International Perspectives on the Possible Impact of the COVID-19 Pandemic and Lockdown on Abuse of the Elderly (JGCR / American Journal of Geriatric Psychiatry / JAGS)


A selection of recent articles presents a surprising consensus on the issues in question, across disparate international regions. First, an article written from the context of India:

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Rina, K. Maiti, T. Panigrahi, M. Patro, B. Kar, N. [and] Padhy, SK. (2020). Impact of COVID-19 pandemic and lockdown on elder abuse. Journal of Geriatric Care and Research (JGCR). August 23rd 2020, Vol.7(3): pp.103-107.

A further article, originating from the USA:

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Makaroun, LK. Bachrach, RL. [and] Rosland, AM. (2020). Elder abuse in the time of COVID-19 – increased risks for older adults and their caregivers. American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry. August 2020, Vol.28(8), pp.876–880.

A letter suggests:

“Caregivers of older adults with dementia or other medical conditions are under particular strain given their responsibilities and should be offered additional means of support and guidance”.

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Han, SD. [and] Mosqueda, L. (2020). Elder abuse in the COVID-19 era. Journal of the American Geriatrics Society. July 2020, Vol.68(7), pp.1386–1387.

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Updates Relating to the Lancet Commission on Dementia Prevention, Intervention, and Care (Lancet / Alzheimer’s Research and Therapy / Alzheimer’s and Dementia)


The Lancet Commission on Dementia Prevention, Intervention, and Care has updated evidence on modifiable risk factors the prevention of dementia, and the “life-course model of dementia prevention”. There were nine modifiable risk factors for reducing the risk of dementia originally; this model has subsequently been extended with an updated 12 risk factor life-course model of dementia prevention.

The potential for dementia prevention may be higher in low-income and middle-income countries (LMIC) where dementia is more prevalent.

Information on multimorbidity, hospital admissions, pharmacological, non- pharmacological, psychological, and social interventions has been updated, with a new section on dementia and COVID-19.

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Livingston, G. Huntley, J. [and] Sommerlad, A. [et al]. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. July 29th 2020; [Epub ahead of print].

“ …up to 35% of dementia cases could be prevented by modifying nine risk factors [around 40% for the 12 risk factors]: low education, midlife hearing loss, obesity, hypertension, late-life depression, smoking, physical inactivity, diabetes, and social isolation”.

Some commentators suggest the strength of the evidence in favour of interventions to promote this good advice may be more modest than expected.

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Montero-Odasso, M. Ismail, Z. [and] Livingston, G. (2020). One third of dementia cases can be prevented within the next 25 years by tackling risk factors. The case “for” and “against”. Alzheimer’s Research and Therapy. July 8th 2020, Vol.12(1), 81.

Possibly also of interest:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).


Kivipelto, M. Mangialasche, F. [and] Snyder, HM. [et al]. (2020). World-Wide FINGERS Network: a global approach to risk reduction and prevention of dementia. Alzheimer’s and Dementia: the journal of the Alzheimer’s Association. July 2020; Vol.16(7): pp.1078-1094.

Regarding Risk Factors Reduction for Alzheimer’s Disease

“Distribution of modifiable factors with Class I recommendation throughout the course of life… Class I suggestions: risk factors include 10 factors with Level A evidence (cognitive activity, hyperhomocysteinaemia, increased BMI in late life, depression, stress, diabetes, head trauma, hypertension in midlife, orthostatic hypotension and education) and 9 factors (obesity in midlife, weight loss in late life, physical exercise, smoking, sleep, CVD, frailty, atrial fibrillation and vitamin C) with Level B evidence”.

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Yu, JT. Xu, W. [and] Tan, CC. [et al]. (2020). Evidence-based prevention of Alzheimer’s disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. Journal of Neurology, Neurosurgery, and Psychiatry. July 20th 2020 [Epub ahead of print].

Healthy Ageing 2020: International Online Conference

Possibly also of interest, a literature review prepared for, and presented at, the “Healthy Ageing 2020” International Conference, organised by GeriCaRe (Geriatric Care and Research Organisation) on August 8th 2020.

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Jolley, D. (2020). Approaches to reduce the incidence of cognitive decline and dementia. Journal of Geriatric Care and Research (JGCR). August 22nd 2020, Vol.7(3): pp.108-112.

A related conference summary:

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Kar, T. (2020). Healthy Ageing 2020: international conference. Journal of Geriatric Care and Research (JGCR). December 3rd 2020, Vol.7(3): p.147.

Prevention of Cardiovascular Disease (CVD): the CVDPREVENT National Primary Care Audit

The idea behind CVDPREVENT is to extract data from primary care, to better understand how many patients with the high-risk conditions – hypertension (high blood pressure), high cholesterol and atrial fibrillation (AF) – are undiagnosed, under-treated or over-treated.

The CVDPREVENT Implementation Steering Group comprises representatives from RCGP, NHS Digital, NICE, Public Health England, NHS England and NHS Improvement, British Heart Foundation, Royal Pharmaceutical Society, Primary Care Cardiovascular Society and GPs.

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CVDPREVENT. London: NHS England, August 2020.

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A Brief Review of How the COVID-19 Pandemic Relates to Elderly Care and Research (JGCR)


A brief literature review examines publications relating to the elderly population arising from the COVID-19 pandemic. Themes, and possible areas for further research, are identified.

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Tripathy, S. (2020). The COVID-19 pandemic and the elderly patient: review of current literature and knowledgebase. Journal of Geriatric Care and Research (JGCR). June 24th 2020, Vol.7(2): pp.79-83.

Likely Background Interest

A brief summary of state-of-the-art clinical understanding regarding COVID-19, across all age groups, from a University of Birmingham medical student:

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Kar, S. (2020). COVID-19: A brief clinical overview. Journal of Geriatric Care and Research (JGCR). June 20th 2020, Vol.7(2): pp.74-78.

International Variations in COVID-19 Mortality Rates

An international study of COVID-19 epidemiology:

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Nischal, A. Prakash, AJ. Singh, N. [and] Kar, SK. (2020). Understanding the variations in death rates during coronavirus pandemic and their preventive implications. Journal of Geriatric Care and Research (JGCR). July 15th 2020, Vol.7(2): pp.84-88.

Risks of Potential Ageism in Medical Resource Allocation

An international consideration of the potentially inherent ethical dilemmas involved in the use of patient age as a criterion for COVID-19 treatment decisions:

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Karahda, A. Sethi, S. [and] Prasad, SK. (2020). Effect of healthcare burden and resource reallocation on elderly during COVID-19 pandemic. Journal of Geriatric Care and Research (JGCR). July 21st 2020, Vol.7(2): pp.89-92.

Coping With COVID-19 in a Resource-Constrained Country

Insights from Nepal, into the impact of the COVID-19 pandemic upon the physical, mental and social wellbeing of the elderly population.

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Shrestha, L. (2020). COVID-19 and elderly in Nepal: current situation. Journal of Geriatric Care and Research (JGCR). July 27th 2020, Vol.7(2): pp.96-99.

A related editorial:

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Kar, N. [and] Kar, B. (2020). Growing social stigma alongside COVID-19 pandemic: signs of a major concern. Journal of Geriatric Care and Research (JGCR). October 1st 2020, Vol.7(2): pp.49-50.

An Examination of the Possble Ambivalent Relationships Between Religion and Behaviour Amidst the COVID-19 Pandemic

Concerning the often co-existing positive and negative role(s) of religion; a “double-edged sword”?

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Kar, SK. Shukla, S. Menon, V. [and] Arafat, SMY. (2020). Religion and behaviour: relevance during the current COVID-19 pandemic. Journal of Geriatric Care and Research (JGCR). December 7th 2020, Vol.7(3): pp.140-142.

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Timeless Good Advice? (Action for Happiness)


The secret to happiness, for challenging times? Simple and evidence-based.

“Action for Happiness helps people take action for a happier and kinder world”.

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Meaningful May. [Online]: Action for Happiness, May 1st 2021.

Aphorisms For Informal Reflection

Some “sayings of the day”, circulated among NHS staff:

April 1st 2020:

“It costs nothing to be kind”.

April 2nd 2020:

“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference”. (Reinhold Niebuhr)

April 3rd 2020:

“No act of kindness, no matter how small, is ever wasted”. (Aesop)

April 4th 2020:

“It’s nice to be important, but it’s more important to be nice”.

April 5th 2020:

“If you see someone without a smile, give them one of yours”.

April 6th 2020:

“Kind Hands, Kind Words, Kind Heart”.

April 7th 2020:

“Fear is a reaction. Courage is a decision”. (Winston Churchill)

April 8th 2020:

“Manners cost nothing but are priceless”.

April 9th 2020:

“Treat everyone how you wish to be treated”.

April 10th 2020:

“Also highly contagious is:
Kindness, Patience, Love, Enthusiasm and a Positive Attitude.
Don’t wait to catch it: BE THE CARRIER”.

April 11th 2020:

“When it rains look for rainbows, when it’s dark look for stars”. (Oscar Wilde)

April 12th 2020:

“A helping hand is just at the end of your sleeve”.

April 13th 2020:

“Be kind whenever possible. It is always possible”. (14th Dalai Lama)

April 14th 2020:

“A smile is a smile in any language”.

April 15th 2020:

“There is no emergency in a pandemic… Do not go in without your PPE”. (Aaron Mishler)

April 16th 2020:

“Tough times do not last, tough people do”.

April 17th 2020:

“You’re braver than you believe, and stronger than you seem, and smarter than you think”.

April 18th 2020:

“Smile and walk forward”.

April 19th 2020:

“Not every day is good, but there is good in everyday”.

April 20th 2020:

“You’re never fully dressed without your smile”.

April 21st 2020:

“Be somebody who makes everybody feel like a somebody!”.

April 22nd 2020:

“Don’t see a problem; see an opportunity for a solution and quality improvement”.

April 23rd 2020:

“After all of this is over, all that will matter is how we treated each other”.

April 24th 2020:

“Never doubt that a small group of thoughtful, committed people can change the world, indeed it is the only thing that ever has”.  (Margaret Mead)

April 25th 2020:

“Remember, today is the tomorrow you worried about yesterday”.

April 26th 2020:

“The NHS will last as long as there are folk left with faith to fight for it”. (Aneurin Bevan)

April 27th 2020:

“Take a step back if it all gets a little too much”.

April 28th 2020:

“Life is like riding a bike. To keep your balance you must keep moving”. (Albert Einstein)

April 29th 2020:

“Out of darkness cometh light”.

April 30th 2020:

“The sun will shine on you again and the clouds will soon disappear!”. (Captain Tom Moore)

May 1st 2020:

“Be the change that you wish to see in the world”. (Mahatma Gandhi)

May 2nd 2020:

“Worry often gives small things a big shadow”.

May 3rd 2020:

“Sunshine always follows the rain”.

May 4th 2020:

“Try to be a rainbow in someone else’s cloud”. (Maya Angelou)

May 5th 2020:

“Kindness is a gift everyone can afford to give, it starts with a kind thought, then a smile and then never ending, it is contagious”.

May 6th 2020:

“It doesn’t take much to be kind and caring to each other”.

May 7th 2020:

“Kind words are short and easy to speak; but their echoes are truly endless”.  (Mother Teresa)

May 8th 2020:

“Difficult roads often lead to beautiful destinations”.

May 9th 2020:

“If you can’t find the sunshine, be the sunshine”.

May 10th 2020:

“A single act of kindness throws out roots in all directions and the roots spring up and make new trees”. (Amelia Earhart)

May 11th 2020:

“A smile is a curve that can set things straight”.

May 12th 2020:

“Yesterday’s the past, tomorrow’s the future, but today is a gift – that’s why it is called the present”.

May 13th 2020:

“Remember there’s no such thing as a small act of kindness. Every act creates a ripple with no logical end”. (Scott Adams)

May 14th 2020:

“Making one person smile can change the world – maybe not the whole world but their world”.

May 15th 2020:

“Love and kindness are never wasted. They always make a difference. They bless the one who receives them, and they bless you, the giver”. (Barbara De Angelis)

May 16th 2020:

“Remember to take care of yourself, you can’t pour from an empty cup”.

May 17th 2020:

“Look after each other with affection”.

May 18th 2020:

“Be strong, be fearless, be beautiful. And believe that anything is possible when you have the right people there to support you”. (Misty Copeland)

May 19th 2020:

“A smile costs nothing but gives much”.

May 20th 2020:

“Look for something positive in each day, even if some days you have to look a little harder”.

May 21st 2020:

“We may not be able to alter the journey, but we can make sure no one walks it alone”. (Jeffrey R. Holland)

May 22nd 2020:

“Laughter is timeless, imagination has no age and dreams are forever”. (Walt Disney)

May 23rd 2020:

“We make a living by what we get, but we make a life by what we give”. (Often attributed to Winston Churchill)

May 24th 2020:

“One of the most important things you can do on this earth is to let people know they are not alone”. (Shannon L. Alder)

May 25th 2020:

“I was taught that the way of progress was neither swift nor easy”. (Marie Curie)

May 26th 2020:

“Life isn’t about waiting for the storm to pass… it’s about learning how to dance in the rain”. (Vivian Greene)

May 27th 2020:

“Sometimes we just all need to go outside and take a deep breath. If anyone asks, just say you are outstanding”.

May 28th 2020:

“Keep your eyes on the stars, and your feet on the ground”. (Theodore Roosevelt)

May 29th 2020:

“We should always have three friends in our lives-one who walks ahead who we look up to and follow; one who walks beside us, who is with us every step of our journey; and then, one who we reach back for and bring along after we’ve cleared the way”. (Michelle Obama)

Posted in Charitable Bodies, Depression, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Management of Condition, Mental Health, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Practical Advice, Quick Insights, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

The Diversionary Value of Music Playlists for Patients With Dementia in Accident and Emergency Settings ( / BBC News)


A recent small-scale trial based at NHS Fife indicates that music playlists used on A&E wards can have a calming effect for most elderly dementia patients, offering potential to reduce agitation and distress without resort to medication.

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Study shows music has a calming influence on elderly dementia patients. [Online]:, September 25th 2019.

See also:

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Music has calming effect on hospital dementia patients. Scotland: Edinburgh: BBC News (Edinburgh, Fife and East Scotland), September 24th 2019.

“The results of the study were welcomed by dementia charity Playlist For Life”.

Early Origins?

The likely early origins of this research (which remains unreported seemingly in the peer-reviewed literature):

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Skinner, H. (2018). An exploration of individualized music on levels of agitation in people with dementia in a specialist mental health setting: a mixed method approach. (Doctoral dissertation). Dundee: University of Abertay, 2018.

Further details, supplied by Matt Farrah (Co-Founder of [direct quotation]:

“How Music Helps Dementia Patients Deal With Distress

NHS Fife conducted an eight-week project. They loaded an MP3 player with songs from a variety of genres. The played them to patients displaying stress and agitation. Researchers used the music as a diversion technique. They discovered that it significantly reduced the levels of anxiety and 96 % of the patients involved in the study appeared less stressed during clinical procedures. Now the method has been introduced in post-theatre recovery and wards with elderly patients. One dementia nurse consultant based in Scotland observed that patients are often distressed when they come to A&E. However, they first try to deal with such distress using non-pharmacological means. Fortunately, music has aided many patients with dementia deal with their distress. They now consider the use of music as a necessity, not a nicety. Furthermore, many health experts see music as part of a broader approach to helping patients and their carers deal with dementia.

The study is based on trials involving 28 patients. It featured assessments on nine key behaviours including eye contact, vocalisations, touch, movements to music, laughter and smiling. It concluded that music supplements scientific treatment by distracting the patient’s attention away from stressful procedures, which decreases anxiety. Sarah Metcalfe, chief executive of Playlist for Life, was pleased with the promising results produced by the NHS Fife project.

She hopes other NHS Trusts adopt the approach. It can help them enhance the level of care they provide to patients with dementia as well as support family members and carers. Royal College of Psychiatrists in Scotland Chairman Adam Daly said they support any evidence-based research that can help people with dementia deal with distress, especially if medication can be avoided. The interventions can take many novel forms, but the use of music is an exciting development. It’s great to see how music is used to benefit people with dementia, especially within the hospital”.

Posted in Acute Hospitals, BBC News, Charitable Bodies, Commissioning, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, Management of Condition, Models of Dementia Care, National, NHS, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, Scotland, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

More on the Possible Role of Neuroinflammation in Frontotemporal Dementia (Bazian / Brain)


Inflammation in the brain has been found to be present alongside (“co-localised” with) protein clusters in patients with frontotemporal dementia, suggesting that neuroinflammation may be involved as a potential cause of frontotemporal dementia.

“The researchers found that both the C-PK-11195 marker for inflammation, and F-AV-1451 marker for protein clusters, were more common in the front (frontal) and sides (temporal) of the brain in people with frontotemporal dementia than the healthy comparison group”.

The following NHS Digital Behind the Headlines critical appraisal interprets this research impartially.

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Brain inflammation linked to uncommon type of ‘early-onset’ dementia. London: NHS Digital; Behind the Headlines, March 18th 2020.

This relates to:

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Bevan-Jones, WR. Cope, TE. [and] Jones, PS. [et al] (2020). Neuroinflammation and protein aggregation co-localize across the frontotemporal dementia spectrum. Brain. March 17th 2020. [Epub ahead of print].

Posted in For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, International, NHS Digital (Previously NHS Choices), Quick Insights, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

COVID-19 Infection: Coronavirus in the UK (DHSC / PHE / BBC News / SCIE / NHS England / JGCR)


Latest guidance for the general public.

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New guidance for households with possible COVID-19 infection. [Online]: Department of Health and Social Care [and] Public Health England, March 17th 2020.

In less than three months the impact of COVID-19 appears to have changed the history of civilisation (briefly at least).

Local Coronavirus Tracking

A quick online checker indicating the spread of this infection locally, from BBC News:

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Coronavirus in UK: How many confirmed cases are there in your area? London: BBC Health News, March 19th 2020.

WHO COVID-19 International Tracking Dashboard

The World Health Organisation has created the WHO Tracking Dashboard showing the numbers of confirmed cases, and fatalities, in countries affected by COVID-19.

Social Distancing

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Social distancing may be needed for ‘most of year’. London: BBC Health News, March 20th 2020.

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Coronavirus: Six months before UK ‘returns to normal’ – deputy chief medical officer. London: BBC Health News, March 29th 2020.

SCIE: Advice for Social Care

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Coronavirus (COVID-19) guidance for social care. [Online]: Social Care Institute for Excellence (SCIE), March 2020.

There is a SCIE COVID-19 Hub offering Coronavirus (COVID-19) advice for social care.

Patient Information on the Coronavirus Pandemic: Basic Advice For the Public in Other Languages

Doctors of the World has made available patient information on Coronavirus (COVID-19) offering basic advice, based on NHS guidance, in 34 languages; produced in partnership with the British Red Cross, Migrant Help and Clear Voice.

NHS England’s Guidance for Clinicians and NHS Managers

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Coronavirus guidance for clinicians and NHS managers. [Online]: NHS England, March 26th 2020.

Mental Wellbeing: Apps For NHS Staff

NHS staff have free access to wellbeing apps (until the end of December 2020), to support their mental health and wellbeing. These include:

  1. Unmind: a mental health platform for staff, to improve their mental wellbeing.
  2. Headspace: a science-based app for mindfulness and meditation,
  3. Sleepio: an evidence-based sleep improvement programme, using cognitive behavioural techniques to improve poor sleep.
  4. Daylight: a smartphone-based app which helps staff experiencing worry and anxiety.

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Free access to wellbeing apps for all NHS staff. [Online]: NHS Employers, March 26th 2020.

Statistical Uncertainties

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Roberts, M. (2020). Coronavirus: Why the UK death count is an inexact science. London: BBC Health News, March 31st 2020.

Online Questionnaire Feeds NHS Datasets to Inform Decision Makers

NHS England, NHSX and NHS Digital have developed the Coronavirus Status Checker.

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NHS COVID-19 symptom checker launched to help build up additional data. [Online]: HTN: Health Tech Newspaper, April 4th 2020.

The Potential Mental Health Impact of COVID-19-Associated Social Isolation

Self-isolation and social distancing reduce the risks of infection transmission, but the potential side-effects for mental wellbeing, perhaps particularly among the elderly, should not be overlooked.

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Psychological impact of the response to coronavirus Covid-19 on older people. Leicester: British Psychological Society; Faculty of the Psychology of Older People (FPOP), March 2020.

Further developments in BPS/FPOP advice:

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Supporting older people and people living with dementia during self-isolation. A compassionate response to COVID-19. Leicester: British Psychological Society; Faculty of the Psychology of Older People (FPOP), April 2020.

Practical considerations of a general nature from a GP’s perspective:

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Rout, N. (2020). Risks to the elderly during the coronavirus (COVID-19) pandemic 2019-2020. Journal of Geriatric Care and Research (JGCR). May 2020, Vol.7(1): pp.27-28.

A related article, with an international perspective:

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Girdhar, R. Srivastava, V. [and] Sethi, S. (2020). Managing mental health issues among elderly during Covid-19 pandemic. Journal of Geriatric Care and Research (JGCR). May 2020, Vol.7(1): pp.32-35.

A related JGCR editorial:

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Kar N. (2020). COVID-19 and older adults: in the face of a global disaster. Journal of Geriatric Care and Research (JGCR). May 2020, Vol.7(1): 1-2.

A subsequent article reviews “the multifaceted challenges… concerning the elderly population since the emergence of the pandemic”:

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Mishra, S. Bhoi, R. [and] Ravan, JPR. [et al]. (2020). COVID-19 pandemic and care of elderly: measures and challenges. Journal of Geriatric Care and Research (JGCR). December 26th 2020, Vol.7(3): pp.143-146.

NHS Volunteer Responders

The NHS Volunteer Responders scheme opens for self-referrals.

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Vulnerable people get direct line to NHS volunteer army. [Online]: NHS England, April 23rd 2020.

Palliative Care Advice in Secondary Care

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Clinical guide for the management of palliative care in secondary care during the coronavirus pandemic, Version 2. Keeping the care in healthcare. London: NHS England, April 22nd 2020.

NHS England and NHS Improvement’s weekly COVID-19 community health, hospital discharge and social care updates are available from here:

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Community health, hospital discharge and social care weekly update. [Online]: NHS England [and] NHS Improvement, April 2020.

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Interventions to Improve Resilience in People Living With Dementia (Frontiers in Medicine)


A review of the literature has identified five types of interventions designed to support resilience (coping with adversity) in people with dementia, which comprise:

  1. Dementia Advisors.
  2. Peer Support Network Services.
  3. Visual Arts Enrichment Activities (VAEA).
  4. Memory Makers.
  5. Early-Stage and Beyond Community Activities (ESBCA).

Limitations to current understanding, and suggestions for further research, are outlined.

Full Text Link


Whelan, S. Teahan, Á. [and] Casey, D. (2020). Fostering the resilience of people with dementia: a narrative literature review. Frontiers in Medicine. February 25th 2020; Vol.7: 45.

Posted in Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, International, Management of Condition, Mental Health, Models of Dementia Care, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment