There have been increasing concerns as to the care provided for people with progressive neurological disease during the COVID 19 pandemic. The change to healthcare services which have been needed to focus on people with the virus, together with the reduced availability of services and opportunities for socialisation have been of concern. These issues are raised in two recent papers.
In Italy Zullo et al discuss the issues for people with neurological disease and suggest that there has been a reduction in healthcare servcies, a reduction in beds available for neurology, neurologists have been diverted to other areas of care, to cope with the large numbers of COVID patients in hospital, nursing homes have closed to or had reduced visiting and palliative care services have been less available. All of these issues have affected patients and families and they argue for a reassessment of care servcies:
- The development of care pathways based on the intensity of care needs, rather than just diagnosis
- The integration of health and social care services
- Increased advance care planning, so that the wishes of patients are known
- Increased availability of neuro-palliative care (Zullo et al 2021)
This has been reinforced by a paper from Austraila where the effects of a lockdown are discussed (Pelicioni et al 2020). They argue that lockdown disrupted the care systems for people wih neurological disease , with often a loss of important therapies, such as physiotherpay. They argue that the effects of this disruption mayncrease frailty, adversely affect the mental health of patients and families, lead to increased falls, reduce interventions and socialisation for patients. The use of teleheath may provide a lifeline, including face to face interaction with therapists, such as for exercise programmes, although this is not feasible for all. They argue for the development of an evidence base for such interventions, and the need for physiotherapy to be prioritised, with this being seen as an essential servcie for neurological patients, and preventing increased frailty.
These papers hsow the issues faced by many patients and their families as the result of the COVID 19 pandemic. Although there has been a focus on the increased deaths of people with neurorological diisease it is important to consider the long term implications for many patients, who have faced isolation, reduced activity, limited access to therapies and healthcare support. There will be a need to ensure that a palliative care approach, considering all aspects of care – physical, psycholological, social and spiritual – is provided to enable patients to recover from this period of the pandemic.
- The COVID pandemic has affected the activity, frailty and social life of people with neurological disease
- There is a need to prioritise support and care after lockdown
- The pandemic is a stimulus to consider increased integration of care
Pelicioni PHS, Schultz-Moore JS, Canning C, Lord SR. Lockdown during COVID-19 and the increase in frailty in people with neurological conditions. Frontiers in Neurology. 2020; 11; article 604299. Doi: 10.3389/fneur.2020.604299.
Zullo S, Ingravallo F, Crespi V et al. The impact of the COVID-19 pandemic on people with neurological disorders: an urgent need to enhance the health care system’s preparedness. Neurol Sci 2021. Doi.org/10.1007/s10072-020-04984-4