alzheimer’s/dementia

After 2020 Increase, Excess Mortality among People with Dementia Drops in Year 2 of COVID

Excess deaths associated with Alzheimer’s disease and related dementias dropped substantially among adults 65 and older in nursing homes, but remained high among seniors living at home. 

People living with Alzheimer’s disease or related dementias (ADRD) are among the groups most vulnerable to the direct and indirect effects of the COVID-19 pandemic, experiencing disproportionately high death rates in the early months of COVID-19. 

Now, a new study led by School of Public Health researchers is the first to examine changes in excess mortality—deaths above what would have been anticipated had there been no pandemic—associated with ADRD over the first two years of the pandemic.

Published in the journal JAMA Neurology, the study found that excess deaths among older adults with ADRD dropped substantially in nursing homes and long-term care (LTC) facilities after COVID vaccines became available. 

But deaths remained high for seniors living at home. Deaths also remained disproportionately high among Black, Latinx and Asian older adults, compared to White older adults.

The study investigated several factors that may contribute to the declines in excess deaths. The results underscore the importance of COVID-19 vaccine efficacy and uptake among seniors, the most at-risk age group for complications from COVID-19. But they also shed light on the disparities in access to these life-saving vaccines.

“These results underscore the urgency of directing efforts toward mitigating the pandemic’s impact on community-dwelling older adults affected by ADRD,” says study lead author Ruijia Chen, postdoctoral fellow in the Department of Epidemiology, who joined SPH in September from the University of California, San Francisco (UCSF) with an interest in studying the effects of social policies on disparities in risk of AD/ADRD, functional outcomes, and survival among older adults. “Our findings also emphasize the importance of ongoing monitoring of these inequalities and addressing how structural racism can exacerbate vulnerability to both ADRD-related and COVID-19 mortality.”

For the study, Chen and colleagues from SPH, UCSF, Massachusetts Institute of Technology, Stanford University, and the University of California, Santa Cruz analyzed data from US death certificates for people 65 and older with ADRD as an underlying or contributing cause of death from January 2014 to February 2022.

In the first year of COVID, there were 509,179 deaths associated with ADRD in the US among people 65 and older, with a total of 94,688 excess deaths among individuals with ADRD. But in the second year, excess deaths decreased to 21,586—a 77-percent drop.

Among long-term care facility residents, excess deaths plummeted from 34,259 in year 1 to −22,050 in year 2.

But among seniors living at home, there were 34,487 excess deaths in the first year of COVID, compared to 28,804 in the second year—only a 16 percent drop. 

Nursing home and LTC residents were among the first to receive COVID vaccines, and the researchers say this effective and widespread vaccine rollout—among staff and patients—in year 2 may contribute to larger reductions in ADRD-related deaths. In contrast, seniors living at home may have struggled with disruptions in care, difficulty adopting certain safety measures, and mental health-related challenges from social isolation, factors that may contribute to the high excess deaths in this population. In addition, study corresponding author Maria Glymour, chair and professor of epidemiology, says she worries that younger or middle-aged adults living with an older adult with cognitive impairment or dementia may make sure the older person is vaccinated, but not get vaccinated themselves.

“Vaccine uptake and other preventive measures make a huge difference in preventing death from COVID,” says Glymour, who joined SPH from UCSF in June. “People with cognitive impairment or dementia are not in a position to demand their own vaccination or to insist that their family, friends, and others around them get vaccinated. The results in this paper reinforce the importance of joining together to make the community safe for people living with cognitive impairment or dementia by reducing disease transmission. 

“I hope families with loved ones living with cognitive impairment or dementia might see these results and really fight to get their families vaccinated to keep their loved one safe,” she says.