Changes in health care during pandemic linked to higher mortality in adults with AD

Increased mortality in older adults with Alzheimer’s disease and related dementias, especially in underrepresented and vulnerable populations, was closely linked to the COVID-19 pandemic, according to a study published in JAMA Neurology.

“In 2020, COVID-19 abruptly altered the delivery of health care and the daily operations of nursing facilities,” Lauren Gilstrap, MD, MPH, of the Dartmouth Institute and Geisel School of Medicine, and colleagues wrote. “The association between those secondary changes related to the pandemic and patient outcomes, especially among vulnerable populations, has not been well described.”

Researchers explored whether COVID-19-related changes to health care were linked with excess mortality of patients with Alzheimer’s disease and related dementias (ADRD) by conducting a retrospective, cross-sectional study using data from more than 53 million Medicare enrollees, aged 65 years and older, between Jan. 1, 2019, and Dec. 31, 2020.

Participants included enrollees with or without ADRD and enrollees with or without ADRD who resided in nursing homes.

Results showed that adjusted mortality in 2020 was 12.4% higher for enrollees without ADRD and more than doubled for those with ADRD compared with 2019, with mortality rates higher among Asian (36%), Black (36.7%) and Hispanic (40.1%) populations with ADRD. Among nursing home residents without ADRD, adjusted excess mortality was 24.2% higher in 2020 compared with 2019 and 33.4% higher in nursing home residents with ADRD.

Researchers also found that the hospital referral region with the fewest COVID-19 cases in 2020 had no excess mortality in enrollees without ADRD but had 8.8% higher mortality among enrollees with ADRD in communal settings and 14.2% higher mortality among enrollees with ADRD in nursing homes.

“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,” Gilstrap and colleagues wrote.

In a related editorial, Elan L. Guterman, MD, MAS, of the department of neurology at the University of California, San Francisco, said that the study should serve to intensify efforts to reduce inequities in heath care services, particularly in vulnerable and underrepresented populations.

“We strive to build a health system that reduces, not enlarges, health disparities,” Guterman wrote. “To this end, we must explicitly acknowledge that certain individuals are more susceptible to both the direct and indirect effects of COVID-19 and that improving health in these populations includes preventing infection.”