Older adults are vulnerable at the onset of natural disasters and crisis, and this
has been especially true during the coronavirus disease 2019 (COVID-19) pandemic.
With the aggressive spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),
the death toll has risen worldwide. According to an interactive online tool that estimates
the potential number of deaths from COVID-19 in a population, by age group, in individual
countries and regional groupings worldwide under a range of scenarios, most of those
who have died were older adults, most of whom had underlying health problems.
Globally, more than 50 million people have dementia, and one new case occurs every
Dementia has emerged as a pandemic in an ageing society.
The double hit of dementia and COVID-19 pandemics has raised great concerns for people
living with dementia.
People living with dementia have limited access to accurate information and facts
about the COVID-19 pandemic. They might have difficulties in remembering safeguard
procedures, such as wearing masks, or in understanding the public health information
issued to them. Ignoring the warnings and lacking sufficient self-quarantine measures
could expose them to higher chance of infection.
Older people in many countries, unlike in China, tend to live alone or with their
spouse, either at home or in nursing homes. As more and more businesses stop non-essential
services or initiate telecommuting work in an attempt to maintain social distancing
limit the further spread of SARS-CoV-2, people living with dementia, who have little
knowledge of telecommunication and depend primarily on in-person support might feel
lonely and abandoned, and become withdrawn.
To lessen the chance of infection among older people in nursing homes, more local
authorities are banning visitors to nursing homes and long-term care facilities.
In January, 2020, the Chinese Ministry of Civil Affairs implemented similar social-distancing
As a result, older residents lost face-to-face contact with their family members.
Group activities in nursing homes were also prohibited. As a consequence, the residents
of nursing homes became more socially isolated. We have observed that under the dual
stress of fear of infection and worries about the residents' condition, the level
of anxiety among staff in nursing homes increased and they developed signs of exhaustion
and burnout after a month-long full lockdown of the facilities.
Some people infected with COVID-19 have had to receive intensive care in hospital.
A new environment can lead to increased stress and behavioural problems.
Delirium caused by hypoxia, a prominent clinical feature of COVID-19, could complicate
the presentation of dementia
, increasing the suffering of the people living with dementia, the cost of medical
care, and the need for dementia support.
During the COVID-19 outbreak in China, five organisations, including the Chinese Society
of Geriatric Psychiatry and Alzheimer's Disease Chinese, promptly released expert
recommendations and disseminated key messages on how to provide mental health and
Multidisciplinary teams started counselling services free of charge for people living
with dementia and their carers. These approaches minimised the complex impact of both
COVID-19 outbreak and dementia.
As recommended by international dementia experts and Alzheimer's Disease International,
support for people living with dementia and their carers is needed urgently worldwide.
In addition to physical protection from virus infection, mental health and psychosocial
support should be delivered. For example, mental health professionals, social workers,
nursing home administrators, and volunteers should deliver mental health care for
people living with dementia collaboratively. Within such a team, dementia experts
could take the lead and support team members from other disciplines. Self-help guidance
for reducing stress, such as relaxation or meditation exercise, could be delivered
through electronic media. Service teams could support behavioural management through
telephone hotlines. Psychological counsellors could provide online consultation for
carers at home and in nursing homes.
In addition, we encourage people who have a parent with dementia to have more frequent
contact or spend more time with their parent, or to take on some of the caregiving
duties so as to give the carer some respite time.
China has contained the epidemic, and business is starting to return to normal. We
believe that learning lessons from China would empower the world to tackle the COVID-19
pandemic, with little risk of compromising the quality of life of people living with
dementia and their carers.