Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: a retrospective cohort study (Preprint)

BACKGROUND Coronavirus disease 2019 has forced the implementation of restrictive measures to control its viral spread and avoid the serious collapse of health systems worldwide. The Spanish government enforced lockdown, home confinement, social distancing and isolation. Limited access to basic services, and decreased family and social support have deleterious effects on physical and mental health, quality of life and cognition. Technology home-based interventions reduce the risk of viral exposure and prevent the health-related negative outcomes of social isolation through: healthcare delivery, cognitive stimulation, social connection, information sharing, and leisure entertainment. OBJECTIVE The aims of this cohort study were: 1) to explore the impact of social isolation resulting from restrictive measures on cognition, quality of life, mood and perceived stress on community-dwelling older adults with mild cognitive impairment or mild dementia; 2) to analyze how living alone and attitude towards technologies affect mental health; 3) to determine healthcare and social support services access and utilization; and finally; 3) to explore the informative, cognitive, entertainment, and social related uses of ICTs during the COVID-19 outbreak . METHODS This cohort study was conducted in the Spanish region of Andalucía (Málaga). In total 151 participants with mild cognitive impairment or mild dementia (PMCI/MD), from the SMART 4 MD (n=75) and TV-AssistDem (n=76) randomized clinical trial, were interviewed by telephone between May 11 and June 26 2020. The R version 4.0.4 program was used for all statistical analysis. RESULTS Of the respondents, 97/151 (64.2%) were women. The mean age was 74.31 years (SD 6.48), and 36/151 (23.8%) lived alone. Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life and mood of our study population when making comparisons with baseline assessments prior to the outbreak, and perceived stress was reported as moderate during the outbreak. Living alone was found a risk factor for fear, and higher technophilia was associated with less negative mental health outcomes. Overall, healthcare and social support services access and utilization was high. The most used ICTs during the COVID-19 outbreak were the Television for informative, cognitive, and entertainment related uses; and the SmartPhone for socialization. CONCLUSIONS While COVID-19 restrictions have demonstrated being effective in viral spread prevention, they have had negative effects in health and well-being and have changed lifestyles worldwide. Our study shows how a presumably vulnerable population of elderly with cognitive impairment has shown more resilience to restrictive measures than expected, experiencing no decline in cognition, quality of life or mood during the period of the COVID-19 outbreak. They reported overall well-being, maintained sleep quality, moderate perceived stress and low depression. Furthermore, findings show how a positive attitude towards technology is associated with less perceived stress, depression and boredom. CLINICALTRIAL NCT 04385797 May 13, 2020 INTERNATIONAL REGISTERED REPORT RR2-10.2196/26431