID: covidwho-1784816

ABSTRACT

INTRODUCTION: A substantial number of patients diagnosed with COVID-19 experience long-term persistent symptoms. First evidence suggests that long-term symptoms develop largely independently of disease severity and include, among others, cognitive impairment. For these symptoms, there are currently no validated therapeutic approaches available. Cognitive training interventions are a promising approach to counteract cognitive impairment. Combining training with concurrent transcranial direct current stimulation (tDCS) may further increase and sustain behavioural training effects. Here, we aim to examine the effects of cognitive training alone or in combination with tDCS on cognitive performance, quality of life and mental health in patients with post-COVID-19 subjective or objective cognitive impairments. METHODS AND ANALYSIS: This study protocol describes a prospective randomised open endpoint-blinded trial. Patients with post-COVID-19 cognitive impairment will either participate in a 3-week cognitive training or in a defined muscle relaxation training (open-label interventions). Irrespective of their primary intervention, half of the cognitive training group will additionally receive anodal tDCS, all other patients will receive sham tDCS (double-blinded, secondary intervention). The primary outcome will be improvement of working memory performance, operationalised by an n-back task, at the postintervention assessment. Secondary outcomes will include performance on trained and untrained tasks and measures of health-related quality of life at postassessment and follow-up assessments (1 month after the end of the trainings). ETHICS AND DISSEMINATION: Ethical approval was granted by the Ethics Committee of the University Medicine Greifswald (number: BB 066/21). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: NCT04944147.


Subject(s)
COVID-19 , Cognitive Dysfunction , Transcranial Direct Current Stimulation , Brain , COVID-19/therapy , Clinical Trials, Phase II as Topic , Cognition , Cognitive Dysfunction/therapy , Humans , Prospective Studies , Quality of Life , Randomized Controlled Trials as Topic
3.
BMJ Open ; 12(3): e055990, 2022 03 28.
Article in English | MEDLINE | ID: covidwho-1769916

ABSTRACT

INTRODUCTION: More than 50 million people worldwide are living with dementia in 2020, and this number is expected to double every 20 years. Physical exercise is a growing field in non-pharmacological interventions for dementia care. Due to public health measures during the COVID-19 pandemic, more people have considered adapting to technology-based exercise via digital devices. This scoping review will explore evidence relating to the use of technology-based group exercise by people with dementia or mild cognitive impairment. METHODS AND ANALYSIS: This review will follow the Joanna Briggs Institute scoping review methodology to review literature published between June and December 2021. This review is designed to identify existing types of technology-based group exercise interventions for people with dementia. The review will provide a synthesis of current evidence on the outcome and impacts of technology-based group exercise. The context of this review will include homes, assisted living facilities and memory care services but exclude hospitals. The review will include a three-step search strategy: (a) identify keywords from MEDLINE and Embase, (b) search using the identified keywords in databases (MEDLINE/PubMed, CINAHL, Web of Science, Embase, Cochrane Library, PsychInfo and Google) and (c) review references from included studies to identify additional studies. Only studies in English will be included. Four researchers will independently assess titles and abstracts and then review the full text of the selected articles, applying the inclusion criteria. The extracted data will be presented in tables and summarised narratively. ETHICS AND DISSEMINATION: Scoping review data will be collected from publicly available articles; research ethics approval is not required. The findings will be disseminated to healthcare practitioners and the public through a peer-reviewed publication and conference presentations.


Subject(s)
COVID-19 , Cognitive Dysfunction , Dementia , Cognitive Dysfunction/therapy , Dementia/therapy , Exercise Therapy , Humans , Pandemics , Research Design , Review Literature as Topic , Technology
4.
Psychogeriatrics ; 22(3): 360-372, 2022 May.
Article in English | MEDLINE | ID: covidwho-1714310

ABSTRACT

BACKGROUND: Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM-FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self-esteem, self-efficacy, self-expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design. METHODS: The participants included 39 patients from a public dementia care centre in Seoul, Korea. The intervention group, which comprised 20 participants, received 12 MM-FAT sessions 3 times a week for 4 weeks, and the control group, which included 19 participants, received usual care. The MM-FAT program was evaluated based on its effectiveness on cognitive, daily living, emotional, and social functioning outcome measures at three time points using repeated measures analysis of variance. Semi-structured interviews (n = 9) were conducted to evaluate the overall experience of the MM-FAT program and its outcomes. RESULTS: The findings reveal that MM-FAT has a positive effect on the cognitive, emotional, and social functioning of individuals with MCI and mild dementia. However, there were no enhancements in individuals' daily living functioning, and the lasting effects of the intervention could not be assessed. Cognition and depression increased significantly at the end of the MM-FAT program. Self-expression and self-efficacy were significantly higher in the MM-FAT group than in the control group. The semi-structured interviews revealed improvements in participants' behaviour, communication, and interaction. CONCLUSION: This mixed methods study focused on individuals with MCI or mild dementia contributes to an understanding of the effectiveness of a FAT program employing a multimodal approach. Despite the COVID-19 pandemic, the study was able to enrich the effects of MM-FAT on cognitive, emotional, and social functioning through qualitative findings.


Subject(s)
Art Therapy , COVID-19 , Cognitive Dysfunction , Dementia , Cognition , Cognitive Dysfunction/psychology , Cognitive Dysfunction/therapy , Dementia/psychology , Dementia/therapy , Humans , Pandemics
5.
Restor Neurol Neurosci ; 39(6): 393-408, 2021.
Article in English | MEDLINE | ID: covidwho-1637141

ABSTRACT

BACKGROUND: An effective treatment is needed for long-COVID patients which suffer from symptoms of vision and/or cognition impairment such as impaired attention, memory, language comprehension, or fatigue. OBJECTIVE: Because COVID-19infection causes reduced blood flow which may cause neuronal inactivation, we explored if neuromodulation with non-invasive brain stimulation using microcurrent (NIBS), known to enhance blood flow and neuronal synchronization, can reduce these symptoms. METHODS: Two female long-COVID patients were treated for 10-13 days with alternating current stimulation of the eyes and brain. While one patient (age 40) was infected with the SARS CoV-2 virus, the other (age 72) developed symptoms following AstraZeneca vaccination. Before and after therapy, cognition was assessed subjectively by interview and visual fields quantified using perimetry. One patient was also tested with a cognitive test battery and with a retinal dynamic vascular analyser (DVA), a surrogate marker of vascular dysregulation in the brain. RESULTS: In both patients NIBS markedly improved cognition and partially reversed visual field loss within 3-4 days. Cognitive tests in one patient confirmed recovery of up to 40-60% in cognitive subfunctions with perimetry results showing stable and visual field recovery even during follow-up. DVA showed that NIBS reduced vascular dysregulation by normalizing vessel dynamics (dilation/constriction), with particularly noticeable changes in the peripheral veins and arteries. CONCLUSIONS: NIBS was effective in improving visual and cognitive deficits in two confirmed SARS-COV-2 patients. Because recovery of function was associated with restoration of vascular autoregulation, we propose that (i) hypometabolic, "silent" neurons are the likely biological cause of long-COVID associated visual and cognitive deficits, and (ii) reoxygenation of these "silent" neurons provides the basis for neural reactivation and neurological recovery. Controlled trials are now needed to confirm these observations.


Subject(s)
COVID-19 , Cognitive Dysfunction , Electric Stimulation Therapy , Vision Disorders , Adult , Aged , Brain , COVID-19/complications , Cognitive Dysfunction/therapy , Cognitive Dysfunction/virology , Female , Humans , Vision Disorders/therapy , Vision Disorders/virology
6.
Int J Environ Res Public Health ; 18(21)2021 11 02.
Article in English | MEDLINE | ID: covidwho-1502426

ABSTRACT

BACKGROUND: Outside activities have decreased due to the spread of the COVID-19 since 2019; therefore, the need for education using information and communication technology (ICT) for older adults with mild cognitive impairment (MCI) has increased. This study systematically evaluated the effects of cognitive enhancement interventions using ICT on older adults with MCI. METHODS: Six electronic databases (CINAHL, Cochrane CENTRAL, EMBASE, PubMed, RISS, and KISS) were searched for relevant articles published from 25 January to 10 February, 2021. RESULTS: As a result of the systematic literature review, 12 research papers were finally selected as the literature for quality evaluation, and 11 final papers were selected, excluding one in the quality evaluation. From the synthesis in this study, it was found that cognitive intervention using ICT showed a statistically significant positive effect on cognitive function when compared with various control groups (SMD = 0.4547; p < 0.001; 95% CI: 0.1980-0.7113). CONCLUSIONS: Through this study, cognitive intervention using ICT showed a small effect size for older adults with mild cognitive impairment, and statistically significant results were found.


Subject(s)
COVID-19 , Cognitive Dysfunction , Aged , Cognition , Cognitive Dysfunction/therapy , Communication , Humans , SARS-CoV-2 , Technology
7.
Int J Environ Res Public Health ; 18(17)2021 09 03.
Article in English | MEDLINE | ID: covidwho-1403594

ABSTRACT

People with dementia (PwD) occupy around 25% of the hospital beds. Once PwD are admitted to hospitals, their cognitive impairment is not considered in most of the cases. Thus, it causes an impact on the development of the disease becoming a stressful situation as care plans are not adapted to PwD. The aim of this study was to explore the published core elements when designing a dementia care pathway for hospital settings. A scoping review was conducted to provide an overview of the available research evidence and identify the knowledge gaps regarding the topic. This review highlights person-centered care, compassionate care and end-of-life process as some of the key elements that should integrate the framework when designing a dementia care pathway. Architectonical outdoor and indoor hospital elements have also been found to be considered when adapting the healthcare context to PwD. Findings provide information about the key points to focus on to successfully design dementia interventions in hospital environments within available resources, mostly in those contexts in which national dementia plans are in its infancy. Hospitals should transform their patients' routes and processes considering the increasing demographic changes of people with cognitive impairment.


Subject(s)
Cognitive Dysfunction , Dementia , Cognitive Dysfunction/therapy , Delivery of Health Care , Dementia/therapy , Hospitalization , Hospitals , Humans
8.
Biol Pharm Bull ; 44(7): 1019-1023, 2021.
Article in English | MEDLINE | ID: covidwho-1292126

ABSTRACT

To prevent cognitive decline, non-pharmacological therapies such as reminiscence for mild cognitive impairment (MCI) are required, however, the use of nursing homes was limited due to coronavirus disease 2019 (COVID-19). Therefore, the demand for remote-care is increasing. We hypothesized that immersive virtual reality (iVR) could be used more effectively than conventional reminiscence for anxiety. We first examined the effectiveness and safety of reminiscence using iVR (iVR reminiscence session) in patients with MCI. After COVID-19 imposed restriction on visiting nursing homes, we conducted online iVR reminiscence session (remote iVR reminiscence session) and compared its effectiveness with that of interpersonal iVR reminiscence session (face-to-face iVR reminiscence session). The results of two elderly with MCI suggested that iVR reminiscence could reduce anxiety and the burden of care without serious side effects. The effects of remote iVR reminiscence might be almost as effective as those of face-to-face one.


Subject(s)
Anxiety/therapy , Cognitive Dysfunction/therapy , Imagery, Psychotherapy/methods , Telemedicine/methods , Virtual Reality , Aged, 80 and over , Anxiety/diagnosis , Anxiety/psychology , Cognitive Dysfunction/complications , Cognitive Dysfunction/psychology , Female , Humans , Male , Mobile Applications , Nursing Homes , Patient Satisfaction , Telemedicine/instrumentation , Treatment Outcome
9.
Exp Gerontol ; 152: 111434, 2021 09.
Article in English | MEDLINE | ID: covidwho-1258367

ABSTRACT

BACKGROUND: Evidence-based interventions to improve mobility in older people include balance, strength and cognitive training. Digital technologies provide the opportunity to deliver tailored and progressive programs at home. However, it is unknown if they are effective in older people, especially in those with cognitive impairment. OBJECTIVE: The aim of this study was to examine the efficacy of a novel tablet-delivered cognitive-motor program on mobility in older people with cognitive impairment. METHODS: This was a 6-month single-blind randomised controlled trial of older people living in the community with subjective and/or objective cognitive impairment. Participants randomised to the intervention were asked to follow a 120 min per week balance, strength and cognitive training program delivered via an app on an iPad. Both the intervention and control group received monthly phone calls and health fact sheets. The primary outcome measure was gait speed. Secondary measures included dual-task gait speed, balance (step test, FISCIT-4), 5 sit to stand test, cognition (executive function, memory, attention), mood and balance confidence. Adherence, safety, usability and feedback were also measured. RESULTS: The planned sample size of 110 was not reached due to COVID-19 restrictions. A total of 93 (mean age 72.8 SD 7.0 years) participants were randomised to the two groups. Of these 77 participants returned to the follow-up clinic. In intention-to-treat analysis for gait speed, there was a non-significant improvement favouring the intervention group (ß 0.04 m/s 95% CI -0.01, 0.08). There were no significant findings for secondary outcomes. Adherence was excellent (84.5%), usability of the app high (76.7% SD 15.3) and no serious adverse events were reported. Feedback on the app was positive and included suggestions for future updates. CONCLUSION: Due to COVID-19 the trial was under powered to detect significant results. Despite this, there was a trend towards improvement in the primary outcome measure. The excellent adherence and positive feedback about the app suggest a fully powered trial is warranted.


Subject(s)
COVID-19 , Cognitive Dysfunction , Accidental Falls , Aged , Cognition , Cognitive Dysfunction/therapy , Exercise , Exercise Therapy , Humans , Postural Balance , SARS-CoV-2 , Single-Blind Method , Tablets
10.
Int J Environ Res Public Health ; 18(11)2021 05 31.
Article in English | MEDLINE | ID: covidwho-1256544

ABSTRACT

Physical training is considered as a low-cost intervention to generate cardioprotective benefits and to promote physical and mental health, while reducing the severity of acute respiratory infection symptoms in older adults. However, lockdown measures during COVID-19 have limited people's opportunity to exercise regularly. The aim of this study was to investigate the effect of eight weeks of Fitness and Dance training, followed by four weeks of COVID-19-induced detraining, on cardiac adaptations and physical performance indicators in older adults with mild cognitive impairment (MCI). Twelve older adults (6 males and 6 females) with MCI (age, 73 ± 4.4 y; body mass, 75.3 ± 6.4 kg; height, 172 ± 8 cm; MMSE score: 24-27) participated in eight weeks of a combined Fitness-Dance training intervention (two sessions/week) followed by four weeks of training cessation induced by COVID-19 lockdowns. Wireless Polar Team Pro and Polar heart rate sensors (H10) were used to monitor covered distance, speed, heart rate (HR min, avg and max), time in HR zone 1 to 5, strenuousness (load score), beat-to-beat interval (max RR and avg RR) and heart rate variability (HRV-RMSSD). One-way ANOVA was used to analyze the data of the three test sessions (T1: first training session, T2: last training session of the eight-week training program, and T3: first training session after the four-week training cessation). Statistical analysis showed that eight weeks of combined Fitness-Dance training induced beneficial cardiac adaptations by decreasing HR (HR min, HR avg and HR max) with p < 0.001, ES = 0.5-0.6 and Δ = -7 to-9 bpm, and increasing HRV related responses (max and avg RR and RMSSD), with p < 0.01 and ES = 0.4. Consequently, participants spent more time in comfortable HR zones (e.g., p < 0.0005; ES = 0.7; Δ = 25% for HR zone 1) and showed reduced strenuousness (p = 0.02, Δ = -15% for load score), despite the higher covered total distance and average speed (p < 0.01; ES = 0.4). However, these changes were reversed after only four weeks of COVID-19 induced detraining, with values of all parameters returning to their baseline levels. In conclusion, eight weeks of combined Fitness-Dance training seems to be an efficient strategy to promote cardioprotective benefits in older adults with MCI. Importantly, to maintain these health benefits, training has to be continued and detraining periods should be reduced. During a pandemic, home-based exercise programs may provide an effective and efficient alternative of physical training.


Subject(s)
COVID-19 , Cognitive Dysfunction , Dancing , Aged , Cognitive Dysfunction/therapy , Communicable Disease Control , Female , Humans , Male , Physical Fitness , SARS-CoV-2
11.
Phys Ther ; 101(6)2021 06 01.
Article in English | MEDLINE | ID: covidwho-1140006

ABSTRACT

OBJECTIVE: The purpose of this case report is to provide the clinical presentation and physical therapist management for a patient with post-COVID syndrome. Secondarily, the report highlights the importance of assessing cognitive and emotional health in patients with post-COVID syndrome. METHODS (CASE DESCRIPTION): A 37-year-old woman tested positive for SARS-CoV-2 and developed mild COVID-19 disease but did not require supplemental oxygen or hospitalization. The patient experienced persistent symptoms, including dyspnea, headaches, and cognitive fog. On day 62, they participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, obtaining 50% of their age-predicted 6-minute walk distance. They had minor reductions in muscle strength and cognitive function. Self-reported quality of life was 50, and they scored above established cut-off scores for provisional diagnosis of posttraumatic stress disorder (PTSD). RESULTS: The patient participated in biweekly physical therapist sessions for 8 weeks, which included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training. Metabolic equivalent for task levels increased with variability over the course of the program. The patient's muscle strength, physical function, and exercise capacity improved. 6-Minute walk distance increased by 199 m, equating to 80% of their age-predicted distance. Quality of life and PTSD scores did not improve. At evaluation after physical therapy, the patient was still experiencing migraines, dyspnea, fatigue, and cognitive dysfunction. CONCLUSION: This case report described the clinical presentation and physical therapist management of a person with post-COVID syndrome, a novel health condition for which little evidence exists to guide rehabilitation examination and interventions. Physical therapists should consider cognitive function and emotional health in their plan of care for patients with post-COVID syndromes. IMPACT: This case alerts physical therapists to post-COVID syndrome-which can include debilitating symptoms of decreased aerobic tolerance, anxiety, PTSD, and cognitive dysfunction-and to the role that therapists can play in assessing these symptoms and managing these patients.


Subject(s)
COVID-19/complications , Physical Therapy Modalities , Adult , COVID-19/therapy , Cognitive Dysfunction/therapy , Cognitive Dysfunction/virology , Dyspnea/therapy , Dyspnea/virology , Female , Humans , Pandemics , Quality of Life , SARS-CoV-2 , Stress Disorders, Post-Traumatic/therapy , Stress Disorders, Post-Traumatic/virology , Surveys and Questionnaires , Syndrome , Walk Test
12.
Clin Neurophysiol ; 132(5): 1138-1143, 2021 05.
Article in English | MEDLINE | ID: covidwho-1128943

ABSTRACT

OBJECTIVE: A high proportion of patients experience fatigue and impairment of cognitive functions after coronavirus disease 2019 (COVID-19). Here we applied transcranial magnetic stimulation (TMS) to explore the activity of the main inhibitory intracortical circuits within the primary motor cortex (M1) in a sample of patients complaining of fatigue and presenting executive dysfunction after resolution of COVID-19 with neurological manifestations. METHODS: Twelve patients who recovered from typical COVID-19 pneumonia with neurological complications and complained of profound physical and mental fatigue underwent, 9 to 13 weeks from disease onset, a psychometric evaluation including a self-reported fatigue numeric-rating scale (FRS, Fatigue Rating Scale) and the Frontal Assessment Battery (FAB). Intracortical activity was evaluated by means of well-established TMS protocols including short-interval intracortical inhibition (SICI), reflecting GABAA-mediated inhibition, long-interval intracortical inhibition (LICI), a marker of GABAB receptor activity, and short-latency afferent inhibition (SAI) that indexes central cholinergic transmission. TMS data were compared to those obtained in a control group of ten healthy subjects (HS) matched by age, sex and education level. RESULTS: Post-COVID-19 patients reported marked fatigue according to FRS score (8.1 ± 1.7) and presented pathological scores at the FAB based on Italian normative data (12.2 ± 0.7). TMS revealed marked reduction of SICI, and disruption of LICI as compared to HS. SAI was also slightly diminished. CONCLUSIONS: The present study documents for the first time reduced GABAergic inhibition in the M1 in patients who recovered from COVID-19 with neurological complications and manifested fatigue and dysexecutive syndrome. SIGNIFICANCE: TMS may serve as diagnostic tool in cognitive disturbances and fatigue in post-COVID-19 patients.


Subject(s)
COVID-19/physiopathology , Cognitive Dysfunction/physiopathology , Fatigue/physiopathology , GABAergic Neurons/physiology , Motor Cortex/physiopathology , Transcranial Magnetic Stimulation/methods , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/therapy , Cognitive Dysfunction/etiology , Cognitive Dysfunction/therapy , Fatigue/etiology , Fatigue/therapy , Female , Humans , Male , Middle Aged
13.
Neurol Sci ; 42(2): 455-465, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1012219

ABSTRACT

INTRODUCTION: Healthy elderly, mild cognitive impairment and Alzheimer's disease populations have been among the most affected in the early stages of the COVID-19 pandemic due to the direct effects of the virus, and numerous indirect effects now emerge and will have to be carefully assessed over time. METHODS: This article reviews the main articles that have been published so far about the direct and indirect effects of the COVID-19 pandemic on these particularly fragile populations. RESULTS: The pandemic associated to COVID-19 has shifted most of the health resources to the emergency area and has consequently left the three main medical areas dealing with the elderly population (oncology, time-dependent diseases and degenerative disease) temporarily "uncovered". In the phase following the emergency, it will be crucial to guarantee to each area the economic and organizational resources to quickly return to the level of support of the prepandemic state. CONCLUSIONS: The emergency phase represented a significant occasion of discussion on the possibilities of telemedicine which will inevitably become increasingly important, but all the limits of its use in the elderly population have to be considered. In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline as well as with their caregivers.


Subject(s)
Aging , Alzheimer Disease , COVID-19 , Cognitive Dysfunction , Delivery of Health Care , Health Resources , Alzheimer Disease/therapy , Cognitive Dysfunction/therapy , Humans
14.
Neurodegener Dis Manag ; 11(1): 83-89, 2021 02.
Article in English | MEDLINE | ID: covidwho-918964

ABSTRACT

The Covid-19 pandemic forced providers to alter their delivery of care to special populations, including older adults with cognitive impairment. The Montefiore-Einstein Center for the Aging Brain, a specialty multidisciplinary center for the evaluation and management of patients with neurodegenerative disorders, developed a coordinated approach (Coordinated Care At Risk/Remote Elderly program [CCARRE]) to reach our diverse population during the initial Covid-19 crisis in New York City, USA. In the tele-evaluation of the first 85 patients seen with CCARRE, we recognized unique factors that could improve patient care, lessen burden and optimize access to community resources. Lessons learned from the experience are shared.


Subject(s)
Advance Directives , Caregivers/psychology , Cognitive Dysfunction/therapy , Dementia/therapy , Patient Safety , Program Development , Telemedicine , Videoconferencing , Activities of Daily Living , Aged , Aged, 80 and over , COVID-19 , Cognitive Dysfunction/diagnosis , Culturally Competent Care , Dementia/diagnosis , Female , Humans , Male , New York City , Social Determinants of Health , Telephone
15.
Australas J Ageing ; 39(3): 283-286, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-868008

ABSTRACT

OBJECTIVE: We developed interim guidance for the care of patients with cognitive impairment in hospital during the COVID-19 pandemic. METHODS: A Guidance Committee and Readers Group were recruited. The content was identified by the Committee and content-specific subgroups, resulting in a draft document, which was sent to the Readers for review. People with dementia and care partners were involved in all aspects of the process. RESULTS: Infection control measures can lead to an escalation of distress. In an environment where visiting bans are applied to care partners/advocates, hospitals need to ensure care partners can continue to provide decision-making support. Health-care professionals can proactively engage care partners using videoconferencing technologies. Developing models of care that proactively support best practice can minimise the risk of delirium, mitigate escalating symptoms and guide the use of non-pharmacological, pharmacological (start low, go slow) or physical restraint in managing behavioural and psychological symptoms.


Subject(s)
Betacoronavirus , Cognitive Dysfunction/psychology , Cognitive Dysfunction/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Adult , Australia , COVID-19 , Coronavirus Infections/transmission , Hospitalization , Humans , Pneumonia, Viral/transmission , SARS-CoV-2
16.
BMJ Open ; 10(8): e039305, 2020 08 27.
Article in English | MEDLINE | ID: covidwho-733153

ABSTRACT

INTRODUCTION: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT) is evaluating a home-based, face-to-face, individually tailored, activity and exercise programme for people living with dementia. Social distancing requirements following the COVID-19 pandemic necessitated rapid changes to intervention delivery. METHODS AND ANALYSIS: A mixed-methods process evaluation will investigate how the changes were implemented and the impact that these have on participants' experience. An implementation study will investigate how the intervention was delivered during the pandemic. A study on the mechanisms of impact and context will investigate how these changes were experienced by the PrAISED participants, their carers and the therapists delivering the intervention. The study will commence in May 2020. ETHICS AND DISSEMINATION: The PrAISED RCT and process evaluation have received ethical approval number 18/YH/0059. The PrAISED process evaluation will enable us to understand how distancing and isolation affected participants, their activity and exercise routines and whether the therapy programme could be continued with remote support. This will be valuable both in explaining trial results and also contribute to understanding and designing new ways of delivering home-based services and rehabilitation interventions for people with dementia and their carers. TRIAL REGISTRATION NUMBER: ISRCTN15320670; Pre-results.


Subject(s)
Cognitive Dysfunction/therapy , Coronavirus Infections , Dementia/therapy , Exercise , Health Promotion , Independent Living , Pandemics , Pneumonia, Viral , Process Assessment, Health Care , Activities of Daily Living , Betacoronavirus , COVID-19 , Caregivers , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Exercise Therapy , Female , Home Care Services , Humans , Male , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Research Design , SARS-CoV-2 , Social Isolation
20.
J Med Internet Res ; 22(5): e19434, 2020 05 22.
Article in English | MEDLINE | ID: covidwho-343127

ABSTRACT

BACKGROUND: The public health emergency of coronavirus disease (COVID-19) is rapidly evolving worldwide; some countries, including Spain, have implemented restrictive measures. Populations that are vulnerable to this outbreak and its physical and mental health effects include community-dwelling older adults with mild cognitive impairment or mild dementia. Telehealth is a potential tool to deliver health care and decrease exposure risk. OBJECTIVE: The aims of this study were to explore the impact of confinement on the health and well-being of community-dwelling older adults with mild cognitive impairment or mild dementia, to provide television-based and telephone-based health and social support, and to study the effects of a television-based assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive Integrated Service to supporT European adults living with mild DEMentia or mild cognitive impairment). METHODS: A telephone-based survey was administered in Spain to 93 participants in the TV-AssistDem clinical trial from March 25 to April 6, 2020. RESULTS: Of the respondents, 60/93 (65%) were women. The mean age was 73.34 (SD 6.07), and 69/93 (74%) lived accompanied. Lockdown measures forced 17/93 respondents (18%) to change their living arrangements. Health status was found to be optimal in 89/93 respondents (96%), with no COVID-19 symptoms. Grocery and pharmacy outings were performed by family members of 68/93 participants (73%); 57 (61%) reported overall well-being, and 65 (70%) maintained their sleep quality. However, participants living alone reported greater negative feelings and more sleeping problems. Regarding leisure activities, 53/93 respondents (57%) took walks, 32 (35%) played memory games, 55 (60%) watched television, and 91 (98%) telephoned relatives. 58/93 (64%) respondents reported accessing moderate or too much COVID-19 information, 89 (97%) received it from television, and 56 (62%) stated that their understanding of the information was extreme. 39/93 (39%) respondents had contacted health and social services, while 29 (31%) requested information regarding these services during the telephone call. There were no significant differences in health and well-being between the intervention and control groups. Respondents with TV-AssistDem performed more memory exercises (24/93, 52% vs 8/93, 17.4%; P<.001) than control respondents. CONCLUSIONS: Our findings suggest that during COVID-19 confinement, the physical and mental health and well-being was optimal for the majority of our vulnerable population. However, those living alone reported greater negative psychological effects and sleeping problems. Measures adopted to address the negative experiences of confinement included keeping informed about the situation, accessing health and social services, having a support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, a daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with cognitive stimulation exercises, and ensuring social connectedness using technology. Television sets were preferred technological devices to access COVID-19 information, watch television as a recreational activity, and perform memory exercises as an intellectual activity. Television-based telehealth support using TV-AssistDem demonstrated potential for cognitive stimulation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03653234; https://clinicaltrials.gov/ct2/show/NCT03653234.


Subject(s)
Cognitive Dysfunction/therapy , Coronavirus Infections/epidemiology , Dementia/therapy , Pneumonia, Viral/epidemiology , Telemedicine/methods , Aged , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Quarantine , Social Support , Surveys and Questionnaires
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