ABSTRACT
BackgroundCovid-19 control policies have entailed lockdowns and confinement. Although these isolation measures are thought to be particularly hard and possibly harmful to people with dementia, their specific impact during the pandemic has not yet been synthesised. We aimed to examine and summarise the global research evidence describing the effect of Covid-19 isolation measures on the health of people living with dementia. MethodWe searched Pubmed, PsycINFO and CINAHL up to February 2021 for peer-reviewed quantitative studies of the effects of isolation measures during Covid-19 on cognitive, psychological and functional symptoms of people with any kind of dementia or mild cognitive impairment. We summarised the findings of included papers following current guidelines for rapid reviews. ResultsWe identified 15 eligible papers, examining a total of 6,442 people with dementia. 13/15 were conducted in people living in the community and 2 in care homes. 60% (9/15) studies reported changes in cognition with 77% (7/9) of them describing declined cognition by >50% of respondents. 93% (14/15) of studies reported worsening or new onset of behavioural and psychological symptoms. 46% (7/15) studies reported changes in daily function, 6 of them reporting a functional decline in a variable proportion of the population studied. ConclusionLockdowns and confinement measures brought about by the pandemic have damaged the cognitive and psychological health and functional abilities of people with dementia across the world. It is urgent that infection control measures applied to people with dementia are balanced against the principles of non-maleficence. This systematic review makes 4 specific calls for action. Key PointsO_LINeuropsychiatric symptoms of people with dementia (e.g., anxiety, depressive symptoms, apathy, agitation) were found to worsen during lockdown in the majority of studies. C_LIO_LICognitive decline affecting memory, orientation concentration and communication was observed by caregivers within few weeks after lockdown. C_LIO_LIThe deterioration reported occurred in a short window of time (between 1 and 4 months) and it is unlikely to be attributable to the natural variation of the course of dementia. C_LIO_LIThere is little research conducted in care home residents with dementia (only 2 papers found). C_LIO_LIIncrease consumption of antipsychotics and benzodiazepines has occurred in people with dementia during lockdown. C_LIO_LIEvidence indicates that isolation measures quickly damaged peoples with dementia cognitive and mental health and probably accelerated overall decline. C_LI
ABSTRACT
BackgroundThe COVID-19 pandemic led to social and physical distancing measures that reduced social contact and support. We explored whether people with more frequent and supportive social contact had fewer depressive symptoms during the UK Spring 2020 lockdown, whether this applied to face-to-face and remote electronic contact, and whether people with higher empathy levels, or more frequent pre-COVID social contact with others were more protected. MethodsUK dwelling participants aged [≥]18 in the internet-based longitudinal COVID-19 Social Study completed up to 22 weekly questionnaires about frequency of face-to-face and phone/video social contact, perceived social support, and depressive symptoms assessed with the patient health questionnaire (PHQ-9). Mixed linear models examined associations between social contact and support, and depressive symptoms. We examined for interaction by empathic concern and perspective taking and pre-COVID social contact frequency. ResultsIn 71,117 people with mean age 49 years (standard deviation 15) we found that daily face-to-face or phone/video contact was associated with lower PHQ-9 scores (mean difference 0.258 (95% confidence interval 0.225, 0.290) and 0.117 (0.080, 0.154) respectively) compared to having no contact. Those with high social support scored 1.836 (1.801, 1.871) PHQ-9 points lower than those with low support. The odds ratio for depression for those with daily face-to-face social contact compared to no face-to-face contact was 0.712 (0.678, 0.747). Daily compared to no phone/video contact was associated with odds ratio for depression 0.825 (0.779, 0.873). And reporting high, compared to low, social support was associated with 0.145 (95%CI 0.138, 0.152) odds ratio for depression. The negative association between social relationships and depressive symptoms was stronger for those with high empathic concern, perspective taking and usual sociability. ConclusionsThose who had more face-to-face contact during lockdown had fewer depressive symptoms. Phone or video communication were beneficial but less so. People who were usually more sociable or had higher empathy were more likely to have depressive symptoms during enforced reduced social contact. Results have implications both for our management of COVID-19 and potential future pandemics, and for our understanding of the relationship between social factors and mental health.
ABSTRACT
PurposeThe Covid-19 pandemic is likely to have a significant impact on older adults mental health care. Our study aimed to explore staff perspectives on key challenges and innovations, to help inform the delivery of older adults mental health care in subsequent waves of the pandemic. MethodsA mixed methods online questionnaire developed by NIHR Mental Health Policy Research Unit (MHPRU) was used to gather staff perspectives on their challenges at work, problems faced by service users and their carers, and sources of help and support. Descriptive statistics were used for quantitative analysis and descriptive content analysis for qualitative analysis. Results158 participants, working in either community or inpatient settings, and from a range of professional disciplines, were included. For inpatient staff, a significant challenge was infection control. In the community, staff identified a lack of access to physical and social care as well as reduced contact with friends and families as being challenges for patients. Remote working was seen as a positive innovation along with Covid-19 related guidance from various sources and peer support. ConclusionOur study, with a focus on staff and patient well-being, helps to inform service development for future waves of the pandemic. We discuss measures to improve infection control in inpatient settings, the role of voluntary organisations in supporting socially isolated community patients, the need for better integration of physical and mental health services at an organisational level, and the importance of training staff to support patients and their families with end of life planning.
