Covid causing increased AMS in dementia patients

[NewRN'16, ADN, RN]

Not an article, or peer studied review. Just my take after 8-9 months of battling this virus in a nursing home. 

It is a well known fact that Covid 19 is causing confusion/ams even in non dementia patients. The problem is worse in dementia patients, because patients become so confused/agitated, they may refuse to eat /take meds, drink fluids, pull out their IV lines, have multiple falls. We can't restrain patients in nursing homes, I honestly believe that these patients should be either in acute care, or Covid units in nursing homes should operate by different standards. 

We have lost so many residents at the last wave (none in this wave so far thank God). These were patients who were otherwise physically stable, but suffered of dementia. 

I don't know what the answer to this is , but If I could change things , I would definitely change the status quo in LTC/SNF and also , hospitals so easily discharging elderly patients , sending them back to SNF , knowing we cant even keep them free of falls at the worse time of their life. 

I apologize if this comes across as a word salad, English is not my native language/was born abroad. 

3 things I would change at a minimum, allow restrains to keep patients safe, increase staffing, give staff enough PPE and time to care for Covid patients, who can decline so quickly and so easily.

[JKL33]

6 hours ago, NewRN'16 said:

increase staffing, give staff enough PPE and time to care for Covid patients, who can decline so quickly and so easily.

These are the answers; not keeping patients in acute care.

I feel for you. Very difficult work; heartbreaking and frustrating so many times. I'm sure you are doing the very best you can, and I truly hope that brings you some small comfort. You are helping and caring for others.

?

[Emergent, RN]

Maybe Mother Nature is trying to tell us something. 

As far as PPE, washable gowns are the solution that my hospital has used. CAPRs, hand washing,  carefully storing N95s have worked for me. 

[NewRN'16, ADN, RN]

On 1/18/2021 at 1:58 AM, Emergent said:

Maybe Mother Nature is trying to tell us something. 

As far as PPE, washable gowns are the solution that my hospital has used. CAPRs, hand washing,  carefully storing N95s have worked for me. 

Well, humanity should look in the mirror and stop abusing the earth and animals the way we currently are. 

Also , we should stop reproducing like rabbits. I'm sorry , but we are overpopulated. We understand cats and dogs shouldn't reproduce so much ,so we spay and neuter them. In the meantime we go and have 16 babies. For which we can't care for!

Yes , nature is trying to tell us something. Humble down and be greatful for what you have . And stop destroying everything. 

[StrwbryblndRN]

On 1/17/2021 at 6:58 PM, NewRN'16 said:

Not an article, or peer studied review. Just my take after 8-9 months of battling this virus in a nursing home. 

It is a well known fact that Covid 19 is causing confusion/ams even in non dementia patients. The problem is worse in dementia patients, because patients become so confused/agitated, they may refuse to eat /take meds, drink fluids, pull out their IV lines, have multiple falls. We can't restrain patients in nursing homes, I honestly believe that these patients should be either in acute care, or Covid units in nursing homes should operate by different standards. 

We have lost so many residents at the last wave (none in this wave so far thank God). These were patients who were otherwise physically stable, but suffered of dementia. 

I don't know what the answer to this is , but If I could change things , I would definitely change the status quo in LTC/SNF and also , hospitals so easily discharging elderly patients , sending them back to SNF , knowing we cant even keep them free of falls at the worse time of their life. 

I apologize if this comes across as a word salad, English is not my native language/was born abroad. 

3 things I would change at a minimum, allow restrains to keep patients safe, increase staffing, give staff enough PPE and time to care for Covid patients, who can decline so quickly and so easily.

Any infection in dementia residents or elderly without dementia will increase/induce confusion and put them at risk for all sorts of things.     Covid is just one of many but is more challenging due to infection control.  

I would prefer hospitals discharge patients/residents back home when they are medically stable.   To keep them in the hospital because they are not back to baseline puts them at further risk of decline.  Elderly, after an infection, are very vunerable and weak.   Get them home.   They will heal way better being placed in a familiar environment. The longer in hospital, the weaker they are, the greater they will fall.   A covid outbreak just makes it even more difficult.   

Best solution, but not necessarily doable, is to increase staff.  (There should always be PPE to care for them)   But I would not want anyone to stay in hospital longer then necessary no matter how challenging it will be when they come back.  

Absolutely no restraints.

 

[TheMoonisMyLantern, ADN, LPN, RN]

I read that scientists believe that covid crosses the blood brain barrier which makes sense due to the neurological and psychiatric symptoms a lot of people have experienced. There have been cases of psychosis in people during and post covid, the symptom of "brain fog" during and post covid, as well as confusion. Anecdotally I have seen dementia patients that were still early disease and high functioning, get covid and become altered mentally sometimes to the point of becoming bed bound and total care in other words a drastic drop in the level of cognitive and physical functioning. While that's not uncommon with elderly, what I've seen is that many times with our patients there's not a return to that baseline of functioning upon recovering from covid. With "normal" infections, pneumonia, UTI, etc. the patients can at least return to a point of having rehab potential. Most of our folks haven't been that lucky, sadly. 

Once again, this has just been what I've observed, and I don't know if that is necessarily the norm for dementia patients and covid.

I did read however that the same scientists that were noticing the brain involvement with covid theorized that it could potentially contribute to people developing dementia later on in life. Because we really needed something else to cause dementia...