Image of Lauren Gilstrap, M.D., MPH,; Image Credit: Dartmouth College
Lauren Gilstrap, M.D., MPH,; Image Credit: Dartmouth College

Seniors with dementia, especially nursing home residents and minorities, had significantly higher mortality rates during the pandemic than their peers without cognitive impairment, a new study finds. Healthcare disruption — rather than COVID-19 illness alone — may be the direct cause of this disparity, investigators say.

The study compared mortality rates in pre-pandemic 2019 vs. rates in 2020 using data from 53 million Medicare beneficiaries aged 65 and older. Study cohorts included people with and without Alzheimer’s disease and related dementia living in the community and people with and without dementia living in nursing homes.

Disparities highest among LTC residents

Overall, seniors with dementia had 26% higher mortality rates in 2020 compared to 2019. Their peers without cognitive impairment had a 12% increase in mortality in 2020. This increased mortality was even more pronounced among nursing home residents with dementia. These study participants had a 33% higher rate of death in 2020 when compared to 2019. In contrast, the rate was 24% for nursing home residents without cognitive impairment, reported Lauren Gilstrap, M.D., MPH, of Dartmouth’s Geisel School of Medicine.

Racial and ethnic minorities with dementia also experienced outsized increases in 2020 mortality relative to 2019, she and her colleagues added. These included Asian, Black, and Hispanic populations.

Deaths in areas with low COVID-19 rates point to disrupted care

And seniors with dementia still suffered, in terms of mortality, in locations where COVID-19 rates were low. Measures of monthly infections across the nation’s hospital referral regions revealed that areas with low COVID-19 prevalence had no excess mortality in enrollees without dementia. But among seniors with dementia, deaths were 8% higher for community dwellers and 14% higher for nursing home residents.

This result suggests that the excess deaths experienced by seniors in 2020 are tied to disrupted access to acute and chronic care as well as to community support services, Gilstrap said in a statement.

“That was the most interesting finding in the study,” Gilstrap said. “I think what that tells us is that those deaths were probably related less to COVID and more to abrupt changes in the healthcare system.”

The findings underscore the need for more creative solutions to better serve vulnerable older adults with dementia, Gilstrap and co-authors concluded.

“When you think about adult populations that are potentially most at risk for bad outcomes when things change dramatically and abruptly in healthcare, older adults with cognitive issues … are at or near the top of the list,” she said.

The study was published in JAMA Neurology.