Dementia and coronavirus risk

Catching coronavirus

Risks for people with dementia at home

A person living with dementia who has memory problems or confusion may struggle with the guidance and rules around coronavirus. These include frequent handwashing, and social distancing when outside to reduce the risk of catching the virus.

So, without help to stay safe, someone with dementia may be more likely to become infected with the virus.

Someone who has paid carers coming in and out to support them may also be more likely to catch coronavirus. The carers should not stop coming, but should use measures like an apron, mask and gloves.

Risks for people with dementia living in residential care

A person with dementia who lives in a care home is at a significantly higher risk of getting coronavirus.

This is partly because frailer older people have weaker immune systems that are less able to fight off infections. It’s also because people in care homes live very closely together.

The person may easily catch coronavirus from another resident, from a visitor or care worker, or from a communal surface with virus on it.

Talk to the care home about any concerns you have and how you can visit the person safely or support the person from a distance.

Severe COVID-19 illness

If a person with dementia does catch coronavirus, they are at higher risk of getting worse COVID-19 illness.

The main reason for this is that most people with dementia are older. The risk of severe symptoms rises steeply with age, and nine out of every 10 deaths have been people over 60. Most people with dementia and many older carers will fall into a higher risk group on age alone.

Long-term health conditions also significantly raise the risk of severe COVID-19. Some of the more common of these, such as heart or blood vessel disease and diabetes, are more often seen in people with dementia. 

There is some evidence that dementia itself may add a further risk on top of age and these other health conditions. 

It is not clear why, but men and people from black and minority ethnic communities, with or without dementia, are also at increased risk. This link is not explained by age or long-term health conditions.

How does the government define vulnerable?

The issue of who the government recognises as vulnerable from coronavirus is complicated but important. It can affect the support available and when people are vaccinated.

The group of people identified as ‘clinically extremely vulnerable’ are mainly those with health conditions that put them at very high risk of severe symptoms if they catch the virus. This is why they are being offered the vaccine ahead of the general population.

There are now three ways a person can be added to the clinically extremely vulnerable (or ‘shielded patient’) list, and so qualify for earlier vaccination. These are:

1. people identified early in the pandemic as having a serious lung condition or greatly weakened immune system. They don’t include people with dementia unless they have any of these conditions, including a kidney transplant, severe chronic obstructive pulmonary disease or certain cancers. (See the government’s full list on GOV.UK). These people are those who were ‘shielding’ (staying at home at all times) between March and August 2020.
2. people added to the list by their doctor’s assessment of their risk of severe COVID-19.
3. people added by their doctor based on a new COVID risk assessment. This is a detailed way for professionals to estimate a person’s COVID-19 risk from their: 
   • age
   • body mass index
   • health (including dementia) and treatments
   • ethnicity 
   • postcode (and the statistics for living standards in their local area).

National advice to shield is no longer being issued to this group of people. Instead, everyone in the clinically extremely vulnerable group must follow the national rules extremely carefully. They should continue to keep their number of social interactions low, and limit the time they spend in places where social distancing is hard or impossible. 

These rules apply even when people have had one or both coronavirus vaccinations. 

What does this mean for people with dementia?

So, for most people with dementia their risk of severe COVID-19 illness is not as high as for the ‘shielded’ group. As explained above, however, people with dementia and many older carers are at higher risk than the general population. Therefore, people with dementia are ‘vulnerable’ on health grounds, but not generally ‘clinically extremely vulnerable’. The exceptions will be in the second and third examples above.

Separately, anyone with dementia and many carers are already seen as ‘vulnerable adults’ by the NHS and social care. This term is commonly used when talking about general support needs or a person’s ability to protect themselves from harm. It is not directly linked to coronavirus.

These terms ‘vulnerable’ and ‘clinically extremely vulnerable’ can make a difference, for example when it comes to food shopping.

The clinically extremely vulnerable group automatically qualify for help with delivery of food or medicines from NHS volunteer responders.

People with dementia should still be treated as vulnerable customers by supermarkets or other suppliers and so be eligible for arrangements such as dedicated shopping times.