Alzheimer's deaths increased by more than a quarter in the first year of Covid pandemic

Alzheimer's patient deaths increased by more than a quarter in the first year of the Covid-19 pandemic, a major study has found, as researchers suggest remote appointments were to blame.

Records of more than 27 million patients were analysed to see if there was a link between coronavirus rates and excess deaths among patients with Alzheimer’s Disease and other related dementias.

Alzheimer’s patients were at “higher risk of dying” in 2020 compared to 2019, “either directly of Covid-19 or because of premature death owing to disruptions in health care”, the authors found.

It comes after patients struggled to see their GP in person during the pandemic and many did not come forward for care amid concerns of overwhelming the health system.

The researchers, from the Harvard Kennedy School, Boston and the Dartmouth-Hitchcock Medical Center, New Hampshire, used data from people who benefited from Medicare - a US government health insurance programme - between January 2019 and December 2020.

Participants were aged 65 or older and were grouped into four categories, with or without Alzheimer’s and with or without Alzheimer’s and living in a care home.

Mortality rates from March to December 2020 were compared to those in the same period in 2019.

Deaths among patients without Alzheimer’s, when adjusted for other factors, were 12 per cent higher in 2020 compared to the previous year.

But for patients with the disease the increase was 26 per cent. The excess mortality was even more marked among Asian, Black and Hispanic populations with Alzheimer’s, the authors found.

Excess deaths for those living in care homes with the disease were also up 14 per cent on the previous year.

Discussing the potential explanations, the authors highlighted the changes in access to healthcare during the pandemic, “including fewer inpatient admissions and the transition of outpatient visits to telehealth platforms, may disproportionately affect older adults with [Alzheimer’s]”.

“Because older adults in general and older adults with cognitive impairments are less able to engage effectively with standard telehealth platforms, it is not difficult to imagine how the combination of less effective (or absent) outpatient care and lower inpatient admission rates led to higher mortality,” they said.

It comes after a UK study found deaths of patients who had their medical care disrupted quadrupled during the first lockdown. Data from mortuaries across the country found a significant increase in deaths "from a potentially treatable condition".

This latest research is the largest analysi of mortality trends among care home residents during the beginning of the pandemic, the authors claim.

It found a general increase in excess mortality among care home residents with Alzheimer’s in 2020, “suggesting that factors other than Covid-19 infection were playing a significant role”.

In regions with low rates of Covid-19, where excess mortality among non-Alzheimer’s patients living in the community were below that in 2019, “excess mortality was 8.8 per cent for patients with [Alzheimer’s] overall and 14.2 per cent for nursing home residents with [Alzheimer’s]”.

Decreased access to community support and the “negative effects of social isolation and loneliness... likely played a role in higher mortality rates”, the authors said.

“Similarly, increases in caregiver stress, burden, and isolation may have indirectly affected the health of people with [Alzheimer’s] and people living in nursing home settings.”

The authors conclude that the effect of remote consultations on Alzheimer's patients should be monitored in future to ensure their needs are met.

The research was published in the journal JAMA Neurol.