Assisted living residents with dementia were more likely to die from any cause in the early months of the COVID-19 pandemic than assisted living residents without dementia, a new study has found.
Investigators examined Medicare claims and vital statistics data for assisted living residents across communities with 25 or more beds. They analyzed weekly excess all-cause mortality rates, comparing the rate from March 2020 through December 2020 with the rate between January 2019 and March 2020. Results were adjusted for demographics, common chronic conditions, community size and other variables.
The study did not examine causes, but investigators theorized that the excess deaths in this group may be due to several dementia-related health and care factors, including:
- The relative inability to follow social distancing guidelines or wear face coverings;
- The need for more hands-on care;
- A reduced ability to verbally communicate symptoms;
- The higher risk of swallowing difficulties and therefore pneumonia; and
- The higher likelihood that they will be receiving antipsychotics, which increase the risk of blood clots, which could in turn be exacerbated by a COVID-19 infection.
The results are similar to findings across US nursing homes, said lead author Kali Thomas, PhD, of the Department of Veterans Affairs Medical Center, Providence, RI.
Same results in memory care
Notably, although residents in assisted living memory care units typically have more advanced dementia, they had the same mortality risk as residents with Alzheimer’s disease and related dementia in the general assisted living population, Thomas and colleagues reported.
The structures and processes of care that aid infection prevention, such as more consistent staff assignments, may help to explain the similar mortality rates and perhaps offset the higher risk of transmission posed by higher staffing levels in these units, they theorized.
In addition, assisted living memory care units likely faced the same burdens as general assisted living, such as lack of access to personal protective equipment and staffing shortages, the authors said. The fact that those residents did not fare worse suggests potential benefits to infection control in those settings, they wrote.
“Our findings illustrate the importance of infection prevention and treatment strategies for residents with ADRD who reside in AL communities,” the investigators concluded.
Full findings were published in JAMDA, the Journal of Post-Acute and Long-Term Care Medicine.
