Dementia Care in Times of COVID-19: Experience at Fundació ACE in Barcelona, Spain

Abstract

Background: Fundació ACE is a non-profit organization providing care based on a holistic model to persons with cognitive disorders and their families for 25 years in Barcelona, Spain. Delivering care to this vulnerable population amidst the COVID-19 pandemic has represented a major challenge to our institution. Objective: To share our experience in adapting our model of care to the new situation to ensure continuity of care. Methods: We detail the sequence of events and the actions taken within Fundació ACE to swiftly adapt our face-to-face model of care to one based on telemedicine consultations. We characterize individuals under follow-up by the Memory Unit from 2017 to 2019 and compare the number of weekly visits in 2020 performed before and after the lockdown was imposed. Results: The total number of individuals being actively followed by Fundació ACE Memory Unit grew from 6,928 in 2017 to 8,147 in 2019. Among those newly diagnosed in 2019, most patients had mild cognitive impairment or mild dementia (42% and 25%, respectively). Weekly visits dropped by 60% following the suspension of face-to-face activity. However, by April 24 we were able to perform 78% of the visits we averaged in the weeks before confinement began. Discussion: We have shown that Fundació ACE model of care has been able to successfully adapt to a health and social critical situation as COVID-19 pandemic. Overall, we were able to guarantee the continuity of care while preserving the safety of patients, families, and professionals. We also seized the opportunity to improve our model of care.

Changing trends in psychiatric emergency service admissions during the COVID-19 outbreak: Report from a worldwide epicentre

“…Also, day hospitals, social centres, and other adult day centres were closed as well as possibly home assistance of carers decreased. A report from a non-profit organization providing care to persons with cognitive disorders and their families in Barcelona, reported a significant increase in assistance to guarantee the continuity of care during the lockdown ( Benaque et al, 2020 ). Nevertheless, we found a significant increase in psychiatric emergency assistance during the COVID-19 outbreak of patients with dementia and intellectual disability.…”

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

“…The COVID-19 pandemic forced Memory Clinics worldwide to close their face-to-face consultations and non-pharmacological interventions for dementia, such as cognitive therapy, exercise and socialization, have been suddenly stopped during lockdown (Benaque et al, 2020;Brown et al, 2020). Many centers, though, took action and implemented telemedicine in order to continue assisting patients during the pandemic, both for their scheduled follow-up visits but also for urgent consultations (Benaque et al, 2020;Ousset and Vellas, 2020;Padala et al, 2020). This continued care during the pandemic has been especially important for those patients and caregivers in a more vulnerable situation.…”

COVID-19 related mortality and spread of disease in long-term care: a living systematic review of emerging evidence

“…The third study reported a total of 84 people with confirmed or suspected COVID-19 among the users of a memory unit and day care centre for people with cognitive disorders in Barcelona (Spain), with a CFR of 44.1%. 49 Evidence on outcomes in long-term care residents compared to others Seven of the included studies compared outcomes in people who contracted COVID-19 between long-term care users and others. These studies generally found that long-term care users had worse outcomes, including higher 28-day-mortality (unadjusted odds ratio for death of nursing home or residential home residents admitted to hospital compared to non-residents: 6.19, 95% CI 3.32-11.8), 23 30-day-mortality (25.3%, 95% CI 24.2-26.4%, among nursing home residents who contracted COVID-19 and were registered in a primary care database compared to 4.0%, 95% CI 3.9-4.2%, among all other people with COVID-19 in the database), 38 and overall mortality (incidence rate ratio for COVID-19 mortality comparing Ontario long-term care residents to community-living adults 70 years and older: 13.1, 95% CI 9.9-17.3), 27 as well as increased risk of complicated disease (odds ratio for deteriorating disease, admission to ICU, or death, comparing nursing home residents to non-residents over 65 years of age: 2.48, 95% CI 1.29-4.65).…”