Dementia grief reconceptualized: Systemic review of psychotherapeutic approaches for BPSD and NPS during COVID‐19

Abstract

BackgroundThe biopsychosocial effects of COVID‐19 experienced by people ages 65 and greater are unprecedented. The gravity of losses will not be realized for decades. Physical, personal, economic and social constraints remain in place, generating feelings of stress and anger. Even graver of a situation is a subset of this population ‐ people who have been diagnosed with dementia and those who are more vulnerable to stress effects on the aging brain ‐ where mental health ramifications of stress are magnified. Traumatic experiences hold the possibility of reactivating previous losses that have not been fully integrated into the gut‐brain axis. At the same time, traumatic events present possibilities in releasing emancipating power when losses are modulated by access to grief‐based psychotherapies. With access to psychotherapy remaining severely limited for the most vulnerable among us, the vastness of mental health disparities remains undocumented.MethodsCritically review psychological intervention studies investigating the biopsychosocial effects of COVID‐19 among people with dementia and assess the evidence for incorporation of grief‐based psychotherapy and presence of strengths‐based language. A systematic review of Web of Science databases was carried out by using keywords dementia and COVID‐19, employing Boolean operating word AND, with search results limited to 2020‐2021.ResultsFrom a total of 229 initial search results, 156 did not meet study criteria and were omitted. Of the 73 studies that met criteria, six thematic therapeutic approaches emerged: neuroscience, management of BPSD, pharmacological, lifestyle, social work, and technological interventions. Secondarily, studies were assigned to one of three categories on viewing COVID‐19 as an event that is: limiting or constraining, growth opportunity, or something else.ConclusionCurrent evidence suggests that the biopsychosocial effects of COVID‐19 and dementia present a complex, dynamic and evolving relationship. Prolonged and sustained exposure to stress and trauma develops a deepening cognitive divide, where people transition from mild cognitive impairment to meeting diagnostic criteria of dementia. These times demand increasing access to grief‐informed psychological services, such as Active Capabilities Therapy, in an attempt to diminish the gut‐brain axis harms of BPSD and NPS as experienced by the individual.