Equity in Changes to Dementia Care in the Community during the First Wave of the COVID-19 Pandemic in High Income Countries: A Scoping Review

Kelly Margaret Bradbury,Meaghan Sim,Katie Aubrecht,Melissa Rothfus,Elaine Moody

doi:10.3390/soc12020030

Abstract

During COVID-19, emergency measures, such as physical distancing and program restrictions, have reduced community-based supports for PLWD and their caregivers. Consequently, reductions in dementia services and resources have contributed to existing health inequities in this population. Academic databases were searched in July 2020. Grey literature was retrieved using the CADTH Grey Matters tool. Articles from 2000 to 2020 in English and from high-income countries were included. Literature that discussed any changes to community support and services for PLWD and/or their caregivers during any infectious respiratory outbreak was included. Findings were extracted using a template adapted from the Health Equity Impact Assessment (HEIA) tool. A total of 15 articles were identified; all focused on the COVID-19 pandemic. Evidence was primarily based on expert opinion, with only three primary research studies meeting inclusion criteria. Most alterations to dementia services described switching to telehealth platforms. There was limited information on social determinants of health and how these intersected to influence the experience of service changes among different populations. More research is needed to better understand how services for PLWD can continue or be transitioned online during infectious disease outbreaks and address issues of health (in)equities for PLWD and/or their caregivers.

Highlights

The World Health Organization declared COVID-19 a global pandemic on 11 March 2020 [1]; public health emergency measures were widespread and significantly impacted health and social service delivery, access and experience
Persons living with dementia (PLWD) often need health and social supports to live in the community and there is concern that they are disproportionately affected by emergency health measures and restrictions during infectious disease outbreaks
Reasons for exclusion at the full text screening phase included: grey literature that did not report on new services or supports (n = 66), articles focused on non-dementia-specific resources and services (n = 10), articles that did not discuss PLWD or caregivers (n = 3), articles that were not written in English (n = 2) and articles that did not include PLWD residing in the community (n = 2) (Figure 1, PRISMA diagram)

Summary

Introduction

The World Health Organization declared COVID-19 a global pandemic on 11 March 2020 [1]; public health emergency measures were widespread and significantly impacted health and social service delivery, access and experience. Physical distancing involves sheltering in place where possible, limiting contact and maintaining a distance from other people who do not live in your household, as well as staying home if you are diagnosed with, or are suspected of having, COVID-19 [2] The effects of these measures had a negative impact on people who were identified as being at greater risk for severe outcomes related to COVID-19, such as older adults and those with pre-existing health conditions [3]. During COVID-19, public health emergency measures that required PLWD to remain at home exacerbated loneliness and anxiety [4] This was further intensified by service changes, such as reductions in home care, lack of social outings and, for many people, inability to access digital and communications technologies, such as smartphones or tablets, to connect with loved ones [4,5,6]

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