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      Dementia care from behind the mask? Maintaining well‐being during COVID‐19 pandemic restrictions : Observations from Dementia Care Mapping on NHS mental health hospital wards in Wales


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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Accessible summary

          What is known on the subject?

          • Coronavirus disease 2019 (COVID‐19) is a new infectious disease that has spread across the world and infected a large number of people many of whom have died.

          • People with moderate to severe dementia are at very high risk of becoming infected as the disease mainly impacts on older people with other health problems and once infected the person with dementia is more likely to become seriously ill than other people.

          • To prevent infection, people are required to wear masks and isolate from contact with others. It is believed that these measures can reduce the quality of life and general well‐being of people with moderate to severe dementia in hospital or social care. This belief has not yet been demonstrated by research.

          What does this paper add to the existing knowledge?

          • We show that people with moderate to severe dementia receiving care on mental health hospital wards and subject to strict infection prevention measures can still achieve high levels of well‐being.

          • We show that mental health nurses alter the focus of their care to deliberately overcome the challenges and particularly the restrictions on visiting by families.

          What are the implications for practice?

          • We believe that the changes in practice we observed can occur in other healthcare and social care settings and that whilst restrictions remain in place care staff can protect and possibly enhance well‐being for people with moderate to severe dementia.


          The effect of coronavirus (COVID‐19) on people living with dementia is potentially severe in its clinical impacts. More widely, for this vulnerable group, the social restrictions to limit the spread of infection may be emotionally and psychologically damaging.


          To explore the impact of restrictions on well‐being for people with moderate to severe dementia in acute mental health hospital care.


          “Dementia Care Mapping” was the observational tool used to determine well‐ or ill‐being. Observations were undertaken in two mental health hospital wards during a time of restrictions and the use of personal protective equipment.


          We report levels of well‐being that are higher than might be expected alongside a change in the focus of psychological care delivered through mental health nursing interventions aimed at enhancing well‐being. Discussion—We postulate that mental health nurses faced with an unprecedented challenge respond by changing practice to mitigate for infection prevention measures and to compensate for family absence.

          Implications for practice

          We suggest that the desirable enhancing actions by nursing staff which raise well‐being in these hospital settings are readily transferable to other settings that are aiming to maintain well‐being but also practising under COVID‐19 restrictions.

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          Most cited references37

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          Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness

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            The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia

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              Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type.

              J Morris (1997)
              Global staging measures for dementia of the Alzheimer type (DAT) assess the influence of cognitive loss on the ability to conduct everyday activities and represent the "ultimate test" of efficacy for antidementia drug trials. They provide information about clinically meaningful function and behavior and are less affected by the "floor" and "ceiling" effects commonly associated with psychometric tests. The Washington University Clinical Dementia Rating (CDR) is a global scale developed to clinically denote the presence of DAT and stage its severity. The clinical protocol incorporates semistructured interviews with the patient and informant to obtain information necessary to rate the subject's cognitive performance in six domains: memory, orientation, judgment and problem solving, community affairs, home and hobbies, and personal care. The CDR has been standardized for multicenter use, including the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) and the Alzheimer's Disease Cooperative Study, and interrater reliability has been established. Criterion validity for both the global CDR and scores on individual domains has been demonstrated, and the CDR also has been validated neuropathologically, particularly for the presence or absence of dementia. Standardized training protocols are available. Although not well suited as a brief screening tool for population surveys of dementia because the protocol depends on sufficient time to conduct interviews, the CDR has become widely accepted in the clinical setting as a reliable and valid global assessment measure for DAT.

                Author and article information

                J Psychiatr Ment Health Nurs
                J Psychiatr Ment Health Nurs
                Journal of Psychiatric and Mental Health Nursing
                John Wiley and Sons Inc. (Hoboken )
                28 April 2021
                : 10.1111/jpm.12763
                [ 1 ] Betsi Cadwaladr University Health Board & Senior Honorary Lecturer in dementia studies School of Health Sciences Bangor University Bangor UK
                [ 2 ] Lecturer in Mental Health Nursing School of Health Sciences Bangor University Bangor UK
                [ 3 ] Betsi Cadwaladr University Health Board Bangor UK
                Author notes
                [*] [* ] Correspondence

                Sean Page, Betsi Cadwaladr University Health Board & Senior Honorary Lecturer in dementia studies, School of Health Sciences, Bangor University, Bangor, UK.

                Email: Sean.page@ 123456wales.nhs.uk

                Author information
                © 2021 John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                : 01 April 2021
                : 08 December 2020
                : 12 April 2021
                Page count
                Figures: 4, Tables: 0, Pages: 9, Words: 11298
                Original Article
                Original Articles
                Custom metadata
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:02.07.2021

                dementia care,older adult psychiatry,patient experience,psycho‐social


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