For older adults and those with chronic conditions like Alzheimer’s disease, the risk of severe illness and death from COVID-19 only escalates, according to the Centers for Disease Control and Prevention (CDC) (PDF). Figures provided by the Alzheimer’s Association show that more than 41,000 extra deaths from Alzheimer’s or another dementia occurred in 2020, when compared with the average yearly deaths over the period from 2015 to 2019. The total number was about 16 percent higher than expected. What has led to the surge in deaths in this population, and what can people do to help protect loved ones with Alzheimer’s and other dementias?
A Perfect Storm of Debilitating Circumstances
“The COVID tsunami created a perfect storm of factors that made the Alzheimer’s community one of the hardest hit,” says Dean Sherzai, MD, PhD, MPH, the codirector of the Brain Health and Alzheimer’s Prevention Program at Loma Linda University in California. A study published on February 9 in the journal Alzheimer’s & Dementia found that people with dementia were twice as likely as those without dementia to become infected with COVID-19. It additionally found that among people with dementia, Black individuals were nearly three times as likely to become infected as white individuals. The researchers, who analyzed nearly 62 million electronic health records, found that even older age and known COVID-19 risk factors, such as residing in a nursing home or having a chronic disease, didn’t fully account for the elevated risk seen in people with dementia. But for Alzheimer’s patients, vulnerability to COVID-19 is compounded by the fact that most are age 65 or older, and they often have other comorbidities, such as diabetes, hypertension, heart disease, and obesity. A study published in May 2020 in the International Journal of Environmental Research and Public Health noted that this population can struggle to communicate and describe symptoms, so detection and treatment of comorbidities can be incredibly difficult. They may also not recognize COVID-19 symptoms if they have them, which further jeopardizes their well-being. On top of that, confusion brought on by their decline in memory and cognitive abilities can make it challenging to keep up with needed treatments. “One of the earliest signs of Alzheimer’s is difficulties with medication management,” says Howard Fillit, MD, the founding executive director and chief science officer of the Alzheimer’s Drug Discovery Foundation. “When people are on five or more medications, which many of these patients are, they may have difficulty managing their diabetes [for example], which puts them at more risk for the complications of COVID.” In addition, Dr. Sherzai says that confusion from Alzheimer’s can create a crippling anxiety in patients. “The stress becomes so massive that it actually affects your health.”
Pandemic Concerns Disrupt Alzheimer’s Care
As Alzheimer’s patients lose more mental capacity, they depend more on family, friends, and professional caregivers. But the infectious virus has interfered with regular care and limited patients’ contact with other people. In many cases, these individuals may not be getting optimal medical attention. “To protect against infection, some family members and caregivers have not been able to see loved ones as much, so they have not been there to recognize symptoms of delirium and other problems,” says Marie Pasinski, MD, a neurologist at the McCance Center for Brain Health at Massachusetts General Hospital, in the Boston area, who also serves on the advisory board for the Women’s Alzheimer’s Movement. “A lot of care facilities are understaffed, and nurses and health aides have been stretched to the max.” A complicating factor, according to Dr. Fillit, is that Alzheimer’s patients require more hands-on care with things like dressing, bathing, toileting, and eating as their mental functions deteriorate, and this type of physical attention puts individuals at greater risk of contracting COVID-19. As a way to help prevent person-to-person transmission of the virus, Sherzai and other healthcare providers have been seeing patients through Zoom, but he believes patient healthcare can suffer when it’s not delivered in person. “I’m not physically checking them,” he says. “I’m not seeing blood pressure, arrhythmias, weight loss, and other factors that accumulate over time.” RELATED: Resources for People Coping With Alzheimer’s Disease
Isolation Contributes to Decline in People With Dementia
To avoid spreading the virus, some care facilities have kept residents basically quarantined in their rooms; they can’t see loved ones, socialize with others, or, in some cases, even leave to take a walk or exercise. “I think that social isolation in that situation is terrible, and especially for a demented person with Alzheimer’s disease,” says Fillit. “I just think it leads to depression, deconditioning, greater risk of falls, and probably weight loss, because they may lose appetite.” Explaining why they can’t see or hug a loved one and why people are wearing masks can contribute to confusion and stress. In some situations, an individual with Alzheimer’s may receive close attention from a dedicated professional caregiver or loved one who remains virus-free by staying secluded with the patient. Fillit warns, however, that this type of intense isolation and togetherness can exact a toll on the caregiver. “I have patients who live in a one-bedroom apartment with their spouse [who is the caregiver],” he says. “Hearing the spouse with Alzheimer’s ask 20 times a day, ‘Where are we going tonight?’ can make you want to strangle the person.” Add to that shopping, cooking, cleaning, and tending to many of the patient’s needs, and that caregiver can get burned out. Make sure the patient is as safe from illness as possible. Because Alzheimer’s patients are at such high risk for serious complications from the coronavirus, caregivers will want to do all they can to keep them from sources of infection. Check that the patient is limiting the number of personal interactions and that when they do meet with others, masks are worn by all parties. It may be advised that a regular caregiver is vaccinated or regularly tested minimize the chance of transmitting the virus. Connect virtually if that’s the only option. When meeting in person is too difficult or not possible, connecting by phone or video chat can be helpful. “The number-one responsibility that families and friends have is to connect — especially around memories that are familiar,” says Sherzai, who, with his wife Ayesha Sherzai, MD, coauthored The Alzheimer’s Solution: A Breakthrough Program to Prevent and Reverse the Symptoms of Cognitive Decline. “Bring in stories from the past that really stand out, and build around that link. That’s a responsibility we all have to our loved ones.” Try to visit safely in person. Alzheimer’s patients can benefit from face-to-face interaction. “Physical contact has powerful effects on our health,” says Dr. Pasinski. “It actually turns on this comprehensive relaxation response, which decreases stress hormones.” So friends and family who can take precautions when visiting (wear a mask, stay at a safe distance) or can be tested or vaccinated may want to do so and arrange to see the affected person when possible. Make sure your loved one’s needs are being met. Those involved with the care of an Alzheimer’s patient need to check that all of his or her needs are addressed. Alzheimer’s patients may have difficulty communicating symptoms of illness, so caregivers should pay close attention to the patient’s physical status — including making sure they are taking their medications and getting proper medical care. “Getting physical activity and mental stimulation, and spending time with others are pillars of brain health,” says Pasinski. Give the primary caregiver a break. Fillit emphasizes that “the stress on caregivers has been tremendous.” In some situations, caregivers may be overwhelmed with providing attention around the clock, and family members have to see to it that a regular caregiver is given the support they need. “If the caregiver fails, the patient will fail,” says Fillit. “So it’s really important that the caregiver find a way to get rest and support.” Family members and caregivers can find more guidance and resources at the Alzheimer’s Association, the Women’s Alzheimer’s Movement, and the Alzheimer’s Drug Discovery Foundation.
