The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany
Authors: Thyrian Jochen René , Kracht Friederike , Nikelski Angela , Boekholt Melanie , Schumacher-Schönert Fanny , Rädke Anika , Michalowsky Bernhard , Vollmar Horst Christian , Hoffmann Wolfgang , Rodriguez Francisca S. , Kreisel Stefan H. 
Published: July 2020

Abstract
Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. Elderly people with comorbidities are at a higher risk and the different levels of government in Germany reacted jointly to the challenge with social distancing and a lockdown. Little empirical evidence exists about the psychosocial situation of elderly people during this time. Thus, the aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety, and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and daily living at home in Germany. Methods: This analysis is based on data from standardized telephone interviews in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Participants were recruited from currently running interventional trials. Therefore, data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, frequency of social activities due to the pandemic and perceived impact of the pandemic on health care services were assessed during the time of lockdown. Results: The vast majority of participants consider themselves sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-V. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low levels of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or birthday visits have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies are reported to have worsened due to the pandemic. Also visits to general practitioners decreased. Discussion: The study shows a limited impact of the pandemic on psychological variables including depression, anxiety and loneliness in the short-term. People are well informed but not especially concerned about themselves or others. There is a decrease in social activities as expected, in line with the restrictions imposed. The impact on health care provision is prominent. There is a need for longitudinal studies to assess longer-term effects of the pandemic and social distancing on elderly people with cognitive impairment living at home and their caregivers. There is also a need for qualitative, in-depth studies to further interpret the results. In general, elderly people in the setting under examination and with the limitations of this specific study seem to compensate restrictions during the time of lockdown in Germany rather well.