“Excess” deaths among Alzheimer disease and related dementia patients dropped by 77% in the second year of the pandemic, leading researchers to suggest that the better care offered in nursing homes compared to those remaining at home mitigated the COVID death rates.
Nearly 95,000 more people aged 65 and older died in the US than would have been expected for that demographic had the pandemic not occurred, according to research published Monday in JAMA Neurology. In total, 509,179 people in that age category diagnosed with dementia died in 2020 — 94,688 more than researchers estimated would have died absent the pandemic.
In 2021, the number of “excess” deaths — or those not expected to perish — dropped by 77% to less than 22,000. “Excess Mortality with Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US” was the name of the study.
Access to vaccines and the care provided in an LTC facility appear to be important factors, the authors wrote.
“Our finding that faster vaccine rollout and greater coverage were associated with larger reductions in [Alzheimer’s disease and related dementias]-related deaths in year two suggests that access to vaccines, both for persons living with ADRD and their care professionals, may play a key role in reducing excess deaths,” the study said. “Vaccination among staff and residents may lower excess deaths in nursing homes directly through preventing viral transmission and infection and indirectly through reducing social isolation.”
The researchers compared deaths inside nursing homes against those of people living at home using data from the National Center for Health Statistics (NCHS) to compare deaths from the first year of the pandemic — March 2020 to February 2021 — to the second, March 2021 to February 2022. They noted that patients with dementia were “especially susceptible to contracting the virus and dying from it due to comorbidities, difficulties adhering to infection control protocols, disruptions in care, and isolation from family members and caregivers.”
There were almost 35,000 “excess” deaths from March 2020 to February 2021 among patients living at home, and that decreased by 16% to 28,804 in the second year. The study noted that nursing home residents were among the first to receive the COVID vaccines and delivery was “not as well coordinated” for the same demographic living at home.
“Loneliness and social isolation also likely played a role for those remaining in the community, along with deferred medical care and the shift to virtual care, which is difficult for this population to access,” the authors wrote. They noted that long-term care facilities also implemented measures to contain the spread of the virus, such as limiting the use of shared spaces, and improved testing for staff members.
Strategies are needed for addressing the complementary goals of keeping dementia patients safe and fostering meaningful social engagement, the study’s corresponding author, M. Maria Glymour, Sc.D, told McKnight’s Long-Term Care News on Monday.
“The longer-term issue is to recognize that people living with [Alzheimer’s disease and related dementias] are especially vulnerable,” she said. “We need structures in place that focus on their safety and well-being. We want to make sure they are vaccinated and also the people around them. We also saw how painful social isolation was for older adults during the pandemic, and substantial prior evidence suggests isolation affects both quality of life and cognitive outcomes.”
Glymour is affiliated with the Department of Epidemiology at Boston University’s School of Public Health.
