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approaches to dementia care, dementia awareness

In an unfortunate turn of events, my 85 year old mother’s first hospital admission in decades took place several weeks ago on the cusp of the coronavirus crisis. She fell over at home and broke her hip and as I was at her house at the time, I was able to call out the paramedics immediately. She has dementia and told them that she had incurred the injury in a skiing accident - in fact she had tripped over a chair! Following a long wait in A and E she was then admitted for surgery. As hospital visiting was suspended the following day, I have not seen or spoken to her since then. I am therefore totally reliant on the updates provided by staff, all of whom I know are doing the best job they can under difficult and unprecedented circumstances. By all accounts her journey has been an eventful one and helps to highlight some of the issues faced by people admitted to hospital during the pandemic, particularly those with dementia.

During her first week in hospital I was informed that she had tested positive for the coronavirus and was being transferred to a specialist ward to be treated for this. As around three quarters of those dying from the virus are over the age of 75, I feared the worse. However, after a few days she appeared to get over the main symptoms and was transferred back to the orthopaedic ward. Although this was obviously good news, I wondered what impact these relocations would be having on her mental and physical condition. Would she know where she was and why she was there, could she express her needs to unfamiliar hospital staff and would she find their masks and full protective clothing incomprehensible and upsetting? Also her temporary transferral to a coronavirus ward would have meant a break in her post-surgery rehabilitation which needs to be promptly provided in order to maximise its effectiveness.

In view of my concerns, I was pleased to hear that three weeks after her initial admission, she was going to be transferred to a local community hospital for further rehabilitation. I felt that this would provide a more peaceful setting where she would have the chance to become familiar with the environment and start to regain her mobility through sessions provided by the hospital physiotherapists. However, due presumably to pressure on bed spaces, she only stayed in this hospital for three nights and was moved yet again to take up a temporary care home placement arranged by the social services. The apparent rationale behind this placement was to give her time to recuperate and to give social workers time to carry out a full assessment before longer term plans were made. However, unfortunately this assessment cannot be carried out until the lockdown is over and there will be few (if any) opportunities for rehabilitation as therapists cannot currently visit the home.

In addition, due to the need for social distancing, the care home facilities and activities normally on offer are not now available to residents. After living a reasonably gregarious and independent life, this has left my mother confined to her room and without any of her pre-operative mobility. Furthermore, although it is reassuring to know that she is getting the care she needs, it also concerns me that this care could be further eroding any remaining skills and independence that she may have. Her mental state is particularly worrying and I wonder whether she will even know who I am when I finally get to visit. Obviously, there are technologies such as Facetime and Skype that would allow me to speak to her in the care home in order to address these issues. However, even if care staff were available to facilitate this, as she has very limited vision and panics when trying to speak into a mobile phone, I have not pursued this option. Instead, a new radio has been delivered to the care home, so at least she is able to listen to some music while she self-isolates in her room.

So while being admitted to hospital for emergency surgery under any circumstances can rarely be a positive experience, her problems have been significantly escalated by the fact that this admission took place during the coronavirus crisis. This is not only due to the fact that she caught the virus herself but also due to the rapid changes in care settings, her isolation within these settings and lapses in her post-operative rehabilitation. The fact that she has dementia has potentially compounded the impact of these issues. For, as a stable and stimulating care environment is important in promoting the wellbeing and orientation of people with dementia, these experiences could have made her confusion worse. Similar experiences will be shared by many other people with dementia during this pandemic. They also face a relatively high risk of catching the virus. Thus although dementia is, in itself, unlikely to increase this risk, behavioural factors such as the lack of awareness of the need for social distancing, increased age and other health conditions that often accompany dementia may increase the probability of getting it. Only time will tell the extent of this risk but it is clear that the repercussions of the pandemic on the lives of people with dementia and their carers will be apparent long after its immediate impact is over.

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