Background The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods This analysis is based on data of a telephone-based assessment in a convenience sample of n = 141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

Background: The sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmissions, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to compare the effectiveness of a collaborative care model with usual care for people with cognitive impairment who have been admitted to a hospital for treatment due to a somatic illness. The aim of the intervention is to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods/design: The trial is a longitudinal multisite randomized controlled trial with two arms (care as usual and intersectoral care management). Inclusion criteria at the time of hospital admission due to a somatic illness are age 70+ years, cognitive impairment (Mini Mental State Examination, MMSE ≤26), living at home, and written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (3 and 12 months after discharge). The estimated sample size is n = 398 people with cognitive inmpairement plus their respective informal caregivers (where available). In the intersectoral care management group, specialized care managers will develop, implement, and monitor individualized treatment and care based on comprehensive assessments of the unmet needs of the patients and their informal caregivers. These assessments will occur at the hospital and in participants' homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden.

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Zusammenfassung Hintergrund In deutschen Krankenhäusern sind etwa 40 % aller Patienten über 65 Jahre kognitiv beeinträchtigt. Für diese ist es besonders wichtig, dass die Überleitung in die Häuslichkeit möglichst bruchlos und vollumfänglich bedarfsgerecht organisiert ist. Ziel der Arbeit Ziel der Arbeit ist es, einen systematischen Überblick über Evidenz des Entlassmanagements (EM) bei Menschen mit kognitiven Beeinträchtigungen (MmkB) oder Demenz (MmD) zu geben. Ferner soll geprüft werden, ob sich, darauf aufbauend, die Notwendigkeit eines sektorenübergreifenden Konzeptes ergibt. Material und Methoden Anhand eines Scoping Review wurden n = 102 Publikationen identifiziert, von denen n = 6 in die Analysen eingingen. Ergebnisse Der Artikel gibt eine Übersicht über die aktuelle Versorgung von MmkB in deutschen Akutkrankenhäusern. Generelle Informationen zum EM im Krankenhaus wurden in 3 der 6 eingeschlossenen Arbeiten gegeben. Informationen zu einem speziellen Entlass- und Versorgungsmanagement für MmkB und MmD waren in 5 von 6 Arbeiten enthalten. Diskussion Der Artikel illustriert bestehende Versorgungslücken von älteren MmkB an der Schnittstelle des Entlassmanagements und zeigt die Notwendigkeit neuer Versorgungsmodelle. Inwieweit diese strukturell, prozessual und systemisch in die Regelversorgung eingebettet und finanziert werden können, ist bislang offen und unerforscht.

Abstract Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. Elderly people with comorbidities are at a higher risk and the different levels of government in Germany reacted jointly to the challenge with social distancing and a lockdown. Little empirical evidence exists about the psychosocial situation of elderly people during this time. Thus, the aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety, and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and daily living at home in Germany. Methods: This analysis is based on data from standardized telephone interviews in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Participants were recruited from currently running interventional trials. Therefore, data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, frequency of social activities due to the pandemic and perceived impact of the pandemic on health care services were assessed during the time of lockdown. Results: The vast majority of participants consider themselves sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-V. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low levels of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or birthday visits have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies are reported to have worsened due to the pandemic. Also visits to general practitioners decreased. Discussion: The study shows a limited impact of the pandemic on psychological variables including depression, anxiety and loneliness in the short-term. People are well informed but not especially concerned about themselves or others. There is a decrease in social activities as expected, in line with the restrictions imposed. The impact on health care provision is prominent. There is a need for longitudinal studies to assess longer-term effects of the pandemic and social distancing on elderly people with cognitive impairment living at home and their caregivers. There is also a need for qualitative, in-depth studies to further interpret the results. In general, elderly people in the setting under examination and with the limitations of this specific study seem to compensate restrictions during the time of lockdown in Germany rather well.