Unmet need high among patients with Alzheimer’s disease/related dementias during pandemic

Unmet need was high among patients with Alzheimer’s disease and related dementias during the COVID-19 pandemic, according to study results presented at the Alzheimer’s Association International Conference.

“At the beginning of the pandemic, there was a lot of concern that persons with Alzheimer’s disease and related dementias would be particularly vulnerable to the consequences of COVID-19 mitigation efforts,” Ivy Benjenk, RN, MPH, of the University of Maryland, said during a virtual presentation. “Additionally, there was a lot of concern that individuals with Alzheimer’s disease and related dementias would, because of cognitive impairment, not be able to technologies like telemedicine and food and supply delivery websites that were used very heavily during the first few months of the pandemic. The point of this project is to explore the types of unmet needs experienced by adults with Alzheimer’s disease and related dementias during the pandemic and the characteristics of adults [in this population] that were experiencing the highest rates of unmet need.”

Benjenk and colleagues conducted a cross-sectional analysis of the summer 2020 and fall 2020 COVID-19 supplemental surveys of the Medicare Current Beneficiary Survey (MCBS), which utilizes complex survey design to reflect a nationally representative sample of Medicare beneficiaries. The researchers analyzed data of 20,800 survey participants, of whom 4.07% received a diagnosis of Alzheimer’s disease or related dementias. Further, they used logistic regression to determine the characteristics of those who reported at least one unmet need.

Results showed at least one unmet need during the COVID-19 pandemic among 16.61% of Medicare beneficiaries with Alzheimer’s disease and related dementias compared with 16.52% among Medicare beneficiaries without this diagnosis (P = .956). Although beneficiaries with and without Alzheimer’s disease and related dementias did not differ in unmet needs related to rent/mortgage, food, supplies and medications, those with this diagnosis reported higher rates of unmet need for health care services (8.86% vs. 5.77%; P = .008). Those with Alzheimer’s disease and related dementias more often reported having an unmet need between March 2020 and June 2020 compared with between July 2020 and November 2020 (18.1% vs. 7.84%; P < .001). Those with Alzheimer’s disease and related dementias who also had depression (aOR = 2.25; P = .001) and multimorbidity (aOR = 1.79; P = .03) had significantly higher unmet need after controlling for age, sex, race/ethnicity, insurance and geographic location. Those with Alzheimer’s disease and related dementias and co-existing depression (P < .001) or co-existing multimorbidity (P < .001) had increased risk for having unmet needs compared with individuals without Alzheimer’s disease and related dementias.

“When we see that people with Alzheimer’s disease and related dementias with multimorbidity and depression have very high rates of unmet need, it makes it clear that we need to target high-risk subgroups during future public health disasters and that we should make sure that this high-risk subgroup has chronic case management services already established so that they're prepared for when a disaster happens in the future or just during normal operations,” Benjenk said. “Limitations of this analysis were that there was a small number of Medicare beneficiaries with Alzheimer’s disease and related dementias in the dataset, we don't have any information on the pre-pandemic period and that these are de-identified files as they are public use.”