Mortality Among OAs With Alzheimer Disease, Related Dementias During Pandemic

With the delivery of health care significantly altered during the COVID-19 pandemic, study authors researched how this affected older adults (OAs) with Alzheimer disease and related dementias (ADRD) living in nursing homes.

“The COVID-19 pandemic may be associated with excess mortality among OAs with ADRD, especially for Asian, Black, and Hispanic populations and people living in nursing homes, even in areas with low COVID-19 prevalence,” stated authors of a study published in JAMA Neurology.

The retrospective cross-sectional study focused on monthly COVID-19 infection rates by hospital referral region from January 2020 to December 2020 and compared mortality rates from March 2020 through December 2020 with those from the same months in 2019.

Researchers noted that 95% COVID-19 infections were estimated using the delta method while means were compared using t tests.

“Among patients diagnosed as having ADRD in 2019, 63.5% were women, 2.7% were Asian, 9.2% were Black, 5.7% were Hispanic, 80.7% were White, and 1.7% were identified as other (included all races or ethnicities other than those given); the composition did not change appreciably in 2020,” explained the researchers.

In comparison to the same months in 2019, higher mortality was observed for all enrollees with ADRD. Additionally, the highest mortality was reported among Asian (36.0%; 95% CI, 32.6%-39.3%), Black (36.7%; 95% CI, 35.2%-38.2%), and Hispanic (40.1%; 95% CI, 37.9%-42.3%) populations with ADRD.

Study data also showed the hospital referral region in the lowest quintile for COVID-19 infections in 2020 had “8.8% (95% CI, 7.5%-10.2%) higher mortality among community-dwelling enrollees with ADRD and 14.2% (95% CI, 12.2%-16.2%) higher mortality among enrollees with ADRD living in nursing homes.”

“In sum, the consistently higher excess mortality within a given COVID-19 quintile underscored the vulnerability of patients with ADRD to abrupt changes in health care delivery, lockdowns, and social isolation, particularly for underserved groups, such as Asian, Black, and Hispanic populations,” concluded study authors.

Reference:
Gilstrap L, Zhou W, Alsan M, Nanda A, Skinner JS. Trends in mortality rates among Medicare enrollees with Alzheimer disease and related dementias before and during the early phase of the COVID-19 pandemic. JAMA Neurol. Published online February 28, 2022. doi:10.1001/jamaneurol.2022.0010