Coronavirus and Alzheimer’s Disease. Protecting Our Vulnerable Older Adults

James M. Ellison, MD, MPH

Swank Center for Memory Care and Geriatric Consultation, ChristianaCare

  • Expert Advice
Published on:
A medical illustration of the virus that causes COVID-19.

Learn some tips to protect those with Alzheimer’s and related dementia from the coronavirus.

In the Midst of a Pandemic

At the time of this writing, we are in the midst of a second wave of the coronavirus disease 2019 (COVID-19) pandemic. Our health care providers and our leaders are reminding us that the best way to survive this wave of infection is to avoid catching it in the first place. The most promising way to slow the spread of the virus is to protect others from infection. Business can no longer be “business as usual” for now. We must all pay greater attention to personal hygiene, masking and social distancing.

Protecting Older Adults from COVID-19

As we endeavor to protect our population, we have to pay special attention to the safety of our older adults with Alzheimer’s disease (AD) and related dementias. In the United States, residents of long-term care facilities have constituted the majority of COVID-19 deaths.  Many of these COVID-19 victims have suffered from dementia. Dementia is not in itself a cause of infection, but it increases the risk of getting infected, for spreading infection, and for having a more serious disease outcome.

Cognitive Impairment Increases Risk of COVID-19

Cognitive impairment gets in the way of self-protection because a vulnerable person may not understand the risk of disease or remember to be as careful as necessary. This makes a person with dementia an easier target for coronavirus infection.

Hand hygiene, which even people with good memories often forget, is a real problem for anyone with significant memory impairment. Covering coughs, too, requires vigilance and executive function.

Social distancing is tough to keep in mind for an older person who was looking forward to a loving hug from a visiting relative. Long-term care facilities have limited visits and contact, which has reduced infection risk but increased residents’ isolation. Some cognitively impaired people may not be able to understand the reason for less contact and fewer visits, adding to their sense of loneliness.

Symptom awareness is another hazard to keep in mind. Someone whose self-awareness is diminished may not recognize the presence of a cough or nausea or might forget to mention an episode of coughing or even vomiting to a care provider. We need to be particularly aware of this when caring for older adults in long term care institutions where they may be in close proximity to others who are symptomatic or asymptomatic carriers. A frustrating feature of COVID-19 infection for all of us is that infected people can spread the virus for days before developing symptoms.

These same dementia-related cognitive limitations can contribute to disease spread. It was not surprising to learn that one of the initial infection clusters in the United States developed in a nursing home. Long-term care facilities are much like cruise ships, another potential locus for infection spread, in that residents are in close contact and, therefore, at greater risk.

Older Adults are More Vulnerable to Severe Illness

Once infected, older adults with dementia are, unfortunately, likely to develop a more severe and dangerous illness. Although most COVID-19 infections are not lethal, and many are mild, we do not yet have accurate estimates of the mortality rate associated with this disease. The COVID-19 death rate is likely to be more than a hundred times the rate associated with flu. We do know already that older age and medical illnesses such as heart or lung disease or diabetes increase the risk for COVID-19 severity and death, which often follows severe effects on the lungs.1 The diseases which make an older adult more vulnerable to coronavirus are frequent age-associated chronic conditions present in many of our older community-dwelling adults and probably in the majority of our institutionalized older adults.

Furthermore, as we age, our immune systems may be less able to fight off infection. In one recent report, 80 percent of all United States COVID-19 deaths were among adults 65 years or older, and the rate of severe outcomes was highest among those 85 years and older.1

Tips for Protecting People with Dementia from COVID-19

In light of these concerns, what can we do to protect our elders and especially those with dementia? Let’s work, first, to minimizing virus exposure.

A person with dementia, at this risky time, should not be exposed unnecessarily to gatherings, public transportation, or unnecessary visitors who may be infected even if they are not showing symptoms. Many older adults with dementia are cared for in their own homes or in the homes of family members, and their caregivers will need to be extra careful about their own health and safety.

That means proper handwashing hygiene, covering coughs, self-quarantining if appropriate, and disinfecting surfaces on which the virus may be living (as it is capable of doing for a week in some cases).

Written reminders in the bathroom and elsewhere may help to remind people with cognitive impairment to wash their hands with soap and water. Alcohol-based hand sanitizers can provide a convenient and quicker alternative, though it may be less effective.

For those who reside in long-term care settings, visiting restrictions and staff education and intervention will help to avoid unnecessary exposure from visitors and gatherings, to keep surfaces disinfected, to note the emergence of possible symptoms, and to isolate those with suggestive symptoms.

Many day programs have switched to virtual attendance. Now is a good time for cognitively impaired older adults to avoid unnecessary mingling,  to stay home or in a long-term care facility, to stockpile an extra month or two of necessary medications in preparation for possible shortages or health care provider unavailability, and to attend health care appointments via telehealth rather than in person when possible.


Our current pandemic crisis will leave its shadow over our society and economy for a long time.

We have a duty to protect the most vulnerable among us, a group that includes older adults with cognitive impairment. Preventing infection must be paramount in our minds, particularly for those at greater risk.


  • Do not bring patients on public transportation
  • Do not allow patients to attend public gathering
  • Limit unnecessary visitors to the elderly
  • Post written reminders in the bathroom and elsewhere to
    remind everyone to wash hands with soap and water
  • Make alcohol-based hand sanitizers available if that makes
    it easier to keep hands clean



  • Be mindful of transmission risks and avoid non-essential
  • Follow proper hand-washing protocols
  • Cover coughs
  • Self-quarantine if appropriate
  • Disinfect surfaces regularly
  • Note the emergence of possible symptoms as soon as possible
  • Stockpile 1-2 months worth of necessary medications in case of possible shortages
  • Replace in-person doctor appointments with telehealth
    appointments whenever possible


About the author

Headshot of Dr. James Ellison

James M. Ellison, MD, MPH

Swank Center for Memory Care and Geriatric Consultation, ChristianaCare

James Ellison, MD received his medical degree from UCSF in 1978 and trained in psychiatry at the Massachusetts General Hospital (1979-1982).

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