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Dementia Is Deadliest Underlying Condition for COVID-19 Patients on Medicare

Nearly 1 in 3 beneficiaries with the brain disorder died from the coronavirus, HHS report shows

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A new government report highlights the distressing impact the pandemic has had on older adults with dementia. Data collected from more than 28 million Medicare beneficiaries enrolled in parts A and B (also known as fee-for-service [FFS] beneficiaries) shows that those with dementia are more likely to contract COVID-19 and die from the disease than the general Medicare population.

Between Feb. 28 and Sept. 27 of last year, 166,485 beneficiaries with dementia (8.8 percent) were diagnosed with COVID-19, compared with 2.4 percent of all Medicare FFS beneficiaries, the report found. And 53,490 beneficiaries with dementia died from COVID-19 during the study period — a 32.1 percent mortality rate — accounting for nearly 45 percent of all deaths among the Medicare FFS population.

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Among 14 common health conditions — including chronic kidney disease, cardiac disorder and obesity — people with dementia had the highest rates for COVID-19 diagnosis and death.

COVID-19 Mortality Rates by Underlying Condition

Data based on Medicare fee-for-service beneficiaries

  • Dementia, 32.1 percent
  • Chronic kidney disease, 28.9 percent
  • End-stage renal disease, 27.3 percent
  • Immune deficiency, 26.1 percent
  • Severe neurological condition, 24.7 percent
  • Cancer, 24.3 percent
  • Cardiac disorder, 24.2 percent
  • Other respiratory disease, 24.2 percent
  • Chronic obstructive pulmonary disease (COPD), 21.4 percent
  • Diabetes, 20.7 percent
  • Hypertension, 15.8 percent
  • Obesity, 15.7 percent
  • Breast/prostate cancer, 15.4 percent
  • HIV/AIDS, 14.9 percent

Source: U.S. Department of Health and Human Services (HHS) report

What's more, it didn't seem to matter where the beneficiaries with dementia lived. Despite the devastatingly high number of COVID-19 deaths seen in nursing homes and long-term care facilities across the country, COVID-19 death rates were “essentially the same” among those with dementia living in the community (31.4 percent) and those living in nursing homes (32.5 percent).

After controlling for factors including living arrangements, age and chronic conditions, researchers found the likelihood of being diagnosed with COVID-19 was 1.5 times greater for adults with dementia; the risk of dying was 1.6 times higher.

"It is important for the public — including people living with dementia, family caregivers, and providers — to understand the heightened risk of mortality among this population,” the report's authors write. They add that the lessons learned from the coronavirus pandemic can help inform actions in future pandemics, “as well as approaches to seasonal influenzas.”

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Deaths from dementia spike during pandemic

Deaths from Alzheimer's disease, the most common type of dementia, were about 16 percent higher in 2020 than in previous years, a report from the Alzheimer's Association shows. Researchers tracked a similar trend among the Medicare FFS population: Nearly 275,000 beneficiaries with dementia died in 2020 during the study period from all causes, compared with 232,449 in 2019 — an 18 percent jump. Most of the excess deaths can be attributed to COVID-19, the report states.

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It's still unclear what, exactly, makes people with dementia more vulnerable to COVID-19. The majority of people with dementia are older than 65 — the same age group that has shouldered about 80 percent of COVID-19 deaths, according to the Centers for Disease Control and Prevention (CDC).

Adults with dementia are also more likely to have a chronic health condition that increases their risk for severe illness from COVID-19. Still, “dementia may exacerbate the risk to these individuals,” the report's authors write, since controlling for these characteristics still resulted in greater risk for COVID-19 diagnosis and death among people with dementia.

"This may be the result of COVID-19's damaging effects on pulmonary, cerebrovascular and renal systems, which may already be compromised by underlying diseases associated with dementia,” they theorize.

Other studies suggest that people with dementia may be more susceptible to COVID-19 because of blood-brain barrier (BBB) damage that makes it easier for viruses and bacteria to get from the person's blood into the brain.

Memory impairment can also make it more difficult for someone with dementia to follow COVID-19 prevention efforts such as social distancing, mask wearing and frequent handwashing. Depression, loneliness and social isolation brought on by the pandemic may also contribute to higher rates of mortality.

COVID-19 is now the third-leading cause of death in the U.S., according to provisional government data. Alzheimer's disease, which affects about 6.2 million Americans over 65, is the seventh.

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