Author: Dr. Dusan Sekulic (Serbia) champions a multidisciplinary approach that transcends medical care. Submitted: October 2023.

 

The unprecedented advent of COVID-19 has revealed glaring disparities in our healthcare system, particularly in residential long-term care homes for people living with dementia. Several facets of this crisis merit urgent attention.

  1. Mortality Rates: It’s distressing to witness the elevated mortality rates of older dementia patients in residential care compared to the general populace. When the pandemic swept Europe and North America, older dementia patients in these settings bore the brunt. In Canada, long-term care residents constituted a staggering 81% of all COVID-19 related deaths, a number that far surpasses averages in other OECD nations.
  2. Morbidity and Physical Distancing: Beyond mortality, morbidity rates escalated in these settings. Public health directives, though necessary, meant that many dementia patients were isolated. Extended periods of no visitor policies and lockdowns equated to solitary confinement for many. This isolation precipitated heightened depression, anxiety, and a reluctance to engage in self-care.
  3. Desperate Circumstances: Heartbreaking reports emerged from some of the hardest hit care homes in Canada, Spain, and Italy. With severe staffing shortages, residents experienced neglect. In Canada, military interventions found residents in deplorable conditions, some even deceased in their beds.
  4. The Stigma Challenge: The pandemic’s toll illuminated a pre-existing concern. Patients with dementia, already marginalized, faced compounded challenges during this period. Many long-term care homes, despite advancements, remain ensnared in neoliberal-driven structural limitations including for-profit care models, understaffing, and insufficient supplies.
  5. Communication Barriers: Dementia patients, especially those with advanced cognitive challenges, often struggle with verbal communication. This impediment renders them unable to advocate for their rights. Misguided societal perceptions about dementia further exacerbate this, with stereotypes relegating them to states of ‘living death’ or ‘loss of self’, facilitating their continued marginalization.
  6. The Imperative for Change: Addressing the COVID-19 ramifications on dementia care in long-term homes goes beyond a medical response. It’s a clarion call for systemic reform, from care practices to policy. As a physician, the health and well-being of these patients is paramount. Yet, the existing framework, focused primarily on safety and control, must be revamped to prioritize inclusion, creativity, justice, and respect.
  7. Engagement of the Arts: The therapeutic power of the arts in healthcare is irrefutable. In the context of dementia care, avenues like theater or storytelling can be instrumental in combating the associated stigma. Initiatives abroad, such as in the UK, have already harnessed the arts to mitigate issues like social isolation in dementia patients.
  8. Inclusion is Key: A holistic approach to addressing this crisis necessitates the active inclusion of those living with dementia. Their insights, experiences, and needs must spearhead reforms. As healthcare professionals, it’s our responsibility to facilitate this.

In conclusion, while the situation in long-term care homes during the pandemic has been grim, it offers an inflection point. It’s an opportunity to reimagine and reformulate dementia care, drawing from a multidisciplinary approach that transcends medical interventions. 

As a physician, my hope lies in witnessing a future where every person living with dementia receives not just medical care but holistic support that upholds their dignity, rights, and well-being.

Author:

 

Dr. Dusan Sekulic is a Medical Doctor specializing in anesthesia and intensive care. With a background in neuroscience research, he works as a medical writer to illuminate systemic healthcare challenges and advocate for holistic, dignified, and patient-centered care models.