The nightmare of resuscitation, the distance from loved ones and the fear of not making it. Covid has had devastating effects especially for older people. Studying the long-term cognitive, psychological, psychiatric and motor consequences are the objective of the study of the Center for Cognitive Disorders and Territorial Dementia in via Romagna, conducted by a team of 2 geriatricians and 3 psychologists, in collaboration with the Department of the Area Medica of the ASSL of Cagliari, which includes the Covid departments of the Santissima Trinità and Binaghi, and with the Department of Mechanical, Chemical and Materials Engineering of the University of Cagliari. Daniela Viale is a psychologist and psychotherapist, in the Geriatrics complex operating unit and in the Territorial Cognitive Disorders and Dementia Center of the 1 district of the ASSL Cagliari.
- Dr. Viale, how was your office born?
"Considering the scientific evidence on possible long-term harm in patients who have contracted Covid and the increased risk in the elderly population of unfavorable outcomes, in terms of disability, worsening quality of life, we decided to address the study to subjects with more than 65 years old who have been hospitalized in the medical area of the Santissima Trinità in Cagliari. The aim of the study is to analyze people's cognitive, neuropsychiatric, psychological and motor performance for a full year with assessments made every 6 months. This study was started in the Center for Cognitive Disorders and Territorial Dementia in via Romagna, and is conducted by a team of 2 geriatric doctors and 3 psychologists, in collaboration with the Department of the Medical Area of the ASSL of Cagliari, which includes the Covid departments of the Santissima Trinità and Binaghi, and with the Department of Mechanical, Chemical and Materials Engineering of the University of Cagliari ”.
- What is your goal?
“To offer a psycho-geriatric assessment, screening and possible care of people hospitalized for Sars-cov 2 infection who agree to participate in the study. Our goal is in fact to intercept situations of fragility early, to favor a global care at a specialized center, both from a geriatric and psychological point of view, to activate prevention interventions in those subjects with higher risk factors ".
- What effects has Covid had on patients over 65 hospitalized in intensive care?
“The pandemic has radically changed the time and way of care in hospitals by depriving patients of interactions and limiting, in a condition of great fragility and need, the right to relationship and communication with the most significant affections. Contact with health workers also had to adapt to the need for distancing, to interaction by means of individual protection devices such as masks, visors, helmets; patients had to learn to recognize operators by voice and eyes, they learned new forms of human contact. Some of them have lived endless moments in motion, looking at the ceiling, isolated from the rest of the world. All this may have left signs especially in the most fragile subjects: anguish, memories of moments of despair, thoughts of not succeeding, of not seeing loved ones again. The attitude of care and attention of the health workers was decisive for most of the patients. From their stories it emerges that they have always felt not only medically cured but also and above all emotionally supported. However, in some cases the discomfort can persist and fall within the effects of the so-called “long-covid that can occur, beyond 12 weeks from the infection. There may be multi-organ complications (affecting the respiratory, neurological, gastrointestinal and musculoskeletal systems) and / or repercussions on psychological well-being (lack of concentration, attention, memory, sense of confusion, mental fog, "brain fog", easy fatigue, sleep disturbances, anxiety, depression, up to symptoms attributable to Post Traumatic Stress Disorder) ".
- Has their life gotten worse?
"We are studying what effects it has had on people over 65 in relation to their functional and motor autonomy, and to psychological and cognitive well-being, even if we do not measure them directly if the lives of people affected by Covid have worsened. We cannot therefore answer objectively, at least not to the direct question. In general we can say, in terms of adaptation to the Covid experience, that some people may perceive a worsening of their quality of life as a result of the lived experience. What we do know is that a characteristic of human beings is to be resilient and therefore "programmed" to react to adversity. In some cases it is necessary to intercept situations of greater fragility in order to intervene specifically and aimed at a more rapid and lasting recovery of one's psychological well-being and of the previous condition of life ”.
- Stress, concentration difficulties and cognitive problems, Covid is leaving deep wounds. How do you help patients cope with these problems?
“By creating an outpatient context in which the staff can take care of the expressed difficulties, both cognitive and psychological, through a specific psycho-geriatric path. In particular, there are short cycles of psychological support, meetings for the processing of traumatic memories, counseling and psycho-education to favor a better processing of one's experience, stimulate the processes of resilience and adaptation, preparing the subject towards a recovery perspective and improvement. We believe that the value of this experience lies in taking global responsibility for the person in a multidisciplinary perspective and integrating the skills between the geriatrician and the psychologist ”.
