Post COVID-19 Experiences Among Adults with ADRD: Individual, Provider and Community Characteristics Associated with Improved Health Outcomes

COVID-19 has disproportionately impacted older individuals with Alzheimer’s Disease and Related Dementias (ADRD), for whom COVID-19 mortality rate was twice as that of older patients without ADRD. Even among survivors, COVID-19 may have further amplified the short-, medium- and long- term morbidity among ADRD patients. The rationale of the proposed research is that a better understanding of how COVID-19 infections and severity of infection has shifted future trajectories of healthcare utilization among ADRD patients will enable designing more effective interventions for older adults with ADRD whose care needs and quality of life may have been altered post-COVID-19 infection. This research will be essential for informing optimal policy responses (now and in the future) and will align with the NIH NIA’s goal to characterize measures or short and medium- term post-COVID-19 healthcare use among fee-for-service Medicare and Medicare Advantage enrollees with prevalent ADRD. We hypothesize that among those with diagnosed COVID-19, people with ADRD will exhibit more severe effects even after adjusting for standard factors, and that these effects will differ by intensity of COVID disease. In addition to ADRD diagnoses, we will construct diagnoses measures of different aging-related brain syndromes (Mild Cognitive Impairment, delirium, etc.), as well as baseline frailty and comorbidity for each patient. We will follow them through a COVID-19 diagnosis or hospitalization, a successful discharge (if hospitalized), and subsequent mortality (in and out of hospital), post-ICU readmission, and other relevant health care use measurable in claims data. Our second specific aim will identify individual sociodemographic, clinical, setting-of-care and geographical factors associated with improved recovery post-COVID19 among patients with ADRD. This research will advance the goals of the parent grant, NBER Center for Aging and Health Research by expanding our understanding of the challenges associated with the compounding impact of the COVID-19 pandemic on delivery of care for patients with ADRD, in preparation for an R01 to continue to study long term outcomes. Understanding the factors associated with improved long-term outcomes of people experiencing COVID-19 will help local, state and national policy makers design strategies to tailor for the needs of rapidly growing population of ADRD and at-risk of ADRD patients and for distribution of resources for this vulnerable group of citizens.