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Dementia Patients Are at an Even Greater Risk During the COVID-19 Pandemic

Few people, especially those within healthcare, are unaware that the COVID-19 pandemic has hit the nursing home and long-term care areas of the care continuum harder than anywhere else. The skilled nursing environment has, unfortunately, become a place where COVID-19 is easily transferred between patients, residents, family members, and staff, necessitating lockdowns, the prohibition of visitors, and elimination of resident gatherings. While some measures have been successful in preventing additional widespread infection and loss of life, there are inherent challenges for this care environment in the face of a pandemic. According to a recent media briefing about nursing facilities and the COVID-19 pandemic, Duke University eldercare experts emphasized that “Nursing homes will continue to be COVID-19 hotspots until state and federal officials can institute sweeping testing of asymptomatic patients and workers.”

This blog post is the fourth in our series based on the HealthStream article, 10 Considerations for COVID-19 and Long-Term Care, which examines specific considerations and recommendations to improve the prospects for people living in this long term care, offered by three Duke experts in the eldercare and public policy space.

Dementia Presents a Unique Challenge During Covid-19.

For patients and residents experiencing dementia, the behavior modifications required for COVID-19 are a significant obstacle. Almost everything related to this population is made more difficult by measures to combat the disease. For example, “As a part of the brain disease, there’s often difficulty in communicating, understanding instructions that other people give you, or remembering about things like hand-washing or social distancing,” according to Eleanor McConnell, an associate professor at the Duke University School of Nursing. Working with dementia patients often includes a strong reliance on non-verbal cues related to touch, direction, tone of voice, and facial expressions. Masks impede this process.

Another issue raised by McConnell is unwitting emotional contagion as anxiety is spread from staff to patients. She adds, “I think if staff are anxious and fraught, there’s likely to be some transmission of that emotion to others. I know from talking to my colleagues in acute care, as they’ve become more comfortable with managing COVID-19… their anxiety has come down. So, there’s part of me that’s hopeful that this can get better.” Caregivers need to continually educate themselves on how to care for people suffering from dementia, especially those continuing to rely on routines plays an important part in making these residents feel more comfortable and secure.

About the Experts

Nathan Boucher is an Assistant Research Professor in the Sanford School of Public Policy at Duke. He studies patients’ and caregivers’ experiences and expectations of health care delivery during advanced illness and near the end of life.

Eleanor Schildwachter McConnell is an Associate Professor at the Duke University School of Nursing. She studies factors that influence functional decline in very frail older adults. Her research has been funded by the National Institute of Nursing Research and the Department of Veterans Affairs.

Donald Taylor is a Professor of Public Policy who researches aging and comparative health systems, including Medicare, long-term care, and health policy. Taylor also directs Duke’s Social Science Research Center.

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