Mental health of Filipino older adults with dementia during COVID‐19 pandemic: Reflections and viewpoints

1.

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‐based ⁴ 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.