Minimising long-term effect of COVID-19 in dementia care
Authors: Karen Harrison Dening, Mari Lloyd-Williams
Journal: The Lancet (2020)

We thank Huali Wang and colleagues1Wang H Li T Barbarino P et al.Dementia care during COVID-19.Lancet. 2020; 395: 1190-1191Summary Full Text Full Text PDF PubMed Scopus (394) Google Scholar for highlighting that dementia is also a pandemic in an ageing society,2Alzheimer's Disease InternationalWorld Alzheimer's report 2019: attitudes to dementia.https://www.alz.co.uk/research/WorldAlzheimerReport2019Date: Sept 20, 2019Date accessed: April 2, 2020Google Scholar albeit the word pandemic generates a negative perspective of dementia. The UK is now dealing with the issues that China has already dealt with. People with dementia in the UK, both those living with families and alone, have lost the invaluable support offered by art, music, and exercise groups.3McDermott O Orrell M Ridder HM The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists.Aging Ment Health. 2014; 18: 706-716Crossref PubMed Scopus (126) Google Scholar Family carers have lost precious respite opportunities, such as those offered by day centres, because of COVID-19, causing them to feel they are alone and abandoned.4Lunt C Dowrick C Lloyd-Williams M The role of day care in supporting older people living with long-term conditions.Curr Opin Support Palliat Care. 2018; 12: 510-515Crossref PubMed Scopus (8) Google Scholar The burden of care was increased by the lockdown enforced in March, 2020, with government advice being that all people older than 70 years should self-isolate, denying them the informal support of family and friends. We, along with other professionals, are deeply concerned regarding the effect of COVID-19 on the wellbeing and on the physical and cognitive function of those with dementia. We are also concerned that increased family carer burden and stress will diminish family carers' ability to cope long term, meaning that more people with dementia will enter full-time care prematurely.5Gaugler JE Yu F Krichbaum K Wyman JF Predictors of nursing home admission for persons with dementia.Med Care. 2009; 47: 191-198Crossref PubMed Scopus (476) Google Scholar COVID-19 has brought death and dying to the forefront, yet dementia is the most common cause of death in men and women older than 80 years.6Office for National StatisticsDeaths registered in England and Wales (series DR): 2016.https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredinenglandandwalesseriesdr/2016#dementia-and-alzheimer-disease-remained-the-leading-cause-of-death-in-2016Date: Oct 12, 2017Date accessed: April 3, 2020Google Scholar Etkind and colleagues7Etkind SN Bone AE Gomes B et al.How many people will need palliative care in 2040? Past trends, future projections and implications for services.BMC Med. 2017; 15: 102Crossref PubMed Scopus (362) Google Scholar predict that deaths from dementia will increase from around 59 000 per year in 2014 to around 220 000 per year by 2040. Wang and colleagues1Wang H Li T Barbarino P et al.Dementia care during COVID-19.Lancet. 2020; 395: 1190-1191Summary Full Text Full Text PDF PubMed Scopus (394) Google Scholar reflect that a vital organisational response in their management of COVID-19 for families affected by dementia would provide better support for family carers to help maintain resilience and psychological and mental wellbeing. The UK is arguably in a good position by having existing services to provide such support. Admiral Nurses are specialists in dementia care who use a case management approach to support the whole family unit affected by dementia, from the point of diagnosis to end-of-life care, and provide continued support of family carers in bereavement.8Harrison Dening K Aldridge Z Pepper A Hodgkison C Admiral Nursing: case management for families affected by dementia.Nurs Stand. 2017; 31: 42-50Crossref Scopus (24) Google Scholar It is more important than ever that the commissioners of health and social care for dementia do not break the care trajectory into an ever-increasing fragmented pathway for those affected9Harrison Dening K Scates C Lloyd Williams M Palliative care in dementia: a fragmented pathway?.Int J Palliat Nurs. 2018; 241: 112-122Google Scholar and adhere to National Institute for Health and Care Excellence guidance10National Institute for Health and Care ExcellenceDementia: assessment, management and support for people living with dementia and their carers. NICE guideline [NG97].https://www.nice.org.uk/ng97Date: June 20, 2018Date accessed: April 3, 2020Google Scholar to minimise the effect of COVID-19 on one of the most vulnerable groups in our society. We declare no competing interests.