Digital delivery of non-pharmacological intervention programmes for people living with dementia during the COVID-19 pandemic

Zara Quail, Laura Bolton, Karina Massey, Zara Quail, Laura Bolton, Karina Massey

Abstract

The COVID-19 pandemic significantly impeded face-to-face health and social care delivery for people living with dementia and their carers. Interruption of meaningful activity engagement along with increased social isolation is known to be associated with loss of skills, increased loneliness, physical deterioration and decline in cognition and mood in people with dementia. To ensure continuity of care for people living with dementia, for whom multimodal, non-pharmacological intervention programmes were being provided, there was an urgent need to adopt a remote delivery model. Guidance on digitally delivered assessment and care specific to non-pharmacological interventions for dementia is lacking. Adoption of technology-enabled care for people with dementia requires overcoming barriers to technology use, adaptation of therapeutic guidelines, adaptation of communication methods and carer support. Despite these challenges, therapists successfully transitioned from in-person to digital delivery of therapeutic interventions with associated benefits of continued meaningful activity engagement discussed.

Keywords: Alzheimer's type; dementia; global health; long-term care; memory disorders.

Conflict of interest statement

Competing interests: LB and KM are employees of Care Visions Limited, UK, the company providing the dementia therapy programme. ZQ is a contracted employee of Care Visions Limited and subsequently Care Visions Healthy Ageing Limited, UK.

© BMJ Publishing Group Limited 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Alzheimer’s Association . 2020 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia 2020;16:391–460.
    1. Livingston G, Sommerlad A, Orgeta V, et al. . Dementia prevention, intervention, and care. Lancet 2017;390:2673–734. 10.1016/S0140-6736(17)31363-6
    1. World Health Organization . Dementia, 2020. Available:
    1. National Guideline Alliance (UK) . Dementia: assessment, management and support for people living with dementia and their carers, 2018. Available:
    1. Hort J, O'Brien JT, Gainotti G, et al. . EFNS guidelines for the diagnosis and management of Alzheimer's disease. Eur J Neurol 2010;17:1236–48. 10.1111/j.1468-1331.2010.03040.x
    1. Ministry of Health Malaysia . Management of dementia. 2nd Edition, 2009.
    1. Kales HC, Lyketsos CG, Miller EM, et al. . Management of behavioral and psychological symptoms in people with Alzheimer's disease: an international Delphi consensus. Int Psychogeriatr 2019;31:83–90. 10.1017/S1041610218000534
    1. Scales K, Zimmerman S, Miller SJ. Evidence-Based nonpharmacological practices to address behavioral and psychological symptoms of dementia. Gerontologist 2018;58:S88–102. 10.1093/geront/gnx167
    1. Alzheimer’s Foundation of America . Therapeutic Actvities for 3 Main Stages of Alzheimer’s disease, 2020. Available:
    1. Gitlin LN, Winter L, Dennis MP, et al. . A biobehavioral home-based intervention and the well-being of patients with dementia and their caregivers: the cope randomized trial. JAMA 2010;304:983–91. 10.1001/jama.2010.1253
    1. Gitlin LN, Winter L, Vause Earland T, et al. . The tailored activity program to reduce behavioral symptoms in individuals with dementia: feasibility, acceptability, and replication potential. Gerontologist 2009;49:428–39. 10.1093/geront/gnp087
    1. Wenborn J, Challis D, Head J, et al. . Providing activity for people with dementia in care homes: a cluster randomised controlled trial. Int J Geriatr Psychiatry 2013;28:1296–304. 10.1002/gps.3960
    1. Suarez-Gonzalez A, Livingston G, Comas-Herrera A. Updated report: the impact of the COVID-19 pandemic on people living with dementia in UK, 2020. Available:
    1. Wang H, Li T, Barbarino P, et al. . Dementia care during COVID-19. Lancet 2020;395:1190–1. 10.1016/S0140-6736(20)30755-8
    1. VCT M, Pendlebury S, Wong A. Tackling challenges in care of Alzheimer’s disease and other dementias amid the COVID-19 pandemic, now and in the future. Alzheimer’s & Dementia 2020;16:1571–81.
    1. Alzheimer’s Disease International . COVID-19 and dementia: difficult decisions about hospital admission and triage, 2020. Available:
    1. Rochford-Brennan H, Keogh F. Giving voice to those directly affected by the COVID-19 pandemic - the experience and reflections of a person with dementia. HRB Open Res 2020;3:29. 10.12688/hrbopenres.13063.2
    1. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health 2020;5:e256. 10.1016/S2468-2667(20)30061-X
    1. Read S, Comas-Herrera A, Grundy E. Social isolation and memory decline in later-life. The Journals of Gerontology: Series B 2019;75:367–76.
    1. Lamont RA, Nelis SM, Quinn C, et al. . Psychological predictors of 'living well' with dementia: findings from the IDEAL study. Aging Ment Health 2020;24:956–64. 10.1080/13607863.2019.1566811
    1. Roland KP, Chappell NL. Meaningful activity for persons with dementia: family caregiver perspectives. Am J Alzheimers Dis Other Demen 2015;30:559–68. 10.1177/1533317515576389
    1. Regier NG, Hodgson NA, Gitlin LN. Characteristics of activities for persons with dementia at the mild, moderate, and severe stages. Gerontologist 2017;57:987–97. 10.1093/geront/gnw133
    1. Ngo J, Holroyd-Leduc JM. Systematic review of recent dementia practice guidelines. Age Ageing 2015;44:25–33. 10.1093/ageing/afu143
    1. Segal-Gidan F, Cherry D, Jones R, et al. . Alzheimer’s Disease Management Guideline: Update 2008. Alzheimer's & Dementia 2011;7:e51–9. 10.1016/j.jalz.2010.07.005
    1. Gitlin LN, Winter L, Dennis MP, et al. . Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc 2010;58:1465–74. 10.1111/j.1532-5415.2010.02971.x
    1. Alzheimer’s Association . Activities at Home: Planning the day for a person living with middle- or late-stage Alzheimer’s, 2019. Available:
    1. Logsdon RG, McCurry SM, Teri L. Evidence-Based interventions to improve quality of life for individuals with dementia. Alzheimers care today 2007;8:309–18.
    1. Keady JD, Campbell S, Clark A. Re-thinking and re-positioning ‘being in the moment’ within a continuum of moments: introducing a new conceptual framework for dementia studies. Ageing and Society 2020:1–22.
    1. Cavalcanti Barroso A, Rai HK, Sousa L, et al. . Participatory visual arts activities for people with dementia: a review. Perspect Public Health 2020;1757913920948916:1757913920948916. 10.1177/1757913920948916
    1. Woods B, Aguirre E, Spector AE, et al. . Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012;2:CD005562. 10.1002/14651858.CD005562.pub2
    1. NHS . Activities for dementia: dementia guide, 2018. Available:
    1. Carter MM, Wei A, Li X. An individualised, non-pharmacological treatment strategy associated with an improvement in neuropsychiatric symptoms in a man with dementia living at home. BMJ 2019;12:e229048.
    1. Quail Z, Carter MM, Wei A, et al. . Management of cognitive decline in Alzheimer's disease using a non-pharmacological intervention program: a case report. Medicine 2020;99:e20128. 10.1097/MD.0000000000020128
    1. Quail Z, Wei A, Zhang VF, et al. . Barriers to dementia diagnosis and care in China. BMJ Case Rep 2020;13. 10.1136/bcr-2019-232115. [Epub ahead of print: 10 Mar 2020].
    1. Bolton L, Quail Z. Meeting psychosocial needs in multicultural groups. The Journal of Dementia Care 2020;28.
    1. Giebel C, Cannon J, Hanna K, et al. . Impact of COVID-19 related social support service closures on people with dementia and unpaid carers: a qualitative study. Aging Ment Health 2020:1–8. 10.1080/13607863.2020.1822292
    1. Bolton L, Carter MC, Sommers B. Care visions healthy ageing. care visions healthy ageing YouTube channel, 2020. Available:
    1. Woods B, O'Philbin L, Farrell EM. Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews 2018.
    1. Nagaendran K, Chen LHC, Chong MS, et al. . Ministry of health clinical practice guidelines: dementia. Singapore Med J 2013;54:293–8. quiz 9. 10.11622/smedj.2013112
    1. Guideline Adaptation Committee . Clinical practice guidelines and principles of care for people with dementia, 2016. Available:
    1. Smith I. Creating the COVID-19 text service for vulnerable people, 2020. Available:
    1. Cabinet Office, Department of Health and Social Care, Public Health England . Government launches coronavirus information service on WhatsApp, 2020. Available:
    1. Royal College of General Practitioners, NHS England, NHS Improvement . Principles of safe video consulting in general practice during COVID-19, 2020. Available:
    1. Alzheimer’s Society . Coronavirus support for people affected by dementia, 2020.
    1. Alzheimer Scotland . Information during coronavirus, 2020. Available:
    1. Age UK . Technology and Internet, 2020. Available:
    1. British Association For Music Therapy . Online & Phone Therapy, 2020. Available:
    1. American Music Therapy Association . Music therapy in telehealth, 2020. Available:
    1. American Music Therapy Association . COVID-19 resources for music therapists and students, 2020.
    1. Royal College of Occupational Therapists . Coronavirus (COVID-19), 2020. Available:
    1. World Federation of Occupational Therapists . Telehealth, 2020. Available:
    1. American Occupational Therapy Association . Telehealth resources, 2020. Available:
    1. British Psychological Society . Adaptations to psychological practice: interim guidance during Covid-19 pandemic, 2020. Available:
    1. American Psychological Association . Guidelines for the practice of Telepsychology, 2013.
    1. Lindauer A, Seelye A, Lyons B, et al. . Dementia care comes home: patient and caregiver assessment via telemedicine. Gerontologist 2017;57:e85–93. 10.1093/geront/gnw206
    1. Gillespie SM, Wasserman EB, Wood NE, et al. . High-Intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities. J Am Med Dir Assoc 2019;20:942–6. 10.1016/j.jamda.2019.03.024
    1. Lazar A, Thompson H, Demiris G. A systematic review of the use of technology for reminiscence therapy. Health Educ Behav 2014;41:51s–61. 10.1177/1090198114537067
    1. Gerritsen DL, Koopmans RTCM, Walravens V, et al. . Using video feedback at home in dementia care: a feasibility study. Am J Alzheimers Dis Other Demen 2019;34:153–62. 10.1177/1533317518808021
    1. Kim H, Jhoo JH, Jang J-W. The effect of telemedicine on cognitive decline in patients with dementia. J Telemed Telecare 2017;23:149–54. 10.1177/1357633X15615049
    1. Tso JV, Farinpour R, Chui HC, et al. . A multidisciplinary model of dementia care in an underserved retirement community, made possible by telemedicine. Front Neurol 2016;7:225. 10.3389/fneur.2016.00225
    1. Possin KL, Merrilees JJ, Dulaney S, et al. . Effect of collaborative dementia care via telephone and Internet on quality of life, caregiver well-being, and health care use: the care ecosystem randomized clinical trial. JAMA Intern Med 2019;179:1658–67. 10.1001/jamainternmed.2019.4101
    1. Catic AG, Mattison MLP, Bakaev I, et al. . ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues. J Am Med Dir Assoc 2014;15:938–42. 10.1016/j.jamda.2014.08.014
    1. Costanzo MC, Arcidiacono C, Rodolico A, et al. . Diagnostic and interventional implications of telemedicine in Alzheimer's disease and mild cognitive impairment: a literature review. Int J Geriatr Psychiatry 2020;35:12–28. 10.1002/gps.5219
    1. NHS England, NHS Improvement . Memory service assessments: a new way of working, 2020. Available:
    1. Carotenuto A, Rea R, Traini E, et al. . Cognitive assessment of patients with Alzheimer's disease by telemedicine: pilot study. JMIR Ment Health 2018;5:e31. 10.2196/mental.8097
    1. Loh PK, Ramesh P, Maher S, et al. . Can patients with dementia be assessed at a distance? the use of telehealth and standardised assessments. Intern Med J 2004;34:239–42. 10.1111/j.1444-0903.2004.00531.x
    1. Yoshida K, Yamaoka Y, Eguchi Y. Remote neuropsychological assessment of elderly Japanese population using the Alzheimer’s Disease Assessment Scale: A validation study. Journal of Telemedicine and Telecare;0:1357633X19845278.
    1. Abdolahi A, Bull MT, Darwin KC, et al. . A feasibility study of conducting the Montreal cognitive assessment remotely in individuals with movement disorders. Health Informatics J 2016;22:304–11. 10.1177/1460458214556373
    1. Bossen AL, Kim H, Williams KN, et al. . Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technol Telehealth 2015;3:49–57. 10.2147/SHTT.S59500
    1. Bolton L, Sommers B. Summer, music and art meditation for people with mild to moderate dementia, 2020. Care visions healthy ageing YouTube channel. Available: [Accessed 19 May 2021].
    1. Folstein MF, Robins LN, Helzer JE. The Mini-Mental state examination. Arch Gen Psychiatry 1983;40:812. 10.1001/archpsyc.1983.01790060110016
    1. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98. 10.1016/0022-3956(75)90026-6
    1. Morris JC. The clinical dementia rating (CDR): current version and scoring rules. Neurology 1993;43:2412–4. 10.1212/wnl.43.11.2412-a
    1. Reisberg B, Ferris SH, de Leon MJ, et al. . The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–9. 10.1176/ajp.139.9.1136
    1. Auer S, Reisberg B. The GDS/FAST staging system. Int Psychogeriatr 1997;9 Suppl 1:167–71. 10.1017/s1041610297004869
    1. Wade DT, Collin C. The Barthel ADL index: a standard measure of physical disability? Int Disabil Stud 1988;10:64–7. 10.3109/09638288809164105
    1. Cummings JL, Mega M, Gray K, et al. . The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308–14. 10.1212/wnl.44.12.2308
    1. Logsdon RG, Gibbons LE, McCurry SM. Quality of life in Alzheimer’s disease: Patient and caregiver reports. Journal of Mental Health and Aging 1999;5:21–32.

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