For the first time, researchers have calculated excess deaths among US dementia patients during the pandemic, and they found a reduction in excess mortality among long-term care residents after COVID-19 vaccines were made available. The study was published today in JAMA Neurology.
Older adults with Alzheimer's Disease and related dementias are very vulnerable to the COVID pandemic.
Researchers from the University of California–San Francisco (UCSF) and their US colleagues analyzed data from US death certificates for those 65 and older with Alzheimer disease and related dementias (ADRD) as a contributing cause of death from January of 2014 to February of 2022.
"Older adults with Alzheimer's Disease and related dementias are very vulnerable to the COVID pandemic," said Ruijia Chen, ScD, the first author of the paper, in a UCSF press release. "What we were trying to understand with this paper is whether the excess deaths actually declined after the vaccines became available."
Big drop in nursing home excess deaths…
Pandemic-related excess deaths were defined as the difference between deaths with ADRD as an underlying or contributing cause observed from March 2020 to February 2021 (year 1 of the pandemic) and March 2021 to February 2022 (year 2 of the pandemic) compared with the expected deaths during this period.
Expected deaths were based on data from January 2014 to February 2020.
The investigators assessed 2,334,101 death certificates. A total of 94,688 (95% prediction interval [PI], 84,192 to 104,890) pandemic-era excess deaths with ADRD were estimated in year 1 and 21,586 (95% PI, 10,631 to 32,450) in year 2. That was a 77% drop in the number of excess deaths.
"Declines in ADRD-related deaths in year 2 were substantial for every age, sex, and racial and ethnic group evaluated," the authors wrote. Most striking was the reduction in deaths among long-term care facility residents, where excess deaths went from 34,259 (95% PI, 25,819 to 42,677) in year 1 to −22,050 (95% PI, −30 765 to −13 273) in year 2.
…but different story in those living at home
Excess deaths from dementia patients who remained at home stayed elevated, however, from 34,487 (95% PI, 32,815 to 36,142) in year 1, to 28,804 (95% PI, 27,067 to 30,571) in year 2.
"Our finding that faster vaccine rollout and greater coverage were associated with larger reductions in ADRD-related deaths in year 2 suggests that access to vaccines, both for persons living with ADRD and their care professionals, may play a key role in reducing excess deaths,” the authors concluded.
Those with ADRD who lived at home may have avoided preventive care appointments, including timely uptake of the COVID-10 vaccine.
Critical resources to make COVID-19 a survivable infection—most importantly vaccinations for themselves and those around them—are not reaching older adults living at home.
"The declining mortality in long-term care settings when vaccines became available show how lives can be saved when systems are in place to achieve comprehensive access to vaccinations," said Maria Glymour, ScD, senior author of the paper, in the UCSF release.
"Our findings suggest critical resources to make COVID-19 a survivable infection—most importantly vaccinations for themselves and those around them—are not reaching older adults living at home."
