Introduction
Older people living with dementia are particularly vulnerable during infectious disease outbreaks and the COVID-19 pandemic is no exception. Those at most risk of dying due to COVID-19 are older adults with underlying health problems, and dementia is one of the most common co-existing conditions among people who die from COVID-19 (Wang et al. 2020; Morgan et al. 2020).
Less understood but equally important are the indirect effects of COVID-19 on people living with dementia. Provision and uptake of preventive and routine healthcare services has decreased during the pandemic, and services such as elective surgeries, respite and home care, allied health care, and memory clinic assessments where dementia is often diagnosed, have been disrupted (Pearce et al. 2020; Sutherland et al. 2020; Royal Commission 2020). This reduced level of care may lead to poorer population health outcomes due to delayed diagnoses, increases in preventable conditions and injuries (including falls) and poorer medication management. Further, the impact of enforced isolation to combat the virus, including lockdowns and/or strict social distancing measures in permanent residential aged care homes (where it is estimated more than half of people have dementia) appears to have resulted in spikes in depression, anxiety, confusion, loneliness and suicide risk among those in care (Royal Commission 2020).
On the other hand, overall death rates have fallen in some countries such as New Zealand and Australia due to higher rates of influenza immunisation, social distancing measures, and stricter infection control protocols (Kung et al. 2021; ABS 2020a). In Australia, enforced isolation in residential aged care homes has likely been the driving factor behind the drop in overall deaths among people living in residential aged care during the 2020 influenza season compared with the previous year (Department of Health 2020).