This document is aimed at psychologists and other health professionals supporting adults who are or have been subject to shielding, who have additional complex needs or considerations, including adults with learning/intellectual disabilities, autism spectrum conditions, and/or those living with dementia | The British Psychological Society
The considerations may also be relevant for those living with long term health conditions and their families. People living with these conditions often live with hidden disabilities and the difficulties they face can consequently be less obvious to services and society due to Covid-19.
The guidance specifically focusses on those in the ‘high’ risk category defined by the UK government but recognises that many people not officially in the ‘high risk’ category may have been shielding and therefore may face similar challenges, especially those shielding others, or those in ‘moderate risk’ categories.
This analysis from the BMJ discusses the relation between cerebrovascular diseases and impairment of cognition, with an emphasis on a chance to prevent dementia by preventing cerebrovascular diseases | BMJ 2020; 371:m3692
Cerebrovascular diseases and dementia are two leading contributors to impairment of brain health and neurological disability in older people. The prevalence of these two neurological disorders has increased in recent years as the population has aged and grown.
Globally, an estimated 42.4 million cases of stroke occurred in 2015, and approximately 50 million cases of dementia (including Alzheimer’s disease, vascular dementia, and other dementias) occurred in 2018. Strategies for preventing and treating stroke have progressed substantially in recent years, but no effective treatment yet exists for Alzheimer’s disease.
Recent studies have shown that many vascular risk factors and unfavourable lifestyle factors are shared predictors of stroke and dementia, and incident cerebrovascular diseases may precipitate a decline in cognitive function or dementia. This suggests that some cognitive impairment and dementia might be prevented by preventing cerebrovascular diseases.
People living in group situations or with dementia are more vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older people and those with multimorbidity have higher mortality if they become infected than the general population. However, no systematic study exists of COVID-19-related outcomes in older inpatients in psychiatric units, who comprise people from these high-risk groups.
The authors aimed to describe the period prevalence, demographics, symptoms (and asymptomatic cases), management, and survival outcomes of COVID-19 in the older inpatient psychiatric population and people with young-onset dementia in five National Health Service Trusts in London, UK, from March 1 to April 30, 2020.
The study found that patients in psychiatric inpatient settings who were admitted without known SARS-CoV-2 infection had a high risk of infection with SARS-CoV-2 compared with those in the community and had a higher proportion of deaths from COVID-19 than in the community.
Implementation of the long-standing policy of parity of esteem for mental health and planning for future COVID-19 waves in psychiatric hospitals is urgent.
NICE| October 2020| NICE impact end of life care for adults
Many people are unable to access all the support they need at the end of their life.
NICE impact end of life care for adults, is a new report from NICE which highlights progress made by the health and care system in implementing NICE guidance on end of life care. This publication highlights how the quality of care can be variable depending on location, social and cultural background, and diagnosis.
Many people are unable to access support at the end of life. We need to understand and strengthen the impact of NICE guidance on people’s experience of end of life care
.Julie Pearce (chief nurse and executive director of caring services) and Dr Sarah Holmes (medical director, service transformation and innovation).
The report makes some of the following key points:
Care of people approaching the end of life
Care at the end of life should be identified in a timely way. If identification is effective and timely, this can allow people, and those important to them, to make decisions about their care.
90% of people did not have a care plan in place on arrival at their final hospital admission
People with conditions such as dementia, which are not always recognised as life-limiting, often face an additional barrier to dying in their preferred place. This is because certain care settings, for example hospices, are not always offered as an option for them.
Healthcare professionals did not always consider the communication needs of people with dementia and sometimes assumed that the person with dementia lacked capacity