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Ye M, Liu Z, Xie W, Shou M, Wang S, Lin X, Xu Y, Yao M, Chen J, Shou Y, Wu J, Guan L. Implementation of Telemedicine for Patients With Dementia and Their Caregivers: Scoping Review. J Med Internet Res 2025; 27:e65667. [PMID: 40324768 DOI: 10.2196/65667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 02/07/2025] [Accepted: 03/11/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND As dementia advances, symptoms and associated concerns lead to significant distress for both the patients and their caregivers. Telemedicine has the capacity to alleviate care-related issues for patients with dementia and their family caregivers. OBJECTIVE This study aims to synthesize the implementation strategies for providing telemedicine to assist patients with dementia and their caregivers in home and community settings and to examine its effectiveness and implementation barriers. METHODS In accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a systematic search was conducted across 6 databases, including MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and ProQuest. The eligibility criteria for peer-reviewed English publications from January 2000 up to January 2025 encompassed research studies related to telemedicine services for individuals diagnosed with dementia and caregivers. RESULTS This study included 54 articles, comprising 14,446 participants from 10 countries. In total, 4 major themes emerged from the articles: the design of telemedicine services, effectiveness of telemedicine, external environmental factors, and barriers in telemedicine implementation. Cognitive training was addressed in 28 studies. Within the domain of work and leisure, 24 solutions were identified. Most reviewed studies indicated favorable experiences with telemedicine services and highlighted perceived personal and social benefits among patients with dementia, as well as identified barriers to accessing and using such services. CONCLUSIONS Future studies should encompass the enhancement of digital accessibility for individuals with restricted resources and limited technological proficiency, the use of randomized controlled trial methodologies to ascertain the comparative efficacy of various service delivery modes, and the augmentation of sample diversity.
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Affiliation(s)
- Mengfei Ye
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Zheng Liu
- Department of Pharmacology, School of Medicine, Shaoxing University, Shaoxing, China
| | - Weigen Xie
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Mengna Shou
- Department of Women's Health, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Shengpang Wang
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Xuebing Lin
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Yan Xu
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Miner Yao
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Jialu Chen
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Yunli Shou
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Jingzhu Wu
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
| | - Lili Guan
- Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University, Shaoxing, China
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Cetin-Sahin D, Godard-Sebillotte C, Bronskill SE, Seitz D, Morgan DG, Maclagan LC, Sourial N, Quail J, Gruneir A, Wilchesky M, Rochette L, Massamba VK, Youngson E, Diong C, Smith EE, Arsenault-Lapierre G, Le Berre M, Maxwell CJ, Kosteniuk J, Bosson-Rieutort D, Wang T, Miskucza K, Vedel I. The COVID-19 Pandemic and Dementia: a Multijurisdictional Meta-Analysis of the Impact of the First Two Pandemic Waves on Acute Health-care Utilization and Mortality in Canada. Can Geriatr J 2025; 28:16-30. [PMID: 40051596 PMCID: PMC11882212 DOI: 10.5770/cgj.28.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2025] Open
Abstract
Background Previous studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons living with dementia (PLWD) were mostly conducted in a single jurisdiction or focused on a limited number of outcomes. Our study estimates the impact of the first two pandemic waves on emergency department (ED) visits (all-cause/ambulatory care sensitive conditions), hospitalizations (all-cause/30-day readmissions), and all-cause mortality in four Canadian jurisdictions. Methods Using administrative databases from Alberta, Ontario, Saskatchewan, and Quebec, we assembled two closed retrospective cohorts (2019/pre-pandemic control and 2020/pandemic) of PLWD aged 65+. Within community and nursing home settings, the rates of the above-mentioned outcomes in three pandemic periods (first wave, interim period, second wave) were compared to the corresponding pre-pandemic periods. We performed random effects meta-analyses on the provincial incident rate ratios. Results Pre-pandemic and pandemic cohorts included 167,095 vs. 173,240 (community) and 93,374 vs. 92,434 (nursing home) individuals, respectively. During the first wave, community and nursing home populations experienced significant declines in the rates of all-cause ED visits (36% vs. 40%) and hospitalizations (25% vs. 22%), which persisted in the following periods in the community. These declines were greater for the rates of ambulatory care sensitive condition ED visits and 30-day readmissions. Mortality was 36% higher in nursing homes (first wave) and 13% higher in the community (second wave). Conclusions It is key to prepare for future health crises and ensure that PLWD receive necessary care and services and do not have such a high mortality rate. Attention should be equally given to PLWD living in their homes and nursing homes.
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Affiliation(s)
- Deniz Cetin-Sahin
- Department of Family Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
| | - Claire Godard-Sebillotte
- Department of Medicine, Division of Geriatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, QC
| | | | - Dallas Seitz
- Department of Psychiatry, University of Calgary, Calgary, AB
| | - Debra G. Morgan
- Canadian Centre for Rural and Agricultural Health, Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | | | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public of Health, University of Montreal, Montreal, QC
| | - Jacqueline Quail
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB
| | - Machelle Wilchesky
- Department of Family Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
- Department of Medicine, Division of Geriatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, QC
- Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, QC
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, QC
| | | | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB
| | | | - Eric E. Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB
| | - Geneviève Arsenault-Lapierre
- Centre for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et services sociaux du Centre-Ouest de l’Ile-de-Montréal, Côte Saint-Luc, QC
| | - Mélanie Le Berre
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC
| | - Colleen J. Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, ON
| | - Julie Kosteniuk
- Canadian Centre for Rural and Agricultural Health, Department of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Delphine Bosson-Rieutort
- Department of Health Management, Evaluation and Policy, School of Public of Health, University of Montreal, Montreal, QC
| | - Ting Wang
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University Faculty of Medicine and Health Sciences, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
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Alsulami N, Hughes CM, Barry HE. A qualitative interview study of care home managers' experiences of medicines optimisation for residents with dementia during the COVID-19 pandemic. BMJ Open 2025; 15:e091645. [PMID: 39832995 PMCID: PMC11751995 DOI: 10.1136/bmjopen-2024-091645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 12/20/2024] [Indexed: 01/22/2025] Open
Abstract
OBJECTIVES To explore care home managers' views and experiences of optimising medicines use for residents with dementia during the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS A descriptive exploratory qualitative study using semistructured interviews (conducted via telephone or online videoconferencing platform), with care home managers across Northern Ireland, purposively sampled from care homes that provided care for residents with dementia. Care home managers were asked to describe their experiences of accessing primary healthcare services (such as those provided by general practitioners and community pharmacists), how medicines use by residents with dementia was affected by the pandemic, and what they had learnt from their experiences. Data were analysed using inductive thematic analysis. RESULTS Fourteen interviews were conducted between January and July 2022. Four themes, 'isolation', 'burden', 'disruption' and 'connection and communication', were identified; isolation was a cross-cutting theme that permeated the other themes. Care home managers described feeling isolated from healthcare professionals, healthcare services and residents' family members. This isolation placed additional burden on care home staff and residents with dementia by increasing staff workload and negatively affecting residents' well-being. Participants reported that disruption to primary healthcare service provision, particularly services provided by general practices, had significant impact on residents with dementia. Participants described a lack of face-to-face contact with healthcare professionals, and medication reviews often ceased to take place. The connection and communication between key stakeholders were perceived to be important when optimising medicines for residents with dementia. CONCLUSIONS This study has highlighted the challenges and initial impact of the COVID-19 pandemic on medicines optimisation for care home residents with dementia, which was characterised by isolation. Further research is needed to determine the extent of the long-term impact of the COVID-19 pandemic on this resident population. In future public health crises, better communication is needed between healthcare professionals and care homes.
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Affiliation(s)
- Nawaf Alsulami
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Escobar Gil T, Quazi MA, Verma T, Sohail AH, Ikram HA, Nasrullah A, Gangu K, Farooq A, Sheikh AB. Outcomes of COVID-19-Associated Hospitalizations in Geriatric Patients with Dementia in the United States: A Propensity Score Matched Analysis. Geriatrics (Basel) 2024; 9:7. [PMID: 38247982 PMCID: PMC10801614 DOI: 10.3390/geriatrics9010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Previous studies have convincingly demonstrated the negative impact of dementia on overall health outcomes. In the context of the COVID-19 pandemic, there is burgeoning evidence suggesting a possible association between dementia and adverse outcomes, however the relationship has not been conclusively established. We conducted a retrospective cohort study involving 816,960 hospitalized COVID-19 patients aged 65 or older from the 2020 national inpatient sample. The cohort was bifurcated into patients with dementia (n = 180,845) and those without (n = 636,115). Multivariate regression and propensity score matched analyses (PSM) assessed in-hospital mortality and complications. We observed that COVID-19 patients with dementia had a notably higher risk of in-hospital mortality (23.1% vs. 18.6%; aOR = 1.2 [95% CI 1.1-1.2]). This elevated risk persisted even after PSM. Interestingly, dementia patients had a reduced risk of several acute in-hospital complications, including liver failure and sudden cardiac arrest. Nevertheless, they had longer hospital stays and lower total hospital charges. Our findings conclusively demonstrate that dementia patients face a heightened risk of mortality when hospitalized with COVID-19 but are less likely to experience certain complications. This complexity underscores the urgent need for individualized care strategies for this vulnerable group.
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Affiliation(s)
- Tomas Escobar Gil
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (T.E.G.); (T.V.); (H.A.I.)
| | - Mohammed A. Quazi
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM 87106, USA
| | - Tushita Verma
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (T.E.G.); (T.V.); (H.A.I.)
| | - Amir H. Sohail
- Division of Surgical Oncology, University of New Mexico, Albuquerque, NM 87106, USA;
| | - Hafiz Abdullah Ikram
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (T.E.G.); (T.V.); (H.A.I.)
| | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA;
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, TX 79409, USA;
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA; (T.E.G.); (T.V.); (H.A.I.)
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Carruba L, Armata M, Vassallo G, Saccaro C, Di Palermo C, Giannettino C, Cilona L, Capitummino R, Veronese N, Dominguez LJ, Barbagallo M. Older People Hospitalized for COVID-19: Prognostic Role of Multidimensional Prognostic Index and Other Prognostic Scores. J Clin Med 2023; 12:594. [PMID: 36675523 PMCID: PMC9865476 DOI: 10.3390/jcm12020594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
During the SARS-CoV-2 pandemic, frailty and patients’ poor outcomes seem to be closely related. However, there is no clear indication of the significance of this connection and the most adequate risk index in clinical practice. In this study, we compared a short version of MPI (multidimensional prognostic index) and other two prognostic scores for COVID-19 as potential predictors of poor patient outcomes. The patients were consecutively enrolled in the hospital of Palermo for COVID-19. The accuracy of Brief-MPI, 4C score and COVID-GRAM score in points was evaluated using the area under the curve (AUC) with 95% CI, taking mortality or sub-ICU admission as outcome. The study included 112 participants (mean age 77.6, 55.4% males). During a mean of 16 days of hospitalization, Brief-MPI significantly increased by 0.03 ± 0.14 (p = 0.04), whilst COVID-GRAM did not. Brief-MPI, 4C score and COVID-GRAM scores had good accuracy in predicting negative outcomes (AUC > 0.70 for all three scores). Brief-MPI was significantly associated with an increased mortality/ICU admission risk, indicating the importance of multidimensional impairment in clinical decision-making with an accuracy similar to other prognostic scores commonly used in COVID-19 study, providing information regarding domains for which interventions can be proposed.
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Affiliation(s)
- Luca Carruba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Maria Armata
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Giusy Vassallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Carlo Saccaro
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Carla Di Palermo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Chiara Giannettino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Laura Cilona
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Rossella Capitummino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Ligia J. Dominguez
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
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Zhang L, Jiang L, Tian T, Li W, Pan Y, Wang Y. Efficacy and Safety of COVID-19 Vaccination in Older Adults: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 11:vaccines11010033. [PMID: 36679878 PMCID: PMC9862835 DOI: 10.3390/vaccines11010033] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objective: To analyze the differences in efficacy and safety of different types of novel coronavirus pneumonia (COVID-19) vaccines in different age groups (young adults and elderly). Methods: Randomized controlled trials (RCTs) on COVID-19 vaccine in PubMed, Embase, Web of Science, and Cochrane library were searched by computer, and eight eligible studies were analyzed. Meta-analysis was performed using Stata 16.0 and RevMan5.4 software. Results: The mean geometric titer (GMT) of the virus in the elderly was significantly higher than that in the placebo group (SMD = 0.91, 95% CI (0.68, 1.15), p < 0.01), presenting no obvious difference compared with the young adults (SMD = 0.19, 95% CI (0.38, 0.01), p = 0.06). Meanwhile, the effect of multiple vaccinations was better than that of single vaccination (SMD = 0.83, 95% CI (0.33, 1.34), p < 0.01). However, the number of adverse events (AEs) in the elderly was lower than that in the young adults (OR = 0.35, 95% CI (0.29, 0.42), p < 0.01). Conclusions: The immunization effect of COVID-19 vaccine in the elderly is obvious, especially after multiple vaccinations, and the incidence of AEs in the elderly is low, which proves that the vaccination of the elderly is safe and effective.
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Affiliation(s)
- Lei Zhang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Lihong Jiang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin 150086, China
| | - Wenjing Li
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yonghui Pan
- Fourth Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
- Correspondence: (Y.P.); (Y.W.)
| | - Yongchen Wang
- Department of General Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
- Correspondence: (Y.P.); (Y.W.)
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Geen O, Gui S, Andreychuk S, DeBono T, Yousuf H. Restraint Practices in Incapable Wandering Patients During COVID-19: Ethics and Best Practice Recommendations. Can Geriatr J 2022; 25:324-327. [PMID: 36505913 PMCID: PMC9684025 DOI: 10.5770/cgj.25.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Patients who wander as one of their psychological and behavioural symptoms of dementia are often unable to follow or recall Infection Prevention and Control precautions, putting them at risk of contracting or spreading COVID-19. Physical and chemical restraints have been used to limit the risk of transmission to wandering patients and their care providers, but restraints are not the standard of care for wandering behaviour in non-pandemic scenarios. Although provincial policies on restraint use are available, their guidance may not provide the context-dependent information necessary for individual patient decisions. To address this knowledge gap, we reviewed the medical, ethical, and legal considerations through an interdisciplinary approach including nurses, physicians, ethicists, hospital leadership, risk management, and legal counsel. We present an ethical framework that front-line health-care workers can use to create a balanced patient-centred care plan for incapable wandering patients who are at risk of contracting or spreading COVID-19.
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Affiliation(s)
- Olivia Geen
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, ON
| | - Shannon Gui
- Department of Medicine, McMaster University, Hamilton, ON
| | | | - Tony DeBono
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON,The Royal Mental Health Centre Ottawa, ON
| | - Haroon Yousuf
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, ON
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8
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Li Z, Liu S, Li F, Li Y, Li Y, Peng P, Li S, He L, Liu T. Efficacy, immunogenicity and safety of COVID-19 vaccines in older adults: a systematic review and meta-analysis. Front Immunol 2022; 13:965971. [PMID: 36177017 PMCID: PMC9513208 DOI: 10.3389/fimmu.2022.965971] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/24/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundOlder adults are more susceptible to severe health outcomes for coronavirus disease 2019 (COVID-19). Universal vaccination has become a trend, but there are still doubts and research gaps regarding the COVID-19 vaccination in the elderly. This study aimed to investigate the efficacy, immunogenicity, and safety of COVID-19 vaccines in older people aged ≥ 55 years and their influencing factors.MethodsRandomized controlled trials from inception to April 9, 2022, were systematically searched in PubMed, EMBASE, the Cochrane Library, and Web of Science. We estimated summary relative risk (RR), rates, or standardized mean difference (SMD) with 95% confidence interval (CI) using random-effects meta-analysis. This study was registered with PROSPERO (CRD42022314456).ResultsOf the 32 eligible studies, 9, 21, and 25 were analyzed for efficacy, immunogenicity, and safety, respectively. In older adults, vaccination was efficacious against COVID-19 (79.49%, 95% CI: 60.55−89.34), with excellent seroconversion rate (92.64%, 95% CI: 86.77−96.91) and geometric mean titer (GMT) (SMD 3.56, 95% CI: 2.80−4.31) of neutralizing antibodies, and provided a significant protection rate against severe disease (87.01%, 50.80−96.57). Subgroup and meta-regression analyses consistently found vaccine types and the number of doses to be primary influencing factors for efficacy and immunogenicity. Specifically, mRNA vaccines showed the best efficacy (90.72%, 95% CI: 86.82−93.46), consistent with its highest seroconversion rate (98.52%, 95% CI: 93.45−99.98) and GMT (SMD 6.20, 95% CI: 2.02−10.39). Compared to the control groups, vaccination significantly increased the incidence of total adverse events (AEs) (RR 1.59, 95% CI: 1.38−1.83), including most local and systemic AEs, such as pain, fever, chill, etc. For inactivated and DNA vaccines, the incidence of any AEs was similar between vaccination and control groups (p > 0.1), while mRNA vaccines had the highest risk of most AEs (RR range from 1.74 to 7.22).ConclusionCOVID-19 vaccines showed acceptable efficacy, immunogenicity and safety in older people, especially providing a high protection rate against severe disease. The mRNA vaccine was the most efficacious, but it is worth surveillance for some AEs it caused. Increased booster coverage in older adults is warranted, and additional studies are urgently required for longer follow-up periods and variant strains.
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Affiliation(s)
- Zejun Li
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shouhuan Liu
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fengming Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yifeng Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Yilin Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Pu Peng
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sai Li
- College of Pediatrics, Chongqing Medical University, Chongqing, China
| | - Li He
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Tieqiao Liu, ; Li He,
| | - Tieqiao Liu
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Tieqiao Liu, ; Li He,
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9
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Barisch-Fritz B, Bezold J, Scharpf A, Trautwein S, Krell-Roesch J, Woll A. ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App. Front Physiol 2022; 13:921105. [PMID: 35874545 PMCID: PMC9304760 DOI: 10.3389/fphys.2022.921105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/27/2022] [Indexed: 01/10/2023] Open
Abstract
Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.
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Affiliation(s)
- Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Vernuccio L, Sarà D, Inzerillo F, Catanese G, Catania A, Vesco M, Cacioppo F, Dominguez LJ, Veronese N, Barbagallo M. Effect of COVID-19 quarantine on cognitive, functional and neuropsychiatric symptoms in patients with mild cognitive impairment and dementia. Aging Clin Exp Res 2022; 34:1187-1194. [PMID: 35325450 PMCID: PMC8943360 DOI: 10.1007/s40520-022-02113-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND During the last two years, COVID-19 affected older people with dementia or mild cognitive impairment (MCI), but conflicting and sparse results are still present. The objective of this study was to investigate the frequency and type of changes in functional, cognitive and behavioral and psychological symptoms of dementia (BPSD), and caregiver's stress during the period of quarantine in 2020 in patients affected by dementia/MCI living in Palermo, Sicily. METHODS Outpatients affected by MCI/dementia were evaluated before and after COVID-19 quarantine. Functional status was investigated using basic and instrumental activities of daily living (ADL); cognitive performance with the mini-mental state examination; BPSD through the neuropsychiatric inventory (NPI). All scales were reported as pre/post-COVID-19 quarantine and a logistic regression analysis was performed for investigating the factors associated with worsening in NPI in patients and their caregivers. RESULTS One hundred patients (mean age 77.1; females = 59%) were evaluated over a median of 10 months. In the sample as whole, a significant decline in functional and cognitive status was observed (p < 0.001 for both comparisons). The NPI significantly increased by 3.56 ± 8.96 points after the COVID-19 quarantine (p < 0.0001), while the caregivers' stress increased by 1.39 ± 3.46 points between the two evaluations (p < 0.0001). The decline was more evident in people with milder dementia. Higher values of instrumental ADL at baseline were associated with a significant lower worsening in NPI and caregiver's stress. CONCLUSIONS COVID-19 quarantine negatively affected functional, cognitive, and neuropsychiatric symptoms in older people affected by dementia/MCI, highlighting the impact of COVID-19 quarantine for this population.
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Affiliation(s)
- Laura Vernuccio
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Davide Sarà
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 127, 90127, Palermo, Italy
| | - Florenza Inzerillo
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Giuseppina Catanese
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Angela Catania
- Geriatric Unit, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Miriam Vesco
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 127, 90127, Palermo, Italy
| | - Federica Cacioppo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 127, 90127, Palermo, Italy
| | - Ligia J Dominguez
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 127, 90127, Palermo, Italy
- School of Medicine, "Kore" University of Enna, Enna, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 127, 90127, Palermo, Italy.
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 127, 90127, Palermo, Italy
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Veronese N, Saccaro C, Demurtas J, Smith L, Dominguez LJ, Maggi S, Barbagallo M. Prevalence of unwillingness and uncertainty to vaccinate against COVID-19 in older people: A systematic review and meta-analysis. Ageing Res Rev 2021; 72:101489. [PMID: 34662744 PMCID: PMC8516660 DOI: 10.1016/j.arr.2021.101489] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 02/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) has been shown to have more severe health outcomes in older people specifically in relation to mortality and disability. Vaccination seems to be efficacious and safe for preventing the negative consequences of COVID-19, but vaccine hesitancy seems to be high in older adults. We therefore aimed to investigate the prevalence of unwillingness and the uncertainty to vaccinate against COVID-19 in older people and the factors that can be associated with the unwillingness to vaccinate. For this work, we searched several databases until 18th June 2021 for studies reporting the prevalence of unwillingness and the uncertainty to vaccinate against COVID-19 in people aged >60 years. A meta-analysis of the prevalence, with the correspondent 95% confidence intervals (CIs), was proposed. Factors that can be associated with the unwillingness to vaccinate against COVID-19 were explored through multivariable analyses and reported as odds ratios (ORs). Among 662 papers initially screened, we included 15 studies for a total of 9753 older adults. The prevalence of unwillingness to vaccinate against COVID-19 in older people was 27.03% (95%CI: 15.10-38.95%), whilst the correspondent figure of uncertainty was 19.33% (95%CI: 12.28-26.39). The risk of being unvaccinated was significantly higher in Hispanics (OR=1.197; 95%CI: 1.010-1.418) and in case of low education (OR=1.678; 95%CI: 1.170-2.408) and low income (OR=1.287; 95%CI: 1.127-1.469). In conclusion, the hesitancy for COVID-19 vaccination is a relevant problem in older people, particularly in those with a low income, a low level of education, and in Hispanics living in the United States.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy; College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Carlo Saccaro
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, Università di Modena e Reggio Emilia, Modena - Azienda USL Sud Est Toscana, Grosseto, Italy
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | | | - Stefania Maggi
- Aging Branch, Neuroscience Institute, National Research Council, Padua, Italy
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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