Exploring the unmet needs facing individuals with Alzheimer’s disease and related dementias during the COVID-19 pandemic

ABSTRACT

Background Many adults with ADRD rely on support from friends, family members, social service agencies, and their communities to meet their basic needs. It is unclear if COVID-19 mitigation policies have made it more difficult for individuals with ADRD to receive this support. The objective of this study was to explore the types of unmet needs experienced by adults with ADRD in the United States during the COVID-19 pandemic as well as the characteristics of adults with ADRD that are experiencing unmet needs. Method We performed a cross-sectional analysis of the Medicare Current Beneficiary Survey (MCBS) summer and fall 2020 COVID-19 supplemental surveys. The MCBS uses complex survey design to provide a nationally representative sample of Medicare beneficiaries. There were 20,800 survey participants in total and 4.07% have received a diagnosis with ADRD. Logistic regression was used to examine the characteristics of those reporting one or more unmet need. Result 16.61% Medicare beneficiaries with ADRD reported having one or more unmet needs during the COVID-19 pandemic (vs. 16.52% Medicare beneficiaries without ADRD, p=0.956). While beneficiaries with and without ADRD had no difference in unmet needs surrounding rent/mortgage, food, supplies, and medications, adults with ADRD had higher rates of unmet need for healthcare services (8.86% vs. 5.77%, p=0.008). Adults with ADRD were more likely to report having an unmet need between March-June than between July-November (18.10% vs. 7.84%, p<0.001). Among those with ADRD, individuals with depression (AOR=2.25, p=0.001) and multimorbidity (AOR=1.79, p=0.030) reported significantly higher unmet need, after controlling for age, sex, race/ethnicity, insurance, and geographic location. As compared with individuals without ADRD, individuals with co-existing ADRD and depression (p<0.001) or co-existing ADRD and multimorbidity (p<0.001) reported higher likelihood of having unmet needs. Conclusion Many adults with ADRD experienced unmet need during the first 4 months of the COVID-19 pandemic. We also found that the ADRD patients with depression and complex health needs who require greatest number of healthcare services were more likely to voice unmet needs. The residual impact of unmet needs during the early pandemic months and on-high risk subpopulations is currently unknown.