Abstract

Objectives

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic.

Methods

People with dementia and their carers completed assessments before (July 2019–March 2020; 206 dyads) and after (July–October 2020) the first Covid-19 ‘lockdown’ in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline.

Results

In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness.

Conclusion

Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed.

中文翻译：

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英格兰痴呆症患者及其护理人员在 Covid-19 大流行期间的孤独预测因素：DETERMIND-C19 研究的结果

摘要

目标

确定预测大流行期间痴呆症患者和护理人员孤独风险的因素。

方法

痴呆症患者及其护理人员在英格兰首次 Covid-19“封锁”之前（2019 年 7 月至 2020 年 3 月；206 对）和之后（2020 年 7 月至 10 月）完成了评估。在后续行动中，分析样本包括 67 名痴呆症患者和 108 名护理人员。我们建立了一个以孤独感作为观察结果的纵向路径模型。两次测量中的照顾者类型和社会接触都被考虑在内。其他社会资源（关系质量、正式的日常活动）、幸福感（焦虑、心理健康）和认知障碍的初始水平和变化使用潜在增长曲线进行测量。我们调整了基线时的社会人口因素和健康状况。

结果

在照顾者中，更高水平的孤独感与非配偶共同居住的照顾者类型、照顾者焦虑的程度和增加、更正式的日常活动以及痴呆症患者更严重的认知障碍直接相关。在痴呆症患者中，非配偶共同居住的照顾者类型、较高的初始社会资源水平、幸福感和认知障碍预测了这些因素的变化；这对社会交往和孤独产生了间接影响。

结论

Covid-19 大流行中的孤独感似乎是由痴呆症患者及其护理人员的不同机制决定的。结果表明，痴呆症患者的护理人员可能会优先考虑提供保护痴呆症患者免受孤独感的护理，而代价是他们自己会感到孤独。讨论了在 Covid-19 大流行期间及以后促进适应性社会关怀的方向。