SMALL daily habits overturned by the restrictions due to the pandemic: the lockdown last spring was very hard for the elderly with dementia and unfortunately had repercussions on their mental well-being and also on that of their caregivers. This is demonstrated by one of the first studies conducted in Italy to evaluate the impact of social confinement on the conditions of elderly patients with dementia, just published in Neurological Sciences. The study was conducted by the “Stroke & Dementia Lab”, the new research laboratory set up within the “Luigi Sacco” Department of Biomedical and Clinical Sciences of the University of Milan thanks to the contribution of the Association for Research on Dementia ARD Onlus (www.ard.it), chaired by Professor Carlo Mariani.
Research
The data, collected on about one hundred elderly people who spent the months from March to May 2020 in their home or in that of their caregiver, indicate that there are above all four discomforts that have appeared or worsened during the weeks of isolation: agitation and aggression, which occurred for the first time or became more severe or frequent in 21% of patients, anxiety (15%), apathy e indifference (13%), irritability (12%). There was also a 10% of elderly people for whom depression appeared or worsened, in over 6% sleep disturbances, hallucinations and disappointments emerged. Even the caregivers, almost always family members and in 68% of cases women, were negatively affected by the period spent in solitude; moreover, almost one in four had to go to the doctor for advice on how to manage psycho-behavioral disorders, in 15% of patients needed to increase the dosage of the drugs already in use or prescribing new therapies. The data collected in the last year also show that the elderly with dementia have a greater risk of contracting Covid-19 and of suffering serious illness or complications, including neurological: to reduce the risk of disease, minimize the probability of negative psychological consequences. -behavioral and better manage the difficulties at home, from the experts comes a handbook of advice for caregivers.
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Everything gets worse with isolation
“Only 7% of our patients before the pandemic did not have any psycho-behavioral symptoms of dementia. However, the long period of isolation, despite 77% receiving visits from other family members and 23% being able to go outside, led for many to a slight worsening of symptoms or the appearance of new disorders – explains the research coordinator. Leonardo Pantoni, director of the Neurology Complex Unit of the Luigi Sacco Hospital in Milan and full professor of Neurology at the University of Milan -. Thus at the end of the lockdown, 51% of patients showed apathy, 43% irritability, 38% aggression, 32% depression; one in four had seen at least one indicator worsen, one in three more than two “.
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In the majority of cases we have been dealing with an aggravation of pre-existing problems, rather than the appearance of new ones. “However, it was not possible to identify any elements capable of predicting the probability of a change for the worse in the behavior or deterioration of the welfare of caregivers. In fact, even for them – adds Pantoni – confinement at home was deleterious, although to a considerable degree of malaise was already present before the lockdown and the quarantine itself had a substantial impact regardless of the caregiving activity. In nine cases out of ten, however, it is the case of partners or children of the patient who are no longer very young, with 64 years on average, and that in two out of three cases live alone with their loved one to care for, all elements that certainly contribute to creating difficulties to which are added the stress and discomfort of the pandemic ”.
The complications
The data collected in the last year also show that the elderly with dementia, in addition to having a greater risk of contracting Covid-19, more often face serious illness and especially neurological complications such as a reduced level of consciousness, delirium, stroke. “The pre-existing cerebral vulnerability connected to dementia, associated with the lack of a good cognitive reserve, could be at the basis of this greater danger of neurological consequences, including a further deterioration of cognitive function that could prove irreversible – notes Pantoni – It is therefore necessary to reduce as much as possible the danger of contagion of these particularly fragile elderly and so, in addition to avoiding the visits of those who have symptoms or may have had contact with Covid patients, some additional caution is appropriate, for example paying particular attention to the sanitization of objects such as cell phones and bags, changing the clothes when you return home and so on. It is also important to minimize the likelihood of negative psycho-behavioral consequences, managing any difficulties at home in the best possible way, also thanks to teleconsultations and television with the health professionals who follow the patient “. To help caregivers of elderly people with dementia to better deal with the care of their loved ones, the experts have drawn up a handbook of useful recommendations.
The Decalogue
- Be extremely careful to limit the risk of contagion, keeping the home of the elderly in a ‘safe area’: for example, it is good to wash your hands and change clothes when returning, sanitize cell phones and bags, leave shoes outside.
- If it is not possible to go out safely, provide for indoor physical exercise (stretching, walking) and cognitively stimulating activities such as reading, card games, manual chores.
- Organize virtual meetings with other caregivers or groups for exercises, recreational activities and chats, but also cognitive and physical telerehabilitation sessions with therapists.
- Monitor parameters such as pressure, heart rate, temperature, oxygen saturation, blood sugar: keeping blood pressure under strict control can help against an aggravation of dementia.
- Subject the elderly to periodic, simple assessments of cognitive function, possibly also using online tests indicated by the doctor.
- Also identify with the help of health professionals which situations trigger the appearance of symptoms such as aggression, anxiety, irritability in order to avoid them.
- Record episodes of difficult-to-manage behavior and discuss them with the healthcare professionals of reference, so as to receive personalized advice to be able to better deal with them.
- Have an easily reachable contact (nurse, family doctor, geriatrician) to be able to consult in case of psycho-behavioral problems.
- Remember that delirium may be one of the earliest manifestations of Covid-19 in elderly patients with dementia.
- Have the emergency number at hand to call in case of psycho-behavioral emergencies that you cannot manage on your own, such as violent or self-harming gestures.
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