. Persons with ADRD face significant challenges under the pandemic of coronavirus disease 2019 (COVID-19). First, persons with ADRD are at a high risk for COVID-19 because they are generally older adults with comorbidities. In addition, persons with ADRD may have difficulty understanding the disease and following the safety procedures, thus making them more susceptible to COVID-19. Furthermore, the general ramifications 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, they may need routine medical and/or psychiatric services to manage their chronic conditions and to address their mental health issues. They are more likely to benefit from in-person medical visits, which has been greatly interrupted during the pandemic. Although the CMS has expanded telemedicine benefits, persons with ADRD may find telecommunication as the means of receiving healthcare, difficult. Lastly, the majority of persons with ADRD live in community, and they may need in-person long-term services and supports (LTSS) to assist with their daily living and psychological or emotional care needs. The pandemic may have reduced the availability of these supports and services. In addition, caregivers (not residing in the same household) may have to wear personal protective equipment to deliver services, causing confusion and upset that trigger behavioral issues among patients. These changes in care may have made it more difficult for persons with ADRD to maintain community living and may accelerate the likelihood of institutionalization. The impact of COVID pandemic on blacks with ADRD could be particularly significant. It has been shown that blacks with ADRD tend to have higher levels of cognitive impairment than their white counterparts. At the same time, it has been revealed that blacks are at disproportionally high risks for COVID-19 infection and death. These racial differences are likely triggered by socioeconomic determinants. For example, blacks tend to aggregate in disadvantaged communities with fewer resources and supports and higher rates of COVID-19 infection. To date, it is unclear how this pandemic affects persons with ADRD, both regarding the risk of and severity of COVID-19, as well as their needs for usual medical care and LTSS (that are not directly related to COVID-19), and how such impacts vary by individual's race. This proposed study has two Aims: 1) to examine the risk of COVID-19 and the severity of illness (hospitalization, ICU, death) among community dwelling older adults with ADRD, and how that varies by individual's race; 2) to examine the impact of this pandemic on non-COVID related 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 and timely information on how this public health crisis affects the vulnerable older population with ADRD, and inform future efforts aimed at reducing racial disparities in health among this already vulnerable population.
This proposed research aims to understand potential impacts of COVID-19 pandemic on community-dwelling older adults with ADRD, both regarding the risk of and severity of COVID-19, as well as individual needs for usual medical care and long-term services and supports (LTSS), and how such impacts vary by individual's race (black versus white). This proposed research is highly relevant to public health because the findings from this study will provide valuable and timely information on how this public health crisis affects the vulnerable older population with ADRD, and provide implications on reducing racial disparities in this already vulnerable population.
