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Japanese hospitals accepting COVID-19 patients with dementia struggle to prevent infections

This Dec. 27, 2020 file photo shows a nurse attending to an elderly patient in a hospital in the city of Osaka. (Mainichi/Rei Kubo)

TOKYO -- Hospitals in Japan that accept dementia patients with COVID-19 have been struggling to enforce countermeasures against coronavirus infections, as some patients refuse to wear masks or tend to wander.

    "It will bleed, so please don't touch the IV drip," a nurse in a hazmat suit told a dementia patient in December 2020 at a COVID-19 ward in a general hospital in eastern Japan. However, the patient didn't seem to comprehend the nurse's instructions, and pulled the needle out of their arm. The nurse had no choice but to wrap the patient's arm in swathes of bandages and a special cover to make sure they didn't touch the needle.

    There had also been a patient who slipped out of their room and headed toward the "green zone," the area of the hospital barred to infected individuals, before being stopped by staff. In some cases where patients have a strong tendency to wander, a camera is set up in their hospital rooms with the consent of the family. There is also a considerable number of patients who do not wear masks.

    The general hospital has around 10 beds designated for mild to moderate COVID-19 cases. It accepts patients from nursing homes where clusters have occurred. Recently, however, over half of the beds have constantly been occupied by dementia patients with COVID-19.

    "They don't understand the word 'coronavirus' and it's hard to get them to cooperate with transmission prevention," said a nurse in her 20s who works at the hospital's COVID-19 ward. "The grave situation at wards for severe COVID-19 cases has been covered in the news, but we're having a rough time here even when the patients have mild symptoms."

    There are only a few hospitals that take dementia patients with the coronavirus, and there have been cases where it takes a long time for people with both conditions to be admitted to a hospital.

    A cluster occurred at a geriatric care facility in Kumamoto Prefecture last July, causing a total of 49 infections among residents and staff, and three deaths. A majority of the patients had dementia.

    The public health center in the area initially tried to direct the patients to a local hospital capable of handling dementia patients, but not all of them could be admitted, and 30 had nowhere to go. The health center then approached several medical institutions in regions beyond the center's jurisdiction. Still, it had a difficult time finding hospitals that could accept the patients, and some did not get a spot in a hospital for nearly 10 days.

    A representative of Kumamoto Prefecture's medical policy section said, "Treatment of dementia patients requires more staff compared to other COVID-19 patients, so they can't be concentrated in a specific hospital. Dementia patients need to be hospitalized in separate hospitals in groups of several people each, and it took time to make arrangements."

    It is estimated that there are as many as some 5 million people with dementia in Japan. What should be done if they become infected with the coronavirus?

    Shinya Ishii, a professor in geriatric medicine at Hiroshima University's graduate school, said that dementia patients are vulnerable to environment changes, and are liable to show symptoms of delirium just by being hospitalized. Besides dementia patients' lack of cooperation with anti-coronavirus measures, including wearing masks, it is difficult for them to communicate problems with their health, meaning they require more elaborate care, he added.

    "Problems in Japan's system for providing health care and nursing care services, which were an issue even in normal times, have emerged even more clearly due to the coronavirus. They're not problems that can be solved overnight," Ishii said.

    According to a June 2020 survey of 945 facilities nationwide, including nursing homes and hospitals with dementia wards, conducted by Ishii in cooperation with Hiroshima University and the Japan Geriatrics Society, 56 of the facilities had confirmed or suspected coronavirus cases among their residents. Among them, nearly 20% responded that "hospitalization requests were rejected due to dementia, and there were difficulties in transporting patients." It is possible that hospitalization has become even more difficult since, as there have been serious bed shortages as hospitals have used up all their remaining space amid a winter surge in COVID-19 cases.

    Some facilities also reported difficulties keeping infected patients isolated, and worries that their nursing staff were risking infection through close contact with those patients.

    "There are probably not that many hospitals in any region that can handle patients with both dementia and COVID-19," Ishii said, adding, "When determining the scale of the bed shortage, it is necessary to consider not only the number of patients with severe symptoms, but also whether the hospital can handle dementia and other possible comorbidities. If infections spread further, hospital beds that can accommodate many diseases will be filled, and I fear that institutions that usually do not take on patients with these diseases will have no choice but to treat them."

    Meanwhile, families caring for dementia patients and support groups have demanded that local governments and other administrative bodies set forth guidelines and support measures for when people with dementia are infected.

    Morio Suzuki, representative director of the Kyoto-based Alzheimer's Association Japan, which takes inquiries from dementia patients' families, told the Mainichi Shimbun, "Those whose family members have dementia really fear the coronavirus."

    Concerns over whether there are hospitals that will accept dementia patients with COVID-19, and the question of whether these patients will continue to receive care if family members living with them are infected, have intensified the emotional burden on families.

    Some local governments have launched original support measures, such as Miyagi Prefecture, which implemented a system to dispatch a team of specialists including doctors and care workers to hospitals with dementia patients who also have COVID-19.

    With the case of Miyagi Prefecture in mind, Suzuki said, "I'd like each local government to hammer out measures so that families can have peace of mind, even if just a little bit."

    (Japanese original by Yongho Lee, Machida Resident Bureau)

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