Dementia patients died at higher rates during pandemic

Medicare beneficiaries with Alzheimer's disease or other types of dementia—particularly nursing home residents and racial minorities—died at higher rates than others during the COVID-19 pandemic, finds a large study published yesterday in JAMA Neurology.A team led by Dartmouth researchers conducted a retrospective study of 53,640,888 Medicare enrollees 65 years or older enrolled in 100% fee-for-service Medicare Parts A and B from Jan 1, 2019, to Dec 31, 2020.

Participants were classified into one of four categories based on Alzheimer's disease and related dementias (ADRD) status and residence in a nursing home.The study authors noted that excess deaths include both those caused by COVID-19 and those related to pandemic-related disruptions in healthcare services, decreased access to community support services, social isolation and loneliness, and caregiver burnout.Of the 26,952,752 patients diagnosed as having ADRD in 2019, 63.5% were women, 2.7% were Asian, 9.2% were Black, 5.7% were Hispanic, and 80.7% were White; the composition changed little among the 26,688,136 patients diagnosed in 2020.Racial minorities, nursing home residents hit hardestCompared with 2019, the death rate was 12.4% higher among Medicare enrollees without ADRD and 25.7% higher among those with ADRD in 2020.

Among nursing home residents without ADRD, the death rate was 24% higher, but it was 33% higher among nursing home residents with ADRD.ADRD patients saw a 13.3% greater risk of death than non-ADRD patients from March to December 2020.

Racial minorities with ADRD had even higher death rates, at 36% for Asian, 36.7% for Black, and 40.1% for Hispanic participants.The hospital referral region in the lowest quintile for COVID-19 infections in 2020