Relationship between dementia, COVID-19 risk, and adherence to COVID-19 mitigation behaviors among older adults in the United States.

Abstract

ObjectivesTo examine how dementia is associated with COVID‐19 risk and adherence to COVID‐19 mitigation behaviors, and whether mitigation behaviors mediate the relationship between dementia and COVID‐19 risk.Methods/DesignWe analyzed 2019 and 2020 data from the National Health and Aging Trends Study, a national prospective cohort study of United States older adults age 65+. Outcomes were COVID‐19 diagnosis and adherence to COVID‐19 mitigation behaviors (handwashing, mask‐wearing, and social distancing).ResultsAmong the 3257 older adults in this study, 485 (14.9%) had dementia in 2019 and 98 (3.1%) were COVID‐19 positive in 2020. Dementia significantly increased the odds of COVID‐19 by 129% (odds ratio [OR] = 2.29, 95% confidence interval [CI] 1.32–3.97), and remained elevated after adjusting for sociodemographics and health (OR = 1.67, 95% CI 0.90–3.11). Dementia significantly decreased the odds of handwashing by 72% (OR = 0.28, 95% CI 0.17–0.44), which remained lower after adjusting for sociodemographics and health (OR = 0.53, 95% CI 0.23–1.21). Dementia was not significantly associated with mask‐wearing and social distancing. The relationship between dementia and COVID‐19 was primarily mediated by functional impairment, income, and residential setting.ConclusionsDementia was associated with an increased COVID‐19 risk and lower adherence to handwashing among U.S. older adults. Adherence to COVID‐19 mitigation behaviors did not mediate COVID‐19 risk by dementia status. For older adults with dementia, COVID‐19 risk could be decreased by prioritizing health interventions.