We know by now that COVID-19 disproportionately affects adults 65 years and older, who are more likely to have severe outcomes. Older adults account for up to nearly two thirds of hospital admissions in the United States due to the coronavirus. On top of this, measures implemented to slow the spread of the virus, such as social distancing, stay-at-home orders, and no-visitor policies disproportionately impact older people, many of whom rely on others for their well-being.
While lifesaving procedures in the ICU and social distancing measures are vitally important, they may lead to long-term consequences for our older population: specifically, a rising wave of dementia in the wake of the current COVID-19 pandemic. COVID-19 is directly relevant to the cognitive health of the aging brain in a number of ways, including the effects of the disease, treatments, and current society. Fortunately, there are promising strategies that can help mitigate this increased risk in older adults:
We need more research on how COVID-19 may affect the brain. Early results have shown that COVID-19 may cause brain effects such as encephalopathy, similar to the 2002 Severe Acute Respiratory Syndrome, which showed seizures and brain tissue injury. Moreover, COVID-19 causes respiratory failure, which is linked to increased risk of dementia due to a lack of oxygen to the brain. Encouragingly, agencies have already started prioritizing research on the brain effects of COVID-19, including the National Institutes of Health and the American Heart Association.
Health care teams should consider interventions that alleviate the consequences of intensive hospitalization on the older brain. Ventilator and sedation use, vital interventions for COVID-19, can cause distressing cognitive changes such as delirium, a state of sudden and severe confusion. Delirium affects up to half of hospitalized older adults and increases risk for dementia in the long term. More generally, emergent and urgent hospitalizations have been linked to an increased risk of dementia, especially those involving critical care. For many older adults with lowered reserve capacities, it can be very difficult to bounce back from a severe illness and intensive care to regain their previous level of cognitive function.
However, validated protocols exist to address ICU delirium that do not overly burden health care teams that are already being stretched. Interrupting sedative medications daily or orienting patients to their surroundings during normal care can help prevent delirium. Long-term impaired memory and thinking are observed long after discharge as a result of post-traumatic stress. Psychological support in the form of mental health services and evidence-based mindfulness activities after hospitalization should be incorporated into discharge planning.
We must make collective efforts to alleviate the cognitive impact of social isolation. Even for older adults who avoid COVID-19, social distancing efforts may unfortunately increase dementia risk. Social distancing, shelter-in-place mandates and limits on nursing home visitation will likely result in marked social isolation for vulnerable older adults, leading to debilitating mental health issues. Social isolation and loneliness are linked to a higher likelihood of declines in memory in old age, as are stress and depression.
Stay-at-home orders and public park closures inhibit regular physical activity, and exercise is one of the more widely recognized contributors to healthy brain aging. Student volunteer programs could be optimized to teach older adults to use smart phones or webcams to connect with loved ones virtually. Retirement facilities and nursing homes can promote safe activities, such as walking outdoors, to encourage regular movement and provide much-needed routine. Finally, community-based organizations can help to provide social support, check on seniors, and assure that essential needs such as groceries are met for those living alone.
As researchers who study the impact of health behaviors and life events on risk for dementia, we foresee another health care crisis looming for older adults as a result of the coronavirus pandemic. In our work, we have seen the importance of promoting lifestyle activities for optimizing brain health in the aging population. Our communities and health care infrastructure are already facing a rising wave of dementia in the aging baby boom generation; the COVID-19 pandemic will only exacerbate this situation.
Additional government funding and support are needed now more than ever to address this building dementia crisis. Research, health care and public health entities must work collaboratively to build interventions and systems to support older adults with cognitive impairment and their families. Such collaboration is our best strategy to support our older adult populations against a rising tide of dementia after the curve of the COVID-19 pandemic is flattened.