COVID-19 and Its Influence on Prevalence of Dementia and Agitation in Australian Residential Aged Care: A Comparative Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Comment 1: abstract: add specific conclusions

Comment 2: discussion: add clinical implications of the results of the study and future implications

 

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

I have read your manuscript submitted to Psychiatry International and have found it quite interesting, providing clues as to what to expect should another pandemic strike and impose a series of restrictions.

However, I find that nursing notes are not the most reliable data regarding the evolution of a patient, even more since November and December 2020 are missing (reason for missing not explained). Moreover, it would have been informative (in my opinion) to check how many of these symptoms were related to COVID-19 infection or other infections causing fever and/or dehydration. During the pandemic we had a few patients in our hospital which were severely confused and agitated, shouting and cursing all night, turned out positive for SARS-CoV2 the next day, and who recovered their cognitive abilities upon receiving treatment for COVID-19. Also, the mortality rates of patients with dementia and agitation vs those without these symptoms would have been informative (any differences?).

As for the language and editing, a few mistakes detected:

- lines 25-27 - the sentence is incomplete

- lines 88-94 are redundant with the prior sentences

- line 387 - PWD without dementia?

 

Comments on the Quality of English Language

The English language is fine, only minor editing issues being detected, and the study protocol and results are clearly presented.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Although an interesting scientific question was addressed in this manuscript, there are some issues with it, thus, a reconsideration after major revision is suggested.

In this study, Zhu and co-workers investigated how the prevalence of agitation symptoms changed during COVID pandemic in Australian residential age care facilities (RACFs). The authors found that the overall agitation symptoms decreased during COVID pandemic, however, the prevalence of some agitation symptoms increased during COVID pandemic. The authors aimed to figure out the reason of alterations in agitation symptoms, however, the importance of these findings are unknown.

Abstract: gives a good summary about the study described in this paper, however, the exact need of this study (why is it important to study how COVID pandemic acts on the agitation behaviour on dementia patients) is missing. Keywords are appropriate.

Introduction: the authors gave a good introduction about COVID pandemic in Australia with special focus on RACFs, where most COVID-related deaths were associated globally. The authors also described that large amounts of COVID victims suffered from dementia. We also received a detailed introduction about agitation in dementia people. As a conclusion, the introduction is very deep, however, I suggest to re-write it in a more focused way to highlight the need to study agitation behaviour pattern before and after COVID pandemic.

Materials and methods: no issues were detected. The authors gave a good overview about materials and methods used in this study with special focus on the algorithm used for processing free text notes from nursing progress notes.

Results:

·        Please explain why the number of male patients increased to 2021

·        Table 1 is confusing. It seems that the authors compare data sets from 2019, 2020 and 2021, respectively, where letters a, b and c means statistical significance among years. In this case, please give an exact note like a means significance between 2019 and 2020, etc

·        Please also explain why the number of younger dementia patients were increased during COVID pandemic

·        Please fix the labels of Table 2. Table 2 contains labels a, b and ab while legend describes a, b and c, respectively.

·        Please cite peer-reviewed articles and less homepages

Discussion and conclusion: results are taken into a wider view, however, the utility of these findings in the future and the explanation of results shown are missing.

English language: no issues were detected.

I suggest to reconsider the manuscript after major revision (giving answers to my questions and concerns). During revision, it is suggested to focus on the explanation of the results and the need and potential utility of the results in the future.

 

Strong points:

·        A well written abstract and appropriate keywords are given

·        A detailed introduction was given, where authors not only focused on Australia, but they gave a wider context

·        Materials and methods section is also well written, no issues were detected

·        English language: no issues were detected, the text is free from typos

Concerns and suggestions:

·        Please insert the necessity of this study into the abstract

·        Please re-edit the introduction in a more focused manner by highlighting the necessity to study agitation behaviour pattern before and during COVID pandemic

·        Please explain why the number of male patients increased to 2021

·        Please fix table legends. Please explain exactly what does a, b, and c means (significance between which years)

·        Please fix labels at Table 2. Table 2 contains a, b, and ab, while legend describes a, b and c, respectively.

·        Please cite peer-reviewed papers and reduce the number of cited webpages

·        Please highlight the importance and the future use of your findings.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

As compared with the first version of the manuscript, a significant improvement was demonstrated. Text re-editing and giving extra pieces of information improved the quality and the scientific soundness of results. The manuscript is now suitable for publication.

As integrating the necessity of this study in the abstract and giving information about it in the discussion, the reader’s interest about the topic is raised which is essential in a scientific publication.

A significant re-editing was detected in the introduction, therefore, the reader now receives all relevant pieces of information to put this topic into a wider concept.

A detailed gender analysis was performed during the study period. It is still not exactly clear why the number of male patients increased in certain age groups, however, some potential reasons were highlighted.

Table legends were fixed and new tables were integrated into the manuscript to support the understanding of the findings.

Peer-reviewed papers and official websites were cited.