The COVID-19 pandemic and its recent resurgences have reminded the world about common humanity in times of crisis. It also exposed wide-scale issues of social inequality, with vulnerable groups facing the worst consequences of this global crisis. While the older adult population is the most vulnerable to the threats of COVID-19 infection,¹ the challenges faced by older adults with dementia are likely amplified due to the needs unique to their condition. Dementia is characterized as a syndrome marked by deterioration in cognitive function beyond what might be expected from the usual consequences of biological aging,² with often co-occurrence of behavioral and psychological symptoms.³ The mental health needs of older adults with dementia have been largely neglected, especially in low- and middle-income countries like the Philippines.

Dementia's inherent problems in cognitive function weaken the older adult's capacity to observe standard protocols against COVID-19. Weakened skills for recall, comprehension, verbal expression, concentration, and thought-processing affect the proper execution of regulations ordered by the national and local government units (e.g., social distancing, proper handwashing regimens, and even vaccination policies). Access restrictions as part of COVID-19 protocols in establishments that cater to dementia care (e.g., diagnostic consultations, pharmacological treatment, cognitive rehabilitation, counseling and/or psychotherapy, and occupational therapy, among others) cause disruptions in the supposedly holistic and optimal management of dementia.

The total cost of care is also a recurrent concern. A population-based⁴ reported that the incidence rate of dementia in the Philippines is 16 cases per 1000 persons and the economic burden per patient was around Php 196,000 (>3700 USD) annually. Although a few government-based establishments (e.g., Geriatric Services and Memory Clinic at National Center for Mental Health and the Center for Memory and Cognition at the Philippine General Hospital) provide affordable medical services, the financial setbacks attributable to the pandemic make dementia-mental health-care expenses difficult and burdensome. Moreover, the Philippine Health Insurance Corporation, the national health insurance program for Filipinos, only covers a small portion of the direct medical costs for dementia in Alzheimer's during hospital confinements. The economic problems brought about by the pandemic to many Filipino families have amplified their already challenging life situations.^{5, 6}

There are a few private institutions and organizations in the country that provide help in addressing the mental health needs of Filipino older adults with dementia even before the COVID-19 outbreak. For instance, the Dementia Society of the Philippines (DSP), a professional organization consisting of a multi-disciplinary group devoted to honing dementia literacy and skills of medical specialists and allied professionals, provides dementia-awareness and literacy programs (e.g., dementia symptoms screening measures, and circulation of research-outputs central to local validation and adaptation of dementia-evaluation tools) through online lay fora, facilitation of workshops. St. Luke's Medical Center's Memory Service and University of Santo Tomas Hospital's Memory and Neuropsychological Center (MNAC)—are both private hospital-based units that cater mental-health services for the Filipino elderly with dementia. Their diagnostic and rehabilitative procedures primarily consist of out-patient cognitive-rehabilitation, cognitive-evaluation, psycho-education, caregiver-education, and face-to-face and telehealth platforms. Asian Hospital and Medical Center, Cardinal Santos Medical Center, Makati Medical Center, and De-Los Santos Medical Center are some of the few other known private health institutions that similarly offer dementia-healthcare services. Only limited dementia patients in the Philippines can access the services of these very few private institutions as their services often require fees not affordable for most Filipinos, more so for older adults who often have no sources of income.

While online (telehealth) programs and services by private institutions and organizations are valuable to dementia care, issues such as sensory problems' co-morbidity, unavailability of communication devices, Internet instability/inaccessibility, and lack of technical know-how among many older adults with dementia seem to hinder the smooth delivery of online mental health services. Additionally, the non-transferability to the online format of some measures used for diagnosis and treatment (e.g., psychological tests and assessment tools) demand remediation. Overall, stakeholders in dementia care must establish collaborative efforts in ensuring continuity of mental health services for the older adult with dementia amidst the pandemic.

We offer several recommendations. Firstly, while there is recent progress in the mental health laws in the Philippines (e.g., The Philippine Mental Health Act or the Republic Act 11036), mental health services and provisions specific to the elderly with dementia are yet to be realized. This entails providing further specialized training among mental health professionals (e.g., psychiatrists, psychologists, and counselors) on systematic evaluation and evidence-based therapeutic approaches for the elderly with dementia, especially in the rural areas in the country, which have less access to mental health information and services.^{7, 8} Next, there is a need to integrate medical/physical health and mental health services for the elderly with dementia within the country's healthcare system to ensure the confluence of collaborative and multidisciplinary interventions. Doing so can help in addressing their needs through a holistic approach. Additionally, there is a need for more active multidisciplinary and transdisciplinary research programs that focus on the unique experiences, social and institutional support, and living conditions of Filipino elderly with dementia, to aid in creating innovative and context-specific solutions to improving their physical and mental health and quality of life. While the COVID-19 pandemic has shown us that all people face the same grand challenges in times of great crisis, it has also made us realize that there are people, including older adults with dementia, who are most vulnerable and had to face the magnified consequences of the global crisis due to their living condition. A society can only truly bounce back from a crisis if it can effectively protect everyone including all vulnerable populations.

COVID-19 大流行及其最近的死灰复燃提醒了世界在危机时期的共同人性。它还暴露了广泛的社会不平等问题，弱势群体面临着这场全球危机的最严重后果。虽然老年人群最容易受到 COVID-19 感染的威胁¹，但老年痴呆症患者面临的挑战可能会由于其病情的独特需求而被放大。^{痴呆症的特征是一种以认知功能恶化为特征的综合征，其特征超出了生物衰老的通常后果2}的预期，并经常同时出现行为和心理症状。³患有痴呆症的老年人的心理健康需求在很大程度上被忽视了，尤其是在菲律宾等低收入和中等收入国家。

痴呆症在认知功能方面的固有问题削弱了老年人遵守针对 COVID-19 的标准协议的能力。回忆、理解、口头表达、注意力和思维处理技能的削弱会影响国家和地方政府部门下达的规定的正确执行（例如，保持社交距离、正确的洗手方案，甚至疫苗接种政策）。在提供痴呆症护理（例如诊断咨询、药物治疗、认知康复、咨询和/或心理治疗以及职业治疗等）的机构中，作为 COVID-19 协议一部分的访问限制会导致所谓的整体和最佳管理中断痴呆症。

护理的总费用也是一个经常出现的问题。以人口为基础的⁴据报道，菲律宾痴呆症的发病率为每 1000 人 16 例，每位患者每年的经济负担约为 196,000 菲律宾比索（>3700 美元）。尽管一些政府机构（例如，国家心理健康中心的老年病学服务和记忆诊所以及菲律宾总医院的记忆和认知中心）提供负担得起的医疗服务，但大流行导致的财务挫折使痴呆症医疗保健费用困难重重。此外，菲律宾人的国家健康保险计划菲律宾健康保险公司仅涵盖住院期间阿尔茨海默氏症痴呆症的直接医疗费用的一小部分。^5、6

甚至在 COVID-19 爆发之前，该国就有一些私人机构和组织在解决菲律宾患有痴呆症的老年人的心理健康需求方面提供帮助。例如，菲律宾痴呆症协会 (DSP) 是一个由多学科小组组成的专业组织，致力于提高医学专家和相关专业人员的痴呆症知识和技能，提供痴呆症意识和识字计划（例如，痴呆症症状筛查措施和研究成果的传播，这些研究成果对当地验证和痴呆评估工具的适应至关重要），通过在线论坛，促进研讨会。圣卢克医疗中心的记忆服务和圣托马斯大学医院' s 记忆和神经心理中心 (MNAC)——都是以私立医院为基础的单位，为菲律宾患有痴呆症的老年人提供心理健康服务。他们的诊断和康复程序主要包括门诊认知康复、认知评估、心理教育、护理人员教育以及面对面和远程医疗平台。亚洲医院和医疗中心、红衣主教桑托斯医疗中心、马卡蒂医疗中心和德洛斯桑托斯医疗中心是少数其他类似提供痴呆症保健服务的知名私人医疗机构。菲律宾只有有限的痴呆症患者可以使用这些极少数私人机构的服务，因为他们的服务通常需要大多数菲律宾人无法负担的费用，对于通常没有收入来源的老年人来说更是如此。

虽然私人机构和组织的在线（远程医疗）计划和服务对痴呆症护理很有价值，但诸如感觉问题的合并症、无法使用通信设备、互联网不稳定/无法访问以及许多老年人缺乏技术知识等问题患有痴呆症的人似乎阻碍了在线心理健康服务的顺利提供。此外，一些用于诊断和治疗的措施（例如，心理测试和评估工具）无法转移到在线格式需要补救。总体而言，痴呆症护理的利益相关者必须开展协作，以确保在大流行期间为患有痴呆症的老年人提供心理健康服务的连续性。

我们提供了几项建议。首先，虽然菲律宾的精神卫生法最近取得了进展（例如，菲律宾精神卫生法或第 11036 号共和国法），但尚未实现专门针对痴呆症老年人的精神卫生服务和规定。这需要在精神卫生专业人员（例如精神科医生、心理学家和咨询师）中提供进一步的专业培训，以对患有痴呆症的老年人进行系统评估和循证治疗方法，特别是在该国农村地区，这些地区获得心理治疗的机会较少健康信息和服务。^7、8其次，需要将痴呆症老年人的医疗/身体健康和心理健康服务整合到国家的医疗保健系统中，以确保协作和多学科干预的融合。这样做有助于通过整体方法满足他们的需求。此外，需要更积极的多学科和跨学科研究计划，重点关注菲律宾患有痴呆症的老年人的独特经历、社会和机构支持以及生活条件，以帮助创造创新和针对具体情况的解决方案，以改善他们的身体和心理健康和生活质量。尽管 COVID-19 大流行向我们展示了所有人在重大危机时期都面临着同样巨大的挑战，但它也让我们意识到有人，包括患有痴呆症的老年人，他们是最脆弱的，由于他们的生活条件，他们不得不面对全球危机的放大后果。一个社会只有能够有效地保护包括所有弱势群体在内的每一个人，才能真正从危机中恢复过来。