After increasing “substantially” during the first year of the COVID-19 pandemic, dementia-related deaths declined in the second year, likely due to vaccination and prevention efforts in long-term care settings, according to a study recently published in JAMA Neurology.
Researchers led by the University of California, San Francisco, analyzed more than 2 million older adult death certificates from the Mortality Surveillance System of the Center for Disease Control and Prevention’s National Center for Health Statistics that listed Alzheimer’s disease or related dementias, or ADRD, as a cause of death.
They also looked at US Census Bureau Population Estimates Program data from January 2014 to February 2020, as well as vaccination data from the CDC’s COVID Data Tracker.
Their goal was to understand how mortality from ADRD changed during the pandemic.
They determined that almost 95,000 excess dementia-related deaths occurred during the first year of the pandemic. That number fell by 77% in the second year to approximately 22,000 excess deaths.
The significant decline in the second year, the data showed, was associated with vaccine rollout. Also according to the data, states with a faster vaccine rollout and greater coverage saw larger reductions in excess dementia-related deaths.
More importantly, the investigators found that long-term care residents experienced the largest decrease in excess deaths, whereas those living at home only saw modest declines. The researchers said that this finding suggests that older adults living with Alzheimer’s or related dementias and living in the greater community did not equally benefit from COVID-19 prevention efforts. Racial and ethnic disparities also were apparent throughout the pandemic, they said.
“These divergent patterns across waves may reflect not only changes in public health policies and interventions, but also differences in transmissibility, infectivity and mortality rates among COVID-19 variants,” the authors wrote.
People living with Alzheimer’s and related dementias, the researchers noted, may have difficulty adopting behavioral changes to reduce infection risk or regulate contact in high-risk settings. Social isolation resulting from pandemic lockdowns also exacerbated depression and loneliness among this population, increasing their risk of hospitalization and mortality.
The investigators concluded that the documented changes in mortality can provide valuable insights into the effectiveness of COViD-19 prevention and treatments developed in the first year of the pandemic that focused on safeguarding older adults — including limiting the use of shared spaces and improved surveillance testing of staff members.
The authors concluded that their findings underscore the need for policy efforts to reduce excess deaths among community-dwelling older adults with ADRD, as well as the need to identify measures to reduce disparities in excess deaths among various groups.
