The impact of COVID-19 pandemic on community-dwelling older adults with ADRD

Project Summary. Persons with ADRD face significant challenges under the pandemic of coronavirus disease2019 (COVID-19). First, persons with ADRD are at a high risk for COVID-19 because they are generally olderadults with comorbidities. In addition, persons with ADRD may have difficulty understanding the disease andfollowing the safety procedures, thus making them more susceptible to COVID-19. Furthermore, the generalramifications stemming from the pandemic may affect the usual medical care received by persons with ADRD.Persons with ADRD often have cognitive impairment and are likely to develop disruptive behaviors. Thus, theymay need routine medical and/or psychiatric services to manage their chronic conditions and to address theirmental health issues. They are more likely to benefit from in-person medical visits, which has been greatlyinterrupted during the pandemic. Although the CMS has expanded telemedicine benefits, persons with ADRDmay find telecommunication as the means of receiving healthcare, difficult. Lastly, the majority of persons withADRD live in community, and they may need in-person long-term services and supports (LTSS) to assist withtheir daily living and psychological or emotional care needs. The pandemic may have reduced the availabilityof these supports and services. In addition, caregivers (not residing in the same household) may have to wearpersonal protective equipment to deliver services, causing confusion and upset that trigger behavioral issuesamong patients. These changes in care may have made it more difficult for persons with ADRD to maintaincommunity living and may accelerate the likelihood of institutionalization. The impact of COVID pandemic onblacks with ADRD could be particularly significant. It has been shown that blacks with ADRD tend to havehigher levels of cognitive impairment than their white counterparts. At the same time, it has been revealed thatblacks are at disproportionally high risks for COVID-19 infection and death. These racial differences are likelytriggered by socioeconomic determinants. For example, blacks tend to aggregate in disadvantagedcommunities with fewer resources and supports and higher rates of COVID-19 infection. To date, it is unclearhow this pandemic affects persons with ADRD, both regarding the risk of and severity of COVID-19, aswell as their needs for usual medical care and LTSS (that are not directly related to COVID-19), andhow such impacts vary by individual's race. This proposed study has two Aims: 1) to examine the risk ofCOVID-19 and the severity of illness (hospitalization, ICU, death) among community dwelling older adults withADRD, and how that varies by individual's race; 2) to examine the impact of this pandemic on non-COVIDrelated health care utilization (e.g. hospitalization, ER visits, nursing home placement) among this population,and how that varies by race. The proposed research is significant as the findings will provide valuable andtimely information on how this public health crisis affects the vulnerable older population with ADRD, andinform future efforts aimed at reducing racial disparities in health among this already vulnerable population.