The early phase of the COVID-19 pandemic was associated with excess mortality in older adults with Alzheimer disease and related dementias (ADRD) in the United States—particularly among those who identified as Asian, Black, or Hispanic or who lived in nursing homes. Researchers published their findings in JAMA Network Open.

“We found that [Medicare] enrollees with ADRD were at higher risk of dying in 2020 compared with 2019, either directly of COVID-19 or because of premature death owing to disruptions in health care,” wrote study lead author Lauren Gilstrap, MD, MPH, of Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and coauthors. “These results hold both for patients with ADRD overall and for patients with ADRD residing in nursing homes.”

The study compared mortality rates for nearly 54 million Medicare enrollees 65 years or older in 2019 and in 2020. Researchers looked at 4 specific cohorts: enrollees with or without ADRD, and enrollees with or without ADRD living in nursing homes.

Related: Dementia Tied to Increased COVID-19 Risk

Age- and sex-adjusted mortality in March through December of 2020 was 12.4% higher among enrollees without ADRD and 25.7% higher among enrollees with ADRD compared with the same period in 2019, according to the study. Among enrollees with ADRD living in nursing homes, mortality was 33.4% higher in 2020. Mortality among nursing home residents without ADRD, meanwhile, was 24.2% higher.

While stratified analysis of Medicare enrollees with ADRD showed excess mortality was similar for women and men (25.9%), it revealed higher mortality percentages for Asian (36.0%), Black (36.7%), and Hispanic (40.1%) enrollees with ADRD.

Mortality increases among older adults with ADRD likely reflect mortality from COVID-19 itself as well as multiple other factors, researchers pointed out.

“The elevated mortality risk was found early in the pandemic even in areas with very low COVID-19 infection rates,” they wrote, “suggesting that older adults with ADRD, especially those in racial and ethnic minority groups and those living in nursing homes, may be particularly susceptible to changes in health care delivery and nursing home care during the ‘lockdowns’ and other restrictions during the pandemic.”

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