The objective of the current bridging measure was to provide the most feasible adaptation of the standard group treatment program, considering hygiene-, distancing-, and contact restrictions during the pandemic, as well as the cognitive performance level of the participants. Once again, it posed a significant challenge to our personal to design and offer bridging measures for individuals affected by dementia within a short timeframe, incorporating insights from the prior treatment observation (Buschert et al. 2022) into the implementation. However, these measures may serve as a blueprint not only for times of pandemic but also for mere regular circumstances of long-distances for patients to reach for stabilizing cognitive training programs.

The survey tools were adapted to the sample by only providing a small number of response options, which may have caused the data collected not to be very differentiated, but it also enabled cognitively impaired patients to self-assess.

We showed significant increase in the subjective experience of discomfort in the present treatment observation is less attributable to a negative intervention effect than to the negative effects of prolonged social isolation and the discontinuation of care and support measures, which other studies also postulated (Cheung and Peri 2020).

The individual face-to-face training was easy to execute and well accepted, from an economic perspective, however, rather unfavorable regarding extensive time and personnel expenditure - similar to the training for caregivers, which made it possible to address personal issues in more detail in an individual setting, which was again also very time-consuming. In conducting online groups, there were various technical difficulties like handling of computers and headphones as well as dialing and logging into the Clickdoc platform. Once all participants were online, the training was easily practicable and according to the participants feedback also an enriching experience. Even some kind of group feeling was created – despite all distance. By considering the feedback from the online group regarding the handling, the targeted group allocation, which based on the assumption that the handling of the online format could lead to excessive demands on more cognitively impaired people, was apparently justified.

A comparison of the bridging measures shows that participants prefer individual or group treatment in person followed by individual treatment by distance (phone/online). The online group set-up performed the worst, as indicated by technical challenges, consistent with findings from other studies (Garcia-Casal et al. 2017). From an economic healthcare perspective, however, online groups would be significantly more economical (in terms of time) compared to individual treatments in person or by phone. By optimizing technical equipment for participants on site, more intensive technical training and a longer adjustment period could increase the acceptance of online treatment.

The results of both treatment observations show that psychosocial bridging measures during the pandemic represented a major benefit for treatment in context of dementia. The Covid-19 pandemic, with its predominantly negative effects, has inevitably prompted considerations within outpatient geriatric psychiatric care regarding alternative treatment methods and experimentation with new technological possibilities. The present explorative treatment observation shows – although only to a limited extent – that telemedical approaches should be considered even at the stage of mild cognitive impairment with adapted, user-friendly technologies. Particularly caregivers who are, for example, unable to participate in outpatient services due to work activities could benefit. In addition, “hybrid groups” consisting of face-to-face and online participation should also be conceivable. In accordance with the demands of the German “National Dementia Strategy” (NDS), both bridging programs can provide positive incentives for location-independent routine care for people with dementia and their caregivers (Federal Ministry for Family Affairs, Senior Citizens, Women and Youth 2020).

The present explorative treatment observation was carried out as part of an outpatient geriatric psychiatric care. The group allocation was based on the severity level of the patient and therefore not randomized, resulting in structural group differences, so that confounding may occur and influence the results accordingly. Due to the small, highly selected sample, it is also difficult to generalize the observations. They may only apply to the sample and situation investigated and may not offer any insights beyond other cases and is therefore not representative. In addition, the small sample size limits the statistical power, making it difficult to detect potential significant differences and effects, or increasing the influence of random variations on the results, potentially distorting them. As the exploratory treatment observation was based on a clinic with a care mandate, there was no control group and therefore no validity with regard to the effectiveness of the bridging measures. Moreover, the pre-post design only allows statements to be made about immediate assessments and evaluations, statements on durability are not possible.