The Effects of COVID-19 Home Confinement in Dementia Care: Physical and Cognitive Decline, Severe Neuropsychiatric Symptoms and Increased Caregiving Burden

Exploring the Support Needs of Chinese Family Carers of People Living with Dementia in New Zealand during the COVID-19 Pandemic: A Resilience Resources Framework Perspective

Caring for people living with dementia during the novel coronavirus disease 2019 (COVID-19) pandemic significantly impacted the emotional, physical, and social well-being of carers. However, no study has focused on the well-being of Chinese carers of people living with dementia in New Zealand during the pandemic. This study aimed to explore the support needs of Chinese carers of people living with dementia in New Zealand during the COVID-19 pandemic. Semi-structured interviews were conducted by two bilingual and bicultural researchers. Thematic analysis was used to explore the resilience resources for Chinese carers. Twelve Chinese carers were recruited from four community organizations in New Zealand. Four themes were identified: (1) social isolation, (2) emotional loneliness, (3) ambivalent feelings of being a carer, and (4) a variety of unmet needs. The findings of our study provide new insights into the multiple support needs of Chinese carers of people living with dementia during the COVID-19 pandemic. Implications for practice include the establishment of culturally appropriate care support services and the development of tailored resilience-building interventions to address the unmet needs of Chinese carers of people living with dementia.

Global trends in dementia care research in the context of COVID-19: bibliometric analysis

Alzheimer's disease is the most common type of dementia, producing a deterioration in the activities of daily living which can lead to the need for care provision. COVID-19 impacted their quality of life and in this care delivery. This study aimed to analyse most productive and prominent authors, the journals and countries with the highest number of publications, the most cited documents and the most used keywords. Publications were retrieved from journals indexed in the Main Collection of the Web of Science (WoS) and analysed using the traditional laws of bibliometrics. A total of 376 documents were found. The WoS categories with the highest number of publications accumulated were "Geriatric Gerontology" and "Gerontology." Clarissa Giebel was the most productive (23 papers) and most cited (with 569 citations) co-author. The Journal of Alzheimer's Disease (21 papers) published the most number of documents. The manuscript "2021 Alzheimer's Disease Facts and Figures" was the most cited. Four thematic clusters related to mental health, telemedicine, care and well-being were found among the authors' keywords. Research networks exist worldwide, with the United States of America and England leading the scientific output. These results may be of interest to researchers, publishers and professionals interested in this subject, as they provide current information on publications related to this topic.

Impact of the COVID-19 pandemic on the self-care and health condition of the older adults. CUIDAMOS+75. A mixed methods study protocol

Aims

To assess the impact of the COVID-19 pandemic on the health condition of people ≥75 years of age and on their family caregivers in Spain.

Design

Multicentric, mixed method concurrent study.

Methods

This work, which will be conducted within the primary care setting in 11 administrative regions of Spain, will include three coordinated studies with different methodologies. The first is a population-based cohort study that will use real-life data to analyze the rates and evolution of health needs, care provision, and services utilization before, during, and after the pandemic. The second is a prospective cohort study with 18 months of follow-up that will evaluate the impact of COVID-19 disease on mortality, frailty, functional and cognitive capacity, and quality of life of the participants. Finally, the third will be a qualitative study with a critical social approach to understand and interpret the social, political, and economic dimensions associated with the use of health services during the pandemic. We have followed the SPIRIT Checklist to address trial protocol and related documents. This research is being funded by the Instituto de Salud Carlos III since 2021 and was approved by its ethics committee (June 2022).

Discussion

The study findings will reveal the long-term impact of the COVID-19 pandemic on the older adults and their caregivers. This information will serve policymakers to adapt health policies to the needs of this population in situations of maximum stress, such as that produced by the COVID-19 pandemic.

Trial Registration

Identifier: NCT05249868 [ClinicalTrials.gov].

Social Connectedness and Perceived Stress Among Caregivers During the COVID-19 Pandemic: a Mixed-Methods Study

BACKGROUND

The COVID-19 pandemic has created unprecedented stressors for caregivers due to social distancing requirements that simultaneously increased their responsibilities and reduced opportunities for social connection and support. This concurrent embedded mixed-methods study examined differences between caregivers and non-caregivers regarding the effects of social connectedness on perceived stress and explored challenges caregivers experienced related to social connectedness and perceived stress.

METHOD

A national online survey containing forced-choice and free-response questions was administered between April and June 2020. The survey was distributed via social media advertisements and a crowdsourcing platform to eligible adult residents in the United States (US) fluent in either English or Spanish. Multivariable regression and thematic analysis were used to analyze the quantitative and qualitative data. Mixed-methods integration occurred during the data analysis, interpretation, and reporting phases.

RESULTS

The study sample comprised 1540 US adults (1275 non-caregivers, 265 caregivers; 65% women; 36% racial/ethnic minorities). Relative to non-caregivers, caregivers had lower levels of social connectedness and higher levels of perceived stress. Social connectedness was also inversely related to perceived stress for non-caregivers (p < 0.001) and slightly but not significantly positively related to perceived stress for caregivers. Qualitative findings showed caregivers experienced a variety of stressors including fear of COVID-19 exposure to their care recipients, disruption to usual care routines, and difficulty accessing healthcare services that may have contributed to decrements in social connectedness and higher levels of perceived stress.

CONCLUSION

Findings suggest social connectedness may be beneficial for reducing perceived stress, but its impact can vary depending on individual circumstances. Overall, findings support the idea that caregivers are a particularly vulnerable sub-group of the population and may benefit from more targeted support and interventions.

Needs for Care, Service Use and Quality of Life in Dementia: 12-Month Follow-Up of the Actifcare Study in Portugal

INTRODUCTION

The intermediate stages of dementia are relatively under-researched, including in Portugal. The Actifcare (ACcess to TImely Formal Care) EU-JPND project studied people with mild-moderate dementia, namely their needs, access to and use of community services (e.g., day centers, home support). In our baseline assessment of the Portuguese Actifcare cohort, the unmet needs of some participants would call for formal support, which was not always accessible or used. We now report the main results of the 12-month follow-up, analyzing changes in needs, service (non)use, quality of life and related variables.

METHODS

This was a longitudinal, observational study using a convenience sample of 54 dyads of people with dementia and their family carers. Our main outcomes were the Camberwell Assessment of Need for the Elderly (CANE) and the Resources Utilization in Dementia. Clinical-functional, quality of life, psychological distress and caregiving-related assessments were also used.

RESULTS

At follow-up, the cognitive and functional status of people with dementia declined (p < 0.001), and their neuropsychiatric symptoms increased (p = 0.033). Considering CANE interviewers' ratings, the total needs of people with dementia increased at follow-up (p < 0.001) but not the unmet needs. Quality of life was overall stable. The use of formal care did not increase significantly, but informal care did in some domains. Carers' depressive symptoms increased (p = 0.030) and perseverance time decreased (p = 0.045). However, carers' psychological distress unmet needs were lower (p = 0.007), and their stress and quality of life remained stable.

CONCLUSION

People with dementia displayed complex biopsychosocial unmet needs. Their cognitive-functional decline over one year was not accompanied by a corresponding increase in any pattern of unmet need, nor of service use. Reliance on informal care (namely supervision) may have contributed to this. Caregiving-related outcomes evolved according to different trends, although stability was almost the rule. Primary carers were even more present at follow-up, without an apparently heavier toll on their own needs, burden, and quality of life. Overall, this longitudinal study comprehensively assessed Portuguese community-dwelling people with dementia. Despite the lack of generalizability, participants' needs remained overall stable and partly unmet over one year. Longer follow-up periods are needed to understand such complex processes.

Impact of the Pandemic on Dementia Care and Caregivers: A Qualitative Study

Physical distancing measures to limit contagion in the COVID-19 pandemic made it difficult to care for older persons with dementia. Non-essential home visits were prevented and family caregivers took over most of their care. The aim of our study was to describe the lived experience of peoples living with dementia caregivers during the pandemic regarding the care provided and the person cared for. A qualitative phenomenological design was used. Participants were recruited using purposeful sampling. Informants were selected from primary healthcare centers, day centers, and a community mental health unit. The study participants comprised 21 caregivers. Semi-structured in-depth interviews by telephone were used, and field notes were collected from the researchers. A thematic analysis was conducted. The criteria used to control trustworthiness were credibility, transferability, dependability, and confirmability. Three main themes and six related sub-themes were identified: (1) care for the person with dementia during the pandemic, including lockdown, associated with difficulties in coping with restrictions, deterioration in health, and the impact of the closure of health and social resources; (2) health and social care provided to people with dementia after the disruptions and the care received from primary care prior to hospital or residential admission; and (3) the caregiver's perspective on the effects of the psycho-emotional impact, and coping strategies adopted in caring. Interventions for people with dementia should be planned in order to prevent the worsening of their health and cognitive status, while also developing programs to prevent stress and alleviate caregiver burden in case of health crises.

Assessing Gender Differences on the Impact of COVID-19 on the Medical and Social Needs of Dementia Caregivers

Our analyses aimed to assess health status and critical needs of caregivers of persons with dementia (PWD) during the COVID-19 pandemic by gender. Between March 2021 and August 2021, respondents (n = 267) were recruited from an Alzheimer's disease (AD) listserv at an US academic center to complete a questionnaire to capture sociodemographic data, caregiving characteristics, health status, status of COVID-19 testing, and COVID-19 preventative practices during the pandemic. Women caregivers reported needing assistance with caregiving responsibilities, whereas men caregivers needed assistance with health and social resources. More men caregivers also reported psychological distress compared to women caregivers. Our findings indicated significant differences in the resources needed and psychological distress of women and men who cared for PWD during the COVID-19 pandemic. The development of recommendations and resources with both men and women caregivers in mind may be beneficial to support informal caregivers during emergency situations.

The Worst of Times: Depressive Symptoms Among Racialized Groups Living With Dementia and Cognitive Impairment During the COVID-19 Pandemic

Objective: To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Methods: Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Results: Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms (p < .01). Older adults racialized as White with CIND reported higher somatic (p < .01) symptoms compared to cognitively normal older adults racialized as White. Discussion: The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time.

Physical and mental health of informal caregivers before and during the COVID-19 pandemic in the United States

BACKGROUND

Informal caregiving, a common form of social support, can be a chronic stressor with health consequences for caregivers. It is unclear how varying restrictions during the COVID-19 pandemic affected caregivers' physical and mental health. This study explores pre-post March 2020 differences in reported days of poor physical and mental health among informal caregivers.

METHODS

Data from the 2019/2020 Behavioral Risk Factor Surveillance System survey were used to match, via propensity scores, informal caregivers who provided care during COVID-19 restrictions to those who provided care before the pandemic. Negative binomial weighted regression models estimated incidence rate ratios (IRRs) and differences by demographics of reporting days of poor physical and mental health. A sensitivity analysis including multiple imputation was also performed.

RESULTS

The sample included 9,240 informal caregivers, of whom 861 provided care during the COVID-19 pandemic. The incidence rate for days of poor physical health was 26% lower (p = 0.001) for those who provided care during the COVID-19 pandemic, though the incidence rates for days of poor mental health were not statistically different between groups. Informal caregivers with low educational attainment experienced significantly higher IRRs for days of poor physical and mental health. Younger informal caregivers had a significantly lower IRR for days of poor physical health, but higher IRR for days of poor mental health.

CONCLUSIONS

This study contends that the physical and mental health burden associated with informal caregiving in a period of great uncertainty may be heightened among certain populations. Policymakers should consider expanding access to resources through institutional mechanisms for informal caregivers, who may be likely to incur a higher physical and mental health burden during public health emergencies, especially those identified as higher risk.

Family Caregiver Support Interventions' Effectiveness Before and During the COVID-19 Pandemic

The authors aimed to assess the impact of a family caregiver support intervention on caregiver burden and hospital readmission before and during the COVID-19 pandemic. By adopting a quasi-experimental design with no randomization, caregivers (n = 65) received a 90-day home visitation caregiver support intervention before the COVID-19 pandemic and caregivers (n = 41) received a 90-day phone-only visitation caregiver support intervention during the COVID-19 pandemic. Caregiver burden was collected in a survey, and hospital readmission of the care recipient was collected by hospital data. The results of a repeated-measures ANOVA demonstrated that participants of a family caregiver support intervention during the COVID-19 pandemic improved their caregiver burden statistically significantly more than those who received the intervention before the pandemic. There were no significant differences in hospital readmissions before or during the COVID-19 pandemic. The study demonstrates the efficacy of family caregiver support interventions over the phone during a pandemic.

Let families decide: Barriers and enablers to participation in family-assisted therapy for older people in transition care

OBJECTIVE

To understand the barriers and enablers to participation in family-assisted therapy for older people in Transition Care.

METHODS

A qualitative study, underpinned by interpretive description, was conducted at two public health services in Melbourne, Australia. Participants included patients in Transition Care, or their family members, who either participated in or chose not to participate in a family-assisted therapy trial. Semi-structured interviews were conducted, transcribed verbatim and analysed thematically.

RESULTS

Forty-four participants were interviewed (17 patients and 27 family members). The unifying theme was to let families decide about participation in family-assisted therapy. The unifying theme was illustrated by three subthemes. The first, what is possible for the family now, described practical considerations including geography, paid and unpaid work structure and commitments and the presence of fit and willing social networks. The second, what is important to the family now, recognised the role of family priorities in deciding. Physical rehabilitation and extra therapy were of high importance to some families. For others, emotional support or searching for a residential aged care bed were more important at the time. Finally, how the family functions described the complexity of relationships and family history that impacted the decision to participate.

CONCLUSIONS

The decision to participate in family-assisted therapy is complex and is best made by patients and their families. Clinicians offering family-assisted therapy are encouraged to avoid assuming what will or will not work for families and instead, to let families decide.

Association between the COVID-19 pandemic, caregiving burden, and quality of life of caregivers of people with dementia: A cross-sectional study

This study aimed to examine the association of COVID-19-related stress, anxiety, access to public healthcare services, and the presence of secondary caregivers (CGs) on the burden of caregiving and health-related quality of life (HRQoL) for CGs of people with dementia (PwD). A cross-sectional survey with 218 family CGs for PwD was completed in various settings between August and September 2021. The CGs had moderate and severe stress (42.7%) and reported having difficulty accessing public healthcare services (51.8%) and receiving help from secondary CGs (42.7%). In the multivariable linear regression, the stress and anxiety levels related to COVID-19 had a positive association with caregiver burden (β = 4.25, p < 0.001, and β = 5.73, p = 0.032, respectively), with no statistically significant association to HRQoL. Unexpectedly, accessing public healthcare services and supporting the secondary CGs were unrelated to the caregiving burden and HRQoL. Therefore, interventions aiming to alleviate family CGs' stress and anxiety levels should be provided to ensure PwD live in their homes in terms of continuity of public health service delivery.

"I felt like I had been put on the shelf and forgotten about" - lasting lessons about the impact of COVID-19 on people affected by rarer dementias

BACKGROUND

The public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer's disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping.

METHODS

This was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes.

RESULTS

184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement.

CONCLUSIONS

This study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of - and may inform the development of - tailored support for these underrepresented groups more generally.

The Use of Telehealth Among People Living With Dementia-Caregiver Dyads During the COVID-19 Pandemic: Scoping Review

BACKGROUND

Telehealth has gained substantial attention during the COVID-19 pandemic, and reimbursement policies in health care settings have increased access to remote modes of care delivery. Telehealth has the potential to mitigate care concerns for people living with dementia and their family caregivers. There is a paucity of knowledge on the performance of telehealth services and user experiences, especially among caregiving dyads during the pandemic.

OBJECTIVE

This study aims to describe the implementation, effectiveness, user experience, and barriers to accessing and using telehealth services for people living with dementia and their caregivers during the COVID-19 pandemic.

METHODS

Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, we searched 7 databases (PubMed, PsycINFO, AgeLine, CINAHL, Social Services Abstracts, Web of Science, and Scopus) and a web-based search engine (Google Scholar). The inclusion criteria for peer-reviewed English publications from March 2020 to August 2022 consisted of studies related to telehealth services for people living with dementia and their family caregivers and studies conducted during the COVID-19 pandemic.

RESULTS

A total of 24 articles (10 quantitative and 14 qualitative studies) from 10 different countries were included. The major findings of the reviewed articles were extracted and organized into the following 4 themes: study design characteristics-strategies were adopted to improve the accessibility and experience of people living with dementia-caregiver dyads; efficacy outcomes of telehealth services-robust evidence is lacking on the comparative effectiveness of in-person services; perceived experiences of people living with dementia and caregivers-most reviewed studies reported positive experiences of using telehealth services and perceived personal and social benefits from their participants; and barriers to accessing and using telehealth services-several barriers related to individuals, infrastructure, and telehealth environments were identified.

CONCLUSIONS

Although evidence of its effectiveness is still limited, telehealth is widely accepted as a viable alternative to in-person care for high-risk groups, such as people living with dementia and their caregivers. Future research should include expanding digital access for those with limited resources and low technology literacy, adopting randomized controlled trial designs to establish the comparative effectiveness of different modes of service delivery, and increasing the sample diversity.

Behavioral and Brain Correlates of Emotional Distress in Older Adults During COVID-19 Quarantine

COVID-19 led to unprecedented lockdowns and changes in older adults' lives, especially those with type 2 diabetes who have high risk of complications and mortality. We investigated the associations of cognitive and motor function and gray matter volumes (GMVs) with COVID-19 lockdown-related emotional distress of type 2 diabetes older adults, participating in the Israel Diabetes and Cognitive Decline Study. We administered a questionnaire to obtain information about anxiety, depression, general well-being, and optimism during a mandated lockdown. Lower grip strength before lockdown was associated with increased sadness, anxiety, and less optimism. Slower gait speed was associated with greater sadness. Lower GMV was related to greater anxiety during the lockdown when compared with anxiety levels before the COVID-19 outbreak. Yet, global cognition was not associated with any emotional distress measure. These results support the role of good motor function on emotional well-being during acute stress and GMV as a potential underlying mechanism.

The impact of social isolation from COVID-19-related public health measures on cognitive function and mental health among older adults: A systematic review and meta-analysis

We aimed to estimate the impact of social isolation on cognitive function and mental health among older adults during the two-year-and-a-half COVID-19 period. Pubmed Central, Medline, CINAHL Plus and PsychINFO were searched between March 1, 2020, and September 30, 2022. We included all studies that assessed proportions of older adults with the mean or the median with a minimum age above 60 reporting worsening cognitive function and mental health. Thirty-two studies from 18 countries met the eligibility criteria for meta-analyses. We found that the proportions of older adults with dementia who experienced worsening cognitive impairment and exacerbation or new onset of behavioral and psychological symptoms of dementia (BPSD) were approximately twice larger than that of older adults with HC experiencing SCD and worsening mental health. Stage of dementia, care options, and severity of mobility restriction measures did not yield significant differences in the number of older adults with dementia reporting worsening cognitive impairment and BPSD, while the length of isolation did for BPSD but not cognitive impairment. Our study highlights the impact of social isolation on cognitive function and mental health among older adults. Public health strategies should prioritize efforts to promote healthy lifestyles and proactive assessments.

The early impacts of COVID-19 on unpaid carers of people living with dementia: part II of a mixed-methods systematic review

OBJECTIVES

With a lack of existing comprehensive reviews, the aim of this mixed-method systematic review was to synthesise the evidence on the early impacts of the pandemic on unpaid dementia carers across the globe.

METHODS

This review was registered on PROSPERO [CDR42021248050]. PubMed, CINAHL, Embase, Scopus and Web of Science were searched from 2020 to July 2021. Studies were included if they reported on the different impacts of the pandemic on unpaid dementia carers aged 18+, with papers published in English, German, Polish, or Spanish. A number of research team members were involved in the selection of studies following PRISMA guidance.

RESULTS

Thirty-six studies (43 papers) from 18 countries reported on the early impact of the pandemic on unpaid dementia carers. Impacts were noted on accessing care and support; carer burden; and well-being. Studies found that carers had limited access to care and support services, increased workload, enhanced feelings of social isolation, and reduced wellbeing. Specifically, reductions in access to care and support increased carer's unpaid caring tasks, removing any opportunities for temporary respite, and thus further increasing carer burden and reducing mental well-being in many.

CONCLUSIONS

The needs of unpaid dementia carers appear to have increased during the pandemic, without adequate support provided. Policy initiatives need to enable better mental health support and formal care provision for unpaid carers and their relatives with dementia, whilst future research needs to explore the long-term implications of carer needs in light of care home restrictions and care delivery.

The early impacts of COVID-19 on people living with dementia: part I of a mixed-methods systematic review

Objectives: The aim of this Part I systematic review was to understand the impact of the COVID-19 pandemic on the lives of people with dementia living in the community or in residential care. Part II focused on unpaid carers.Methods: This review was registered on PROSPERO [CRD42021248050]. Five data bases (PubMed, CINAHL, Embase, Scopus, Web of Science) were searched in July 2021. Studies were included if they reported on the impacts of the pandemic on people living with dementia, either in the community or residential settings, and published in English, German, Polish, or Spanish. Risk of bias was assessed using the Standard Quality Assessment QualSyst.Results: Forty papers from 33 studies reported on the effects of COVID-19 on people with dementia. Included studies were conducted across 15 countries, focusing on single-country evaluations except in one study. Three studies focused on care homes, whilst the remainder reported on the community. Studies were categorised into five impacts: Cognition; Independence and physical functioning; Behavioural symptoms; Well-being; and Access to care. All studies evidenced the negative pandemic impacts, including faster cognitive, physical, and behavioural deterioration, limited access to care, and poorer mental and social health.Conclusions: Future restrictions need to consider the need for people with dementia to stay cognitively, physically, and socially stimulated to live well, and this review provides a call for a future pandemic strategy for dementia. Longitudinal research is required on the long-term impacts of the pandemic on the lives of people with dementia, including time to care home entry.

Salud mental de cuidadores de niños con trastornos del neurodesarrollo durante la pandemia

Los cuidadores son especialmente propensos a verse más afectados psicológicamente durante las restricciones sociales y del sistema sanitario generadas por la pandemia por COVID-19. Los cuidadores de niños con trastornos del neurodesarrollo (es decir, autismo, discapacidad intelectual, déficit de atención, hiperactividad, discapacidad motora) tienen un papel más importante que los que acompañan niños sanos. Se diseñó un estudio cuantitativo transversal, utilizando técnicas estadísticas descriptivas, comparativas y correlacionales, para analizar la calidad de vida relacionada con la salud, el malestar emocional y la sobrecarga en cuatro subgrupos de cuidadores, clasificados según el diagnóstico del niño. Se incluyeron 132 cuidadores (86,4% mujeres). En el grupo 1 (discapacidad cognitiva) participaron 28 cuidadores; en el grupo 2 (TDAH) se incluyeron 51; en el grupo 3 (trastorno del espectro autista) participaron 33 cuidadores, y en el grupo 4 (discapacidad motora) se incluyeron 20. Los principales hallazgos de este estudio fueron: 1) alteraciones en el rol físico, el dolor corporal, la salud general y la vitalidad; 2) porcentajes muy bajos de sintomatología de depresión, ansiedad, estrés y sobrecarga; 3) diferencias en el funcionamiento social entre los grupos de discapacidad motora y TDAH, y en el estrés y la sobrecarga entre los grupos de autismo y discapacidad motora, y 4) correlaciones moderadas entre las dimensiones de dolor corporal y rol emocional y la depresión, la ansiedad, el estrés y la sobrecarga. Se concluyó que hay más afectación en variables asociadas con la salud física que con las de la salud mental.

Telehealth Support for Dementia Caregivers During the COVID-19 Pandemic: Lessons Learned From the NYU Family Support Program

OBJECTIVES

In response to the needs of dementia caregivers during the COVID-19 pandemic, the NYU Langone Alzheimer's Disease and Related Disorders Family Support Program (FSP) quickly transitioned to providing most services online. To understand how dementia caregivers experienced FSP services after the switch to video telehealth, we conducted qualitative interviews of spouse or partner dementia caregivers.

PARTICIPANTS

Ten participants were recruited from a convenience sample of dementia spouse or partner caregivers who used one or more online FSP services offered during the pandemic.

DESIGN

Caregivers engaged in semi-structured interviews held via videoconference between May and June 2020. Qualitative analysis of interviews was conducted according to the principles of framework analysis.

RESULTS

Caregivers reported high satisfaction with the FSP pre-pandemic and continued to feel supported when services were provided online. They transitioned to video telehealth services with little difficulty.

CONCLUSIONS

While video telehealth is frequently cited as beneficial for those in rural communities, socioeconomically disadvantaged groups, or homebound individuals, our findings suggest that video telehealth is also advantageous for dementia caregivers, given their unique barriers, including lack of time due to caregiving responsibilities, lack of respite care for the person with dementia, and the additional burdens of travel time to access in-person services.

Racial Differences in the Dementia Caregiving Experience During the COVID-19 Pandemic: Findings From the National Health and Aging Trends Study (NHATS)

OBJECTIVES

Given racial disparities in both dementia and coronavirus disease 2019 (COVID-19), non-Hispanic Black (Black) dementia caregivers (CGs) may be at greater risk for care burden during the COVID-19 pandemic than non-Hispanic White (White) CGs. This study investigates the impact of dementia care provision on CGs' quality of life by race using the 2020 National Health and Aging Trends Study Family Members and Friends COVID-19 data (FF).

METHODS

This study features a secondary analysis of FF data (2020-2021), including 216 Black and 1,204 White CGs. We used ANOVA to determine differences in caregiving stressors (i.e., changes in providing help with activities of daily living [ADL], instrumental ADL [IADL], and emotional support). Ordinary least square regression was used to investigate the moderating effects of dementia care on the associations of race with perceived well-being, care burden, and self-reported health and to conduct subgroups analyses of Black and White dementia CGs.

RESULTS

Black dementia CGs provided significantly more help with ADL before and during the COVID-19 pandemic than Black nondementia, White dementia, and White nondementia CGs. Dementia care status did not moderate the associations between race and CG outcomes. For Black dementia CGs, changes in objective stressors (assistance with ADL and IADL) were associated with care burden and well-being. For White CGs, the provision of emotional support was associated with care burden and well-being.

DISCUSSION

This study highlights that increased caregiving demands during the pandemic amplified racial differences in CG stress. Findings suggest that outreach to reduce CG stress and burden is critical for Black dementia CGs.

Burdens on caregivers of patients with stroke during a pandemic: relationships with support satisfaction, psychological distress, and fear of COVID-19

BACKGROUND

Caregivers have faced unprecedented circumstances throughout the COVID-19 pandemic, but previous research only minimally addresses the caregivers' burden. Therefore, this study aimed to investigate the relationship between caregiver burden, psychological stress, satisfaction with support, and fear of COVID-19 in caregivers of patients with stroke during the pandemic.

METHODS

A cross-sectional survey study with total of 171 caregivers of patients with stroke in a community hospital in Taiwan. All participants completed the Zarit Burden Interview, Depression, Anxiety, Stress Scale (DASS-21), satisfaction of support survey, and Fear of COVID-19 Scale. Pearson correlations were used to examine the bivariate correlations between study variables. Then, with the control of demographic confounders, a multiple linear regression model was applied with significant variables to construct and explain caregiver burden.

RESULTS

The proposed model significantly explained the caregiver burden of caregivers of patients with stroke. Specifically, the caregiver burden was negatively correlated with satisfaction with family support, but positively with psychological distress and the fear of COVID-19.

CONCLUSIONS

Caregivers of patients with stroke will suffer a greater burden if they have lower satisfaction with family support, experienced higher psychological distress, and perceived more fear of the COVID-19 pandemic. Health professionals must address these concerns, support caregivers, and enhance available resources.

Investigating the burden of disease dimensions (time-dependent, developmental, physical, social and emotional) among family caregivers with COVID-19 patients in Iran

Background

The caregivers of patients with covid-19 face constant responsibilities such as providing personal, health, and social care to family, which can be physically, and emotionally exhausting resulting in a considerable stress burden. Therefore, given the importance of the subject, this study aimed to investigate the burden of disease dimensions (time-dependent, developmental, physical, social and emotional) among family caregivers with covid-19 patients in Iran.

Methods

This cross-sectional study was conducted one year after the onset of the Covid-19 outbreak in Iran. Family caregivers of Covid-19 patients discharged from the hospitals in Kerman city, Iran, were chosen by simple randomization (n = 1500). Data were collected utilizing a demographic characteristics inventory created by the researcher as well as the Novak and Guest Caregiver Burden Inventory. Descriptive statistics such as mean and standard deviations, frequency, and percentages and analytical statistics such as Kolmogorov–Smirnov, T-test, ANOVA, and Multivariate Linear Regression were used for data analysis using the 20, SPSS Inc., Chicago, IL Software at the level of P < 0.05.

Results

The results demonstrated that the mean score of family caregiver burden was 2.61±0.6 and the severity of this burden was in a moderate range. The finding showed a statistical difference was seen between the family caregiver burden mean score of participants in terms of gender, duration of treatment, age and employed status. The multivariable linear regression model showed demographic variables of caregivers included (female, married, employed, elderly, low income and poor education) had a beneficial influence on family caregiver burden.

Conclusion

The findings of this study can increase the awareness of health managers, about the level of burden of disease among family caregivers from the covid-19 patients and can help to provide economic, social and psychological support programs for improvement and reducing the burden of disease of caregivers during the covid-19 outbreaks.

Conspiracy mentality among informal caregivers as a risk factor for caregiver burden, mental health, perceived loneliness and social isolation during the COVID-19 pandemic: findings of a representative online study from Germany

PURPOSE

This study aims to analyze if and how conspiracy mentality is associated with mental health, burden and perceived social isolation and loneliness of informal caregivers of older individuals with care needs.

METHODS

A quantitative, cross-sectional study was conducted. Participants had to be at least 40 years of age and were drawn randomly from the German online panel forsa.omninet and questioned between the 4th and 19th of March 2021. A sample of 489 informal caregivers (relatives and non-relatives supporting individuals aged ≥ 60 years) was questioned. Conspiracy mentality, depressive symptoms, loneliness and social exclusion were measured with validated instruments (e.g., The Conspiracy Mentality Questionnaire). Questions referred to the last three months prior to assessment. Multiple linear regression analyses, adjusted for sociodemographic, economic and health factors and indicators of the pandemic, were conducted.

RESULTS

Findings indicate a significant positive association between conspiracy mentality and caregiver burden, loneliness, social exclusion, and depressive symptoms. No gender differences were found for any outcome.

CONCLUSIONS

The results indicate that conspiracy mentality could be a risk factor for mental health, perceived social isolation and loneliness, and contribute to increased caregiver burden among informal caregivers of older care recipients during the COVID-19 pandemic. Accordingly, informal caregivers could benefit from actions focused on reducing conspiracy mentality during a health crisis, which could improve psychosocial health and wellbeing in this vulnerable group.

Caregiving for People With Dementia or Cognitive Impairment During the COVID-19 Pandemic: A Review

The COVID-19 pandemic has been a major source of stress for informal caregivers for people with dementia. Studies show the unique challenges caregivers face, such as social isolation, extended work hours, and adherence to public health guidelines. We conducted a narrative review of factors impacting well-being of informal caregivers of older adults with dementia during the COVID-19 pandemic. Sixty-four papers were identified as published between June 2020 and December 2021. All studies were conducted in the U.S. or other Western countries and were cross-sectional and conducted prior to COVID-19 vaccines. Articles highlighted increasing burdens such as financial and physical stress, as well as worsened psychological well-being from anxiety and depression. Protective factors such as social support and telehealth interventions also emerged. Limitations include lack of longitudinal information to identify broader themes on caregiving during the pandemic. Studies not only identified new, pandemic-related risk factors, but also a heightened effect of pre-existing risk factors (e.g., income, living situation) on caregiver burden.

The effect of COVID-19 on the home behaviours of people affected by dementia

The COVID-19 pandemic has dramatically altered the behaviour of most of the world’s population, particularly affecting the elderly, including people living with dementia (PLwD). Here we use remote home monitoring technology deployed into 31 homes of PLwD living in the UK to investigate the effects of COVID-19 on behaviour within the home, including social isolation. The home activity was monitored continuously using unobtrusive sensors for 498 days from 1 December 2019 to 12 April 2021. This period included six distinct pandemic phases with differing public health measures, including three periods of home ‘lockdown’. Linear mixed-effects modelling is used to examine changes in the home activity of PLwD who lived alone or with others. An algorithm is developed to quantify time spent outside the home. Increased home activity is observed from very early in the pandemic, with a significant decrease in the time spent outside produced by the first lockdown. The study demonstrates the effects of COVID-19 lockdown on home behaviours in PLwD and shows how unobtrusive home monitoring can be used to track behaviours relevant to social isolation.

Taking the 'care' out of care homes: The moral dilemma of institutional long-term care provision during COVID-19

Little is known on how the pandemic has changed care home care delivery. The aim of this study was to explore the impact of COVID-19 on care provision and visits in care homes from staff and family members' perspectives. For this purpose, we conducted a telephone- and zoom-based qualitative semi-structured interview study. Care home staff and family carers of people living with dementia (PLWD) across the UK were recruited via convenience sampling and participated via telephone or online. Participants took part in a semi-structured remote interview. Data were collected between October and November 2020. Anonymised transcripts were analysed separately by two research team members using thematic analysis, with codes discussed and themes generated jointly, supported by research team input. 42 participants (26 family carers and 16 care home staff) took part. Five themes were generated: (a) Care home reputation and financial implications; (b) Lack of care; (c) Communication or lack thereof; (d) Visiting rights/changes based on residents' needs; (e) Deterioration of residents. With a lack of clear guidance throughout the pandemic, care homes delivered care differently with disparities in the levels and types of visiting allowed for family members. Lack of communication between care homes and family members, but also government and care homes, led to family carers feeling excluded and concerned about the well-being of their relative. Improved communication and clear guidance for care homes and the public are required to negate the potentially damaging effects of COVID-19 restrictions upon residents, their families and the carers who support them.

A Culturally and Linguistically Appropriate Telephone Support Intervention for Diverse Family Caregivers of Persons With Dementia During the COVID-19 Pandemic

Caregivers of persons with dementia (PWDs) were socially isolated with little support during the COVID-19 pandemic "Stay-At-Home" order in the United States. To enhance social and emotional connection for diverse caregivers, a culturally/linguistically appropriate telephone intervention provided compassionate listening, mindful breathing, and COVID-19 safety education. The study purpose was to understand caregiving challenges and to evaluate the intervention for caregivers during the early pandemic using a qualitative approach. Twenty-three caregivers participated in the intervention provided by bilingual research assistants for 3 months. Call logs were used to describe the caregivers' dialogue. Thematic analysis identified (a) the challenges, including fear of coronavirus disease, providing around-the-clock care, and forced isolation and negative emotions; and (b) caregivers' experience with the intervention, including connecting with the outside, relief from emotional stress, reliable COVID-19 information, and reinformed caregiving skills. Results suggest that the telephone support was of benefit to diverse caregivers of PWDs during the pandemic by promoting social connection and reducing emotional distress.

Experiences of Black American Dementia Caregivers During the COVID-19 Pandemic

Dementia caregivers are responsible for the daily care and management of individuals who are among the most vulnerable to the serious consequences of COVID-19. This qualitative study explores the experience of Black dementia caregivers during the COVID-19 pandemic in the United States. Nineteen Black dementia caregivers were recruited to participate in semi-structured focus groups held in April 2021. Four overarching themes were constructed during analysis: social isolation, decreased well-being, the good and bad of telehealth, and challenges fulfilling health care needs. The results indicate the experience of Black dementia caregivers overlaps with existing literature on the experiences of dementia caregivers of other races during COVID-19. These results can assist in addressing the specific needs and improving the experiences of dementia caregivers in current and future public health crises.

"A Different Way to Survive": The Experiences of Family Caregivers of Persons Living With Dementia During the COVID-19 Pandemic

Family caregivers of persons living with dementia often experience challenges to their health and quality of life related to their caregiving role. The COVID-19 pandemic added substantially to the responsibilities of family caregivers, potentially putting them at greater risk of poor health outcomes and impeded quality of life. To better understand the impact of the pandemic on the experiences of family caregivers, a multimethods study was conducted. Family caregivers of persons living with dementia were invited to complete a cross-sectional survey and a subset of survey respondents were invited to participate in focus groups for added insight. A total of 161 caregivers responded to the survey and 30 participated in the focus groups. Qualitative data from focus groups were used to elucidate deeper insight into quantitative findings from the survey. Findings reflect that the pandemic affected family caregiver health and wellness, access of care and resources, identity, and resilience.

Family caregivers' concerns about advance care planning for home-dwelling people with dementia: a cross-sectional observational study in Japan

Background

The importance of advance care planning for people with dementia has increased during the Coronavirus Disease 2019 Pandemic. However, family caregivers may have concerns about having conversations regarding advance care planning with their loved ones, which may hinder the initiation of such planning. This study investigated family caregivers’ concerns regarding conducting advance care planning for home-dwelling individuals with dementia.

Methods

A prospective cross-sectional study compared the level of family-caregiver concern between those who had initiated advance care planning and those who did not. In June 2021, an internet-based questionnaire survey was administered to Japan-based family caregivers of persons with dementia. Registered members of a Japan-based survey company were recruited; inclusion criteria were being aged 40 years or older and having been a primary, non-professional caregiver of a family member with dementia. Respondents rated their level of agreement with six statements regarding advance-care-planning-related concerns. Respondents also reported their psychological well-being using the WHO-5 Well-Being Index.

Results

Overall, 379 family caregivers participated in this survey. Of these, 155 (40.9%) reported that their loved ones had initiated advance care planning, of whom 88 (56.8%) stated that care professionals were involved in the advance-care-planning conversations. The level of family-caregiver concern was significantly lower when the loved one initiated the conversation concerning advance care planning. After adjusting for the characteristics of persons with dementia and their caregivers, family caregivers with lower psychological well-being showed significantly higher levels of concern.

Conclusions

Family caregivers reported concerns regarding conducting advance care planning. There is a need for educational and clinical strategies that encourage professionals to address the psychological needs of family caregivers.

Care burden, loneliness, and social isolation in caregivers of people with physical and brain health conditions in English-speaking regions: Before and during the COVID-19 pandemic

BACKGROUND

Public health restrictions due to the COVID-19 (SARS CoV-2) pandemic have disproportionately affected informal caregivers of people living with long term health conditions. We aimed to explore levels of care burden, loneliness, and social isolation among caregivers of people with enduring physical and brain health conditions in English-speaking regions worldwide, by investigating outcomes before and during the COVID-19 pandemic.

METHODS

A cross-sectional anonymous online survey data from 2287 English-speaking caregivers of people with long term health conditions from four English-speaking regions (UK, Ireland, USA, New Zealand) included measures of care burden, loneliness, and social isolation, reported before and during the COVID-19 pandemic. Analyses were descriptive, followed by an ordinal regression model for predictors of burden.

RESULTS

Compared to pre-pandemic levels, all caregivers experienced a significant increase in burden, loneliness, and isolation. Caregivers of people with both brain health and physical conditions were the most burdened and had the highest levels of loneliness and isolation compared to caregivers of people with either a brain health or physical condition only. The increase in care burden among caregivers of people with brain health challenges was associated with caregiver's gender, moderate and severe emotional loneliness, magnitude and frequency of isolation during the pandemic, and care circumstances (cohabitation with the care recipient, restrictions on the ability to provide care).

CONCLUSIONS

Health and social care interventions should target caregivers' care circumstances and psychological outcomes, particularly in women, accounting for the significant additional burden of care, loneliness, and isolation resulting from pandemic-related restrictions.

Exploring lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the COVID-19 lockdown in China: A phenomenological study

OBJECTIVE

We aimed to explore the lived experiences of informal caregivers for pregnant women seeking scheduled antenatal care during the early stage of China's COVID-19 lockdown and potential measures to address the challenges.

DESIGN

This is a phenomenological qualitative study.

SETTING

The study was carried out in a leading teaching hospital in Southwest China.

PARTICIPANTS

We recruited 15 informal caregivers for healthy pregnant women on routine antenatal visits about six months after China launched the city-wide lockdown and other control measures for COVID-19, including 10 males and 5 females with diverse demographic backgrounds.

MEASURES AND FINDINGS

The research team developed a demographic form and an interview outline with key questions, conducted semi-structured interviews with the informal caregivers, and analyzed the data using the Colazzie's method. Five themes of lived experiences were revealed, i.e., increased caregiving burdens, disruption of routines in family life, lack of accurate information and knowledge, active role adjustment, and positive attitudes and coping in a difficult time. Some caregivers reacted positively to the lockdown experience and saw it as an opportunity to rethink their lives and improve family relations.

KEY CONCLUSIONS

The informal caregivers experienced increased physical and psychological burdens. Strategies such as adoption of a less frequent prenatal visit schedule, use of tele-medicine technologies, and provision of accurate information and knowledge may help to ease the increased informal caregiving burdens. Psychological counseling, community services and disaster response policies specially targeting pregnant women and their informal caregivers may also be valuable resources.

IMPLICATIONS FOR PRACTICE

Attention should be drawn to the group of informal caregivers for pregnant women during a COVID-19 lockdown, including professional assistance delivered by nursing and other related professionals. Measures are called for to minimize exposure opportunities such as adoption of a new prenatal care schedule and tele-medicine technologies. Patient education with reliable information should be provided, preferably by nursing staff and physicians. Social support efforts including professional mental counseling may added and work with other resources such as community services and policy makers.

A Comparison of Well-Being of Carers of People with Dementia and Their Ability to Manage Before and During the COVID-19 Pandemic: Findings from the IDEAL Study

BACKGROUND

Social restriction measures imposed to curb the spread of COVID-19 in the United Kingdom impacted on carers of people with dementia, limiting access to support services and increasing perceived burden of caring. Few studies have compared data collected both during and before the pandemic to examine the effect of these changes.

OBJECTIVE

To explore whether the COVID-19 pandemic affected the well-being of carers of people with dementia living in the community, and their ability to cope with their caring responsibilities.

METHODS

Analysis was conducted on two groups of carers who were enrolled in the IDEAL programme; the 'pre-pandemic group' (n = 312), assessed at two time points prior to the pandemic, and the 'pandemic group', assessed prior to and several months into the pandemic (n = 156). For the pre-pandemic group, carers were matched 2:1 to carers in the pandemic group on certain characteristics. Differences in change over time between the two groups on self-reported well-being, quality of life, coping, perceived competence, and role captivity, was investigated using mixed effect modelling.

RESULTS

Compared to the pre-pandemic group, those in the pandemic group appeared to cope better and had more stable self-rated competency and role captivity. They did not differ in terms of well-being or quality of life.

CONCLUSIONS

Despite reports of negative impacts on carers early in the pandemic, the findings suggest the pandemic had little negative longer-term impact on carers of people with dementia, and in fact they appeared to have a more positive attitude towards coping several months into the pandemic.

The Effects of COVID-19 lockdown on neuropsychiatric symptoms in patients with dementia or mild cognitive impairment: A systematic review and meta-analysis

The COVID-19 pandemic may have a disproportionate impact on people with dementia/mild cognitive impairment (MCI) due to isolation and loss of services. The aim of this systematic review was to investigate the effects of the COVID-19 lockdown on neuropsychiatric symptoms (NPS) in people living with dementia/MCI. Two authors searched major electronic databases from inception to June 2021 for observational studies investigating COVID-19 and NPS in people with dementia/MCI. Summary estimates of mean differences in NPS scores pre- versus post-COVID-19 were calculated using a random-effects model, weighting cases using inverse variance. Study quality and risk of bias were assessed by the Newcastle-Ottawa Scale. From 2730 citations, 21 studies including 7139 patients (60.0% female, mean age 75.6 ± 7.9 years, 4.0% MCI) with dementia were evaluated in the review. Five studies found no changes in NPS, but in all other studies, an increase in at least one NPS or the pre-pandemic Neuropsychiatric Inventory (NPI) score was found. The most common aggravated NPS were depression, anxiety, agitation, irritability, and apathy during lockdown, but 66.7% of the studies had a high bias. Seven studies including 420 patients (22.1% MCI) yielded enough data to be included in the meta-analysis. The mean follow-up time was 5.9 ± 1.5 weeks. The pooled increase in NPI score before compared to during COVID-19 was 3.85 (95% CI:0.43 to 7.27; P = 0.03; I²  = 82.4%). All studies had high risk of bias. These results were characterized by high heterogeneity, but there was no presence of publication bias. There is an increase in the worsening of NPS in people living with dementia/MCI during lockdown in the COVID pandemic. Future comparative studies are needed to elucidate whether a similar deterioration might occur in people without dementia/MCI.

The Spill-Over Impact of the Novel Coronavirus-19 Pandemic on Medical Care and Disease Outcomes in Non-communicable Diseases: A Narrative Review

Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.

Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.

Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.

Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.

Health-related quality of life in caregivers of community-dwelling individuals with disabilities or chronic conditions. A gender-differentiated analysis in a cross-sectional study

Background

Most care for people with chronic or disabling conditions living in the community is provided in the family context, and this care is traditionally provided by women. Providing informal care has a negative impact on caregivers’ quality of life, which adds to existing health inequalities associated with gender. The aim of this study was to analyze factors associated with the health-related quality of life of caregivers and to determine their differences in a gender-differentiated analysis.

Methods

An observational, cross-sectional, multicenter study was conducted in primary healthcare. A total of 218 caregivers aged 65 years or older were included, all of whom assumed the primary responsibility for caring for people with disabling conditions for at least 6 months per year and agreed to participate in the CuidaCare study. The dependent variable was health-related quality of life, assessed with the EQ-5D. The explanatory variables tested were grouped into sociodemographic variables, subjective burden, caregiving role, social support and variables related to the dependent person. The associations between these variables and health-related quality of life were estimated by fitting robust linear regression models. Separate analyses were conducted for women and men.

Results

A total of 72.8% of the sample were women, and 27.2% were men. The mean score on the EQ-5D for female caregivers was 0.64 (0.31); for male caregivers, it was 0.79 (0.23). There were differences by gender in the frequency of reported problems in the dimensions of pain/comfort and anxiety/depression. The variables that were associated with quality of life also differed. Having a positive depression screening was negatively associated with quality of life for both genders: -0.31 points (95% CI: -0.47; -0.15) for female caregivers and -0.48 points (95% CI: -0.92; -0.03) for male caregivers. Perceived burden was associated with quality of life in the adjusted model for women (-0.12 points; 95% CI: -0.19; -0.06), and domestic help was associated in the adjusted model for male caregivers (-0.12 points; 95% CI: -0.19; -0.05).

Conclusions

Gender differences are present in informal caregiving. The impact of providing informal care is different for male and female caregivers, and so are the factors that affect their perceived quality of life. It could be useful it incorporates a gender perspective in the design of nursing support interventions for caregivers to individualize care and improve the quality of life of caregivers.

Trial registration

NCT 01478295 [https://ClinicalTrials.gov]. 23/11/2011.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00845-x.

Impact of COVID-19 on carers of people with dementia in the community: Findings from the British IDEAL cohort

OBJECTIVE

Unpaid carers for people with dementia play a crucial role in society. Emerging evidence suggests the COVID-19 pandemic has negatively impacted on carers. This study sought to explore the impact of the COVID-19 pandemic on carers for community-dwelling people with dementia and compare responses with pre-pandemic data.

METHODS

Data were collected between September 2020 and April 2021 in England and Wales. Carers were identified from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort and data were collected either through the telephone, video conferencing, or an online questionnaire. Responses from 242 carers were compared against benchmark data from the IDEAL cohort collected pre-pandemic. Analyses were conducted for the full sample of carers and spousal/partner carers only.

RESULTS

In total 48.8% of carers thought their healthcare needs were negatively affected during the pandemic. Compared with pre-pandemic data carers were more lonely and experienced less life satisfaction. There was little impact on carers' experience of caregiving, although carers felt trapped in their caregiving role. Carers were more optimistic and had higher social contact with relatives. There were changes in the methods carers used for contacting relatives and friends. Most carers coped very or fairly well during the pandemic. There was little difference in the experiences of spousal/partner carers and the full sample.

CONCLUSIONS

After a long period of providing care under pandemic conditions carers require additional support. This support needs to be focused on alleviating feelings of loneliness and increasing life satisfaction. Services need to consider how to improve access to health care, particularly resuming face-to-face appointments.

Effect of COVID-19 quarantine on cognitive, functional and neuropsychiatric symptoms in patients with mild cognitive impairment and dementia

BACKGROUND

During the last two years, COVID-19 affected older people with dementia or mild cognitive impairment (MCI), but conflicting and sparse results are still present. The objective of this study was to investigate the frequency and type of changes in functional, cognitive and behavioral and psychological symptoms of dementia (BPSD), and caregiver's stress during the period of quarantine in 2020 in patients affected by dementia/MCI living in Palermo, Sicily.

METHODS

Outpatients affected by MCI/dementia were evaluated before and after COVID-19 quarantine. Functional status was investigated using basic and instrumental activities of daily living (ADL); cognitive performance with the mini-mental state examination; BPSD through the neuropsychiatric inventory (NPI). All scales were reported as pre/post-COVID-19 quarantine and a logistic regression analysis was performed for investigating the factors associated with worsening in NPI in patients and their caregivers.

RESULTS

One hundred patients (mean age 77.1; females = 59%) were evaluated over a median of 10 months. In the sample as whole, a significant decline in functional and cognitive status was observed (p < 0.001 for both comparisons). The NPI significantly increased by 3.56 ± 8.96 points after the COVID-19 quarantine (p < 0.0001), while the caregivers' stress increased by 1.39 ± 3.46 points between the two evaluations (p < 0.0001). The decline was more evident in people with milder dementia. Higher values of instrumental ADL at baseline were associated with a significant lower worsening in NPI and caregiver's stress.

CONCLUSIONS

COVID-19 quarantine negatively affected functional, cognitive, and neuropsychiatric symptoms in older people affected by dementia/MCI, highlighting the impact of COVID-19 quarantine for this population.

Resilience in Informal Caregivers of People Living with Dementia in the Face of COVID-19 Pandemic-Related Changes to Daily Life

Abstract. Informal caregivers of people living with dementia (PwD) are at increased risk for the development of stress-related physical and mental illness. Nevertheless, because of differing resilience, they show interindividual differences in their ability to cope. Particularly during the COVID-19 pandemic, with the associated pandemic control measures and pandemic-related changes to daily life, resilience might be further challenged, and stress might consequently increase. Therefore, we review the evidence on informal caregivers’ experience during the COVID-19 pandemic regarding effects of the pandemic control measures on (a) the caregiver’s health, (b) the care recipient’s health, (c) the stability of the care situation, and (d) coping in daily life. We conclude with implications on how to strengthen resilience and reduce stress in terms of environmental, social, and individual resources.

Caring for a Relative With Dementia in Long-Term Care During COVID-19

OBJECTIVES

The COVID-19 pandemic created unique stressors for caregivers of persons with dementia living in long-term care (LTC) facilities. The purpose of this qualitative study was to identify the challenges associated with caring for a relative with dementia in LTC during the pandemic, as well as resources, strategies, and practices caregivers found helpful in coping with COVID-19.

DESIGN

This study was conducted within the context of an ongoing randomized controlled trial of a psychosocial intervention to support caregivers. Open-ended survey responses (n = 125) and semistructured interviews with a subset of the sample (n = 20) collected between June 2020 and June 2021 explored caregivers' experiences during COVID-19.

SETTING AND PARTICIPANTS

Participants included 125 family caregivers of persons with dementia living in residential LTC.

METHODS

Thematic analysis was used to identify themes capturing caregivers' experiences.

RESULTS

In addition to concerns about COVID-19 infection, participants reported key challenges such as the difficulty of maintaining contact with relatives because of visiting restrictions, lack of information about relatives' health and well-being, worries about overburdened LTC staff, impossibility of returning relatives home from the LTC facility, and fears about relatives dying alone. Participants also identified resources, strategies, and practices that they perceived as helpful, including effective infection prevention within the LTC facility, good communication with LTC staff, and creative strategies for connecting with their relatives.

CONCLUSIONS AND IMPLICATIONS

This qualitative analysis informs recommendations for practice within LTC facilities, as well as supports that may help caregivers manage stressful situations in the context of COVID-19. Vaccination and testing protocols should be implemented to maximize family caregivers' opportunities for in-person contact with relatives in LTC, as alternative visiting modalities were often unsatisfactory or unfeasible. Informing caregivers regularly about individual residents' needs and status is crucial. Supports for bereaved caregivers should address complicated grief and feelings of loss.

Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective

OBJECTIVES

Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India.

METHODS

This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the "cluster of cases" transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services.

RESULTS

The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = -0.552 [1.993], t58 = -2.109, p = 0.039) and eating disturbances (mean difference [SD] = -1.121 [2.493], t59 = -3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up.

CONCLUSION

Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.

COVID-19 and Physical Activity Behaviour in People with Neurological Diseases: A Systematic Review

The COVID-19 pandemic has led to a radical lifestyle change, which may unintendedly change physical activity levels. We aimed to perform a systematic review to investigate the physical activity changes in people with neurological diseases, and to examine the relationship between physical activity and disease symptoms, and psychosocial factors. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of the literature across five databases (PubMed, CINAHL, Web of Science, SCOPUS, and Cochrane Library) was carried out using the keywords relating to COVID-19, physical activity, sedentary behaviour, exercise, and the name of the neurological diseases. The systematic search was updated on 4 February 2021 with the same keywords. Fourteen studies (n = 7662 persons with neurological diseases, n = 1663 healthy controls) were eligible for this review. The study populations were Parkinson disease (n = 7), dementia (n = 1), multiple sclerosis (n = 1), spinal cord injury (n = 1), hereditary spastic paraplegia (n = 1), neuromuscular diseases (n = 1), Charcot-Marie-Tooth neuropathy (n = 1), and epilepsy (n = 1). Thirteen studies reported a decreased physical activity level, one study reported a high interruption rate of physiotherapy/rehabilitation. Furthermore, the physical activity reduction was associated with worse disease symptoms, depression, perceived health, and mental and physical components of quality of life. The COVID-19 pandemic has a negative impact on the physical activity levels of people with neurological diseases, and this change was related to the worsening of disease symptoms and psychosocial factors. Registration number A protocol of the review was registered with the PROSPERO database (CRD42020207676).

Supplementary Information

The online version contains supplementary material available at 10.1007/s10882-022-09836-x.

Care for dementia patients and caregivers amid COVID-19 pandemic

BACKGROUND

Multiple efforts have been taken across the world to bridge gaps in evidence and provide recommendations for dementia care and caregiver support during the COVID-19 pandemic. We aimed to review the available literature on measures used to alleviate the negative impacts of the pandemic on dementia care.

METHODS

We searched three databases: PubMed, CINAHL and PsycINFO to identify studies that described strategies that were recommended or taken to provide care and support to persons with dementia and their caregivers during the COVID-19 pandemic.

RESULTS

We included a total of 37 papers, originating from high, middle and low-income countries. We also included 6 papers exploring safety of COVID-19 vaccinations. Infection prevention recommendations predominantly involved providing consistent reminders to persons with dementia to engage in infection prevention measures and included measures to restrict wandering in long-term care settings to reduce spread of infection. Medical care included tele and video consultations to maintain and monitor clinical stability. Guidance for continuing rehabilitation activities for persons with dementia through remotely conducted cognitive stimulating activities, physical exercises and environmental modifications were further highlighted by multiple studies/articles. In addition, strategies to support caregivers were also advised and included teleconsultations and psycho-educational programs.

CONCLUSION

The COVID-19 pandemic has exposed gaps in health and social care systems across the world, but has also revealed the enduring dedication of clinicians, expert groups and dementia support organizations to modify and adapt existing dementia care services to meet the needs of persons with dementia and their caregivers during periods of emergency.

Psychosocial Effects of COVID-19 Measures on (Pre-)Dementia Patients During Second Lockdown

BACKGROUND

The COVID-19 pandemic poses enormous social challenges, especially during lockdown. People with cognitive decline and their caregivers are particularly at risk of lockdown consequences.

OBJECTIVE

To investigate psychosocial effects in (pre-)dementia patients and caregivers during second lockdown and compare effects between first and second lockdown.

METHODS

We included n = 511 (pre-)dementia patients and n = 826 caregivers from the Amsterdam Dementia Cohort and via Alzheimer Nederland. All respondents completed a self-designed survey on psychosocial effects of COVID-19. We examined relations between experienced support and psychosocial and behavioral symptoms using logistic regression. In a subset of patients and caregivers we compared responses between first and second lockdown using generalized estimating equation.

RESULTS

The majority of patients (≥58%) and caregivers (≥60%) reported that family and friends, hobbies, and music helped them cope. Support from family and friends was strongly related to less negative feelings in patients (loneliness: OR = 0.3[0.1-0.6]) and caregivers (loneliness: OR = 0.2[0.1-0.3]; depression: OR = 0.4[0.2-0.5]; anxiety: OR = 0.4[0.3-0.6]; uncertainty: OR = 0.3[0.2-0.5]; fatigue: OR = 0.3[0.2-0.4]; stress: OR = 0.3[0.2-0.5]). In second lockdown, less psychosocial and behavioral symptoms were reported compared to first lockdown (patients; e.g., anxiety: 22% versus 13%, p = 0.007; apathy: 27% versus 8%, p < 0.001, caregivers; e.g., anxiety: 23% versus 16%, p = 0.033; patient's behavioral problems: 50% versus 35%, p < 0.001). Patients experienced more support (e.g., family and friends: 52% versus 93%, p < 0.001; neighbors: 28% versus 66%, p < 0.001).

CONCLUSION

During second lockdown, patients and caregivers adapted to challenges posed by lockdown, as psychosocial and behavioral effects decreased, while patients experienced more social support compared to first lockdown. Support from family and friends is a major protective factor for negative outcomes in patients and caregivers.

The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study

BACKGROUND

People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden.

METHODS

Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0.

RESULTS

No significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0.

CONCLUSION

PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.

Factors Associated with Increased Caregiver Burden of Informal Caregivers during the COVID-19 Pandemic in Japan

This study's objective was to explore the association between various factors and the increased caregiver burden of informal caregivers during the COVID-19 pandemic. On February, 2021, 700 informal caregivers completed an online survey. We assessed the change in caregiver burden during the COVID-19 pandemic. Among all caregiver participants, 287 (41.0%) complained of an increased caregiver burden due to the COVID-19 pandemic. The factors associated with increased caregiver burden were depressive symptoms in caregivers [odds ratio (OR), 2.20; 95% confidence interval (CI), 1.50-3.23], dementia (OR, 2.48; 95%CI, 1.07-5.73) and low Barthel Index scores (OR, 2.01; 95%CI, 1.39-2.90) in care receivers, care days (OR, 1.09; 95%CI, 1.01-1.17) and times (OR, 1.06; 95%CI, 1.01-1.10), and use of home care service (OR, 1.46; 95%CI, 1.01-2.10) and visiting care service (OR, 1.71; 95%CI, 1.20-2.45). These findings suggest we need to pay attention to the physical and mental health of both the care receivers and caregivers.

Algorithmic harms and digital ageism in the use of surveillance technologies in nursing homes

Ageism has not been centered in scholarship on AI or algorithmic harms despite the ways in which older adults are both digitally marginalized and positioned as targets for surveillance technology and risk mitigation. In this translation paper, we put gerontology into conversation with scholarship on information and data technologies within critical disability, race, and feminist studies and explore algorithmic harms of surveillance technologies on older adults and care workers within nursing homes in the United States and Canada. We start by identifying the limitations of emerging scholarship and public discourse on "digital ageism" that is occupied with the inclusion and representation of older adults in AI or machine learning at the expense of more pressing questions. Focusing on the investment in these technologies in the context of COVID-19 in nursing homes, we draw from critical scholarship on information and data technologies to deeply understand how ageism is implicated in the systemic harms experienced by residents and workers when surveillance technologies are positioned as solutions. We then suggest generative pathways and point to various possible research agendas that could illuminate emergent algorithmic harms and their animating force within nursing homes. In the tradition of critical gerontology, ours is a project of bringing insights from gerontology and age studies to bear on broader work on automation and algorithmic decision-making systems for marginalized groups, and to bring that work to bear on gerontology. This paper illustrates specific ways in which important insights from critical race, disability and feminist studies helps us draw out the power of ageism as a rhetorical and analytical tool. We demonstrate why such engagement is necessary to realize gerontology's capacity to contribute to timely discourse on algorithmic harms and to elevate the issue of ageism for serious engagement across fields concerned with social and economic justice. We begin with nursing homes because they are an understudied, yet socially significant and timely setting in which to understand algorithmic harms. We hope this will contribute to broader efforts to understand and redress harms across sectors and marginalized collectives.

Impact of COVID-19 on 'Living Well' with Mild-to-Moderate Dementia in the Community: Findings from the IDEAL Cohort

BACKGROUND

Negative impacts of the COVID-19 pandemic on people with dementia have been widely-documented, but most studies have relied on carer reports and few have compared responses to information collected before the pandemic.

OBJECTIVE

We aimed to explore the impact of the pandemic on community-dwelling individuals with mild-to-moderate dementia and compare responses with pre-pandemic data.

METHODS

During the second wave of the pandemic, we conducted structured telephone interviews with 173 people with dementia and 242 carers acting as informants, all of whom had previously participated in the IDEAL cohort. Where possible, we benchmarked responses against pre-pandemic data.

RESULTS

Significant perceived negative impacts were identified in cognitive and functional skills and ability to engage in self-care and manage everyday activities, along with increased levels of loneliness and discontinuity in sense of self and a decline in perceived capability to 'live well'. Compared to pre-pandemic data, there were lower levels of pain, depression, and anxiety, higher levels of optimism, and better satisfaction with family support. There was little impact on physical health, mood, social connections and relationships, or perceptions of neighborhood characteristics.

CONCLUSION

Efforts to mitigate negative impacts of pandemic-related restrictions and restore quality of life could focus on reablement to address the effects on participation in everyday activities, creating opportunities for social contact to reduce loneliness, and personalized planning to reconnect people with their pre-COVID selves. Such efforts may build on the resilience demonstrated by people with dementia and carers in coping with the pandemic.

Dementia wellbeing and COVID-19: Review and expert consensus on current research and knowledge gaps

OBJECTIVES

In response to a commissioned research update on dementia during the COVID-19 pandemic, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research.

METHODS

We supplemented a rapid literature search (including unpublished, non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the context of COVID-19 with expert group members' consensus about future research needs. From this we generated potential research questions the group judged to be relevant that were not covered by the existing literature.

RESULTS

Themes emerged from 141 studies within the six domains of the NHS England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, Treating Well, Supporting Well, Living Well and Dying Well. We describe current research findings and knowledge gaps relating to the impact on people affected by dementia (individuals with a diagnosis, their carers and social contacts, health and social care practitioners and volunteers), services, research activities and organisations. Broad themes included the potential benefits and risks of new models of working including remote healthcare, the need for population-representative longitudinal studies to monitor longer-term impacts, and the importance of reporting dementia-related findings within broader health and care studies.

CONCLUSIONS

The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia. Researchers and funding organisations have responded rapidly to try to understand the impacts. Future research should highlight and resolve outstanding questions to develop evidence-based measures to improve the quality of life of people affected by dementia.