Clinical Scorecard: Impact of Alzheimer’s Disease and Related Dementias on Racial Disparities in COVID-19 Outcomes Among Nursing Home Residents

At a Glance

Key Highlights

• Black nursing home residents had higher incidence of COVID-19 infection and hospitalization compared to White residents, but not higher mortality.
• Racial disparities in hospitalization and combined hospitalization or death were more pronounced among residents with ADRDs.
• ADRD status may exacerbate racial disparities in COVID-19 outcomes due to increased care complexity and challenges in symptom assessment.

Guideline-Based Recommendations

Diagnosis

• Use comprehensive electronic health records including Minimum Data Set clinical assessments to identify ADRD status and COVID-19 infection.
• Recognize challenges in assessing COVID-19 symptom progression in residents with ADRDs, especially in locked dementia care units.

Management

• Implement targeted infection control and prevention measures in nursing homes, with special attention to residents with ADRDs.
• Provide staff training to effectively care for residents with ADRDs to potentially reduce adverse COVID-19 outcomes.
• Address structural factors contributing to racial disparities in care and outcomes.

Monitoring & Follow-up

• Monitor COVID-19 infection rates, hospitalizations, and mortality stratified by race and ADRD status.
• Use parametric g-formula or similar epidemiologic methods to assess disparities without bias from adjusting for mediators.

Risks

• Increased risk of COVID-19 transmission in congregate living and locked dementia care units.
• Higher risk of hospitalization and death among Black residents with ADRDs due to compounded vulnerabilities.
• Potential underestimation of disparities if mediators are improperly adjusted for in analyses.

Patient & Prescribing Data

Nursing home residents with and without ADRDs, stratified by race (Black and White).

No specific pharmacologic treatment data provided; emphasis on infection control, monitoring, and tailored care for residents with ADRDs to mitigate disparities.

Clinical Best Practices

• Leverage comprehensive EHR data including cognitive assessments to identify high-risk residents.
• Recognize ADRDs as a modifier that exacerbates racial disparities in COVID-19 outcomes.
• Enhance staff training and resources to address the complex care needs of residents with ADRDs.
• Implement infection prevention strategies tailored to dementia care units.
• Use advanced epidemiologic methods to accurately estimate and monitor disparities.

References

• Brown University Institutional Review Board approval and data use agreements
• Minimum Data Set (MDS) clinical assessments