[image geralt@pixabay]
“It’s a double, even a triple whammy,” said Dr. Fred Buckner, an infectious-disease specialist who has been treating COVID patients in the intensive care unit at the University of Washington Medical Center….”
“So the first thing that happens is they’re put into an isolation room and everybody who comes in is in a hazmat suit. It’s frightening to people and worse for older individuals and those who have cognitive issues such as dementia,” he said. “And because they’re in isolation, they can have no visitors; they’re expected to get through this alone, by themselves, without their people.” [From writer Mike Carter, Seattle Times Mar 31 ” Coronavirus is posing special challenges for those trained to help the dying and their families”]
Dr. J. Karlawish, at UPenn Memory Center, wrote an online piece about allowing caregivers into acute care hospitals to help with the infected patient who also has Mild Cognitive Impairment or dementia . He stresses that caregivers are not just for convenience and to prevent loneliness, but can help prevent acute delirium.
“Delirium is a sudden onset of confusion and disordered thinking, a kind of acute brain failure. Alertness waxes and wanes. Some people with it are lethargic. Others become fiercely agitated…”
He further writes: “Sharon Inouye, creator of the HELP [Hospital Elder Life Program] and now a professor at Harvard explains, ‘Allowing a single caregiver to be present at the bedside is essential for delirium prevention and optimal care.’ ”
Geriatricians in China, and others, are describing issues they’ve seen with dementia care in this crisis. Prof H. Wang is a geriatric psychiatrist at Peking Univ, and sits on international groups, (she evidently did some training in the US).
With colleagues, she describes some issues briefly in an online letter to the UK medical journal The Lancet, dated March 30. They point out that some consider dementia incidence a pandemic already.
She had previously given a more detailed video talk on the same subject, in English; surprisingly (to me) it seems like a Western medicine approach. Not a description of the respiratory illness in those patients,but some the challenges of the triage and care. She also discusses delirium, along with psychological (anxiety) and behavioral (agitation) impacts, both on Persons With Dementia (PWD) and their carers.
https://www.youtube.com/watch?v=zM6cd1QSSFo&feature=youtu.be
27 minutes long, first 5 minutes is background about China’s mental health/dementia care systems. She mentions using virtual systems (telemedicine), but doesn’t describe details. At 5:30, starts describing COVID-19; she mentions that evidently the infection has no specific effect on cognitive status. At 7:10 “key messages” on a chart in English. Then a description of various issues PWD and carers can have. 16:48 “Psychological First Aid,” 18:00 some other practical management issues, 22:47 dealing with delirium, 25:01 summary.
Our state data this AM says we have 195 deaths, and 93% are above age 60 (54% > age 80). WA has done 65, 462 tests, with 4896 positive for the novel coronavirus, but only 40% of the positives are above age 60 (12%>age 80).
According to the Alz Assn, 10% of the US population over 65 have Alzheimer’s Dementia (AD); over age 85, 32% have AD.
[the links above should be active, for more information]
