key: cord-0711041-g5vad2gy
authors: Canevelli, Marco; Bruno, Giuseppe; Cesari, Matteo
title: Providing simultaneous COVID-19-sensitive and dementia-sensitive care as we transition from crisis care to ongoing care
date: 2020-05-21
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2020.05.025
sha: 18a5b9d703463bab1d5dda5048dbe87f4e2ff1e2
doc_id: 711041
cord_uid: g5vad2gy

nan

1 As of April 29 th , 2020, more than 3 million COVID-19 cases and 217,183 associated deaths 1 have been counted worldwide. 1 Entire national populations are still under restrictive measures for 2 social distancing and self-isolation. Encouragingly, recent epidemiological data show that the 3 epidemic curve seems to have entered into a plateauing/descending phase in most of the affected 4 countries. Accordingly, national and local administrators start reasoning about the post-5 emergency phase (or the so-called "phase 2"), that is the set of measures that should allow the 6 country to gradually return to a condition of "normality" after the lockdown is eased. 2 It is, 7 however, very likely that nothing will be as before this experience, and it is expected that the 8 coronavirus crisis will cause major social and economic issues for a long time. 9

From a public health perspective, one of the main challenges that healthcare systems will 10 probably face is how to progressively move from a COVID-19-centric organization (built up for 11 combating the emergency) to models of care that reflect the "ordinary" health needs of the 12 population. During these last weeks, many hospital and nursing home units have been converted 13 into COVID-19 units to provide care and support to the huge number of patients infected by the 14 SARS-CoV-2. Traditional clinical units have been transformed to host intensive care beds. 3 Several 15 healthcare professionals have temporarily been relocated, sometimes outside their qualifications 16 and specialties, to tackle the contingent needs caused by the epidemic. Elective clinical activities 17 have largely been suspended and/or postponed sine die. All these measures, urgently needed 18 during the period, will have to be gradually reconsidered as the emergency comes to the end. 19

Older, frail people are paying the highest toll in the ongoing pandemic being at higher risk 20 of more severe infections and mortality. Moreover, due to the COVID-19 outbreak, their complex 21 health needs have somehow been forgotten and relegated to the background, as they do not exist. 22

However, they are still there and have often been left apart, untreated, not monitored by the 23 fragmentation of care! 24 2 Frail individuals with chronic conditions have been especially recommended to adhere to 25 social distancing and self-isolation because they are at particularly high risk of adverse events in 26 case of infection. The segregation of these persons at home, the difficulties at adequately 27 monitoring their clinical conditions, and the reduction of social support are negatively affecting 28 their precarious health status. For example, many had scheduled appointments to perform routine 29 clinical checkups and diagnostic examinations that have been canceled at the coronavirus 30 outbreak. Even the mere forced sedentariness and social isolation will probably show their 31 dramatic consequences in these persons when everything will be over. 4 32

As we move beyond a singular focus on COVID-19, the management of dementia will 33 probably assume special relevance in light of its high prevalence and specific features. have developed during the crisis. If this will not be done, the risk is that the most vulnerable 119 persons will pay a high tool to the coronavirus, even without having been infected by it. 120 121 6

Authors have no competing interest to disclose for the present study. 123

Transforming ORs into ICUs

Coronavirus lockdown: 132 forced inactivity for the oldest old?

Dementia care during COVID-19

Nonpharmacologic management of behavioral symptoms 136 in dementia

Advice for caregivers and families -COVID-19 -Living with dementia

Frailty in elderly people

After COVID-19-Thinking Differently About Running the Health Care System

The Coronavirus Disease 2019 Crisis as Catalyst for 145

Telemedicine for Chronic Neurological Disorders

The diagnostic accuracy of 147 8

telegeriatrics for the diagnosis of dementia via video conferencing

Rimmer A. I Don't Feel Confident Providing Remote Consultations. What Do I Need to Know? 150

Adopting a Diary to

Assessment of Neuropsychiatric Symptoms of Dementia