Dementia and COVID-19 Risk: What Caregivers Need to Know

Yes, having dementia does increase the risk of dying from COVID-19, but this doesn't mean you're powerless. Research shows that people with dementia—whether living at home or in a nursing home—face higher risks of severe illness and death from COVID-19, partly because of age, other health conditions, and the challenges dementia creates for following safety measures. The good news is that understanding these risks helps you take concrete steps to protect your loved one, from vaccination to creating a safer environment. You are not alone in this, and small, consistent actions can make a real difference.

Key points

Dementia is an independent risk factor for severe COVID-19 and death, even after accounting for age.
People with dementia living at home have similar death rates from COVID-19 as those in nursing homes—don't let your guard down.
Delirium is common with COVID-19 in older adults and triples the risk of death; watch for sudden confusion or sleepiness.
Vaccination and boosters are the most powerful protection—talk to the doctor about the best schedule.
Create a written emergency plan with medications, doctor contacts, and a 'delirium alert' card for hospital visits.
Caregiver health matters: get vaccinated, wear masks, and have a backup plan if you get sick.

Why Dementia Raises COVID-19 Risk

Dementia itself is a risk factor for severe COVID-19 and death, independent of age. Studies from the UK and elsewhere have shown that people with dementia are more likely to be hospitalized and die from COVID-19 compared to those without dementia, even after accounting for age and other health issues. This is not just because people with dementia are often older—though age is a major factor—but because the brain changes of dementia can weaken the body's ability to fight infection and recover.

Additionally, dementia often comes with other conditions that raise COVID-19 risk, such as heart disease, diabetes, or lung problems. The cognitive and physical challenges of dementia—like difficulty understanding or remembering safety guidelines, trouble wearing masks, or needing close-contact care—can also increase exposure. For example, people with dementia living in nursing homes or receiving home care may have more contact with caregivers who could unknowingly carry the virus.

Importantly, the risk of dying from COVID-19 is similar whether a person with dementia lives at home or in a nursing home. One study found death rates around 31-32% in both settings, suggesting that dementia itself, not just the living situation, drives the higher risk. This means that even if your loved one is at home, you need to take extra precautions.

The Role of Delirium and Other Factors

Delirium—a sudden state of confusion, agitation, or drowsiness—is very common in older adults with COVID-19 and is especially dangerous for people with dementia. Research shows that delirium occurs in about 28% of people over 65 admitted to the hospital with COVID-19, and in up to 75% of those in the ICU. Having delirium during COVID-19 triples the risk of death, even after adjusting for age and dementia. This is critical because dementia already makes a person more prone to delirium from any illness, and COVID-19 can trigger it easily.

Other factors that raise risk include advanced age (people 65+ have 60-340 times higher risk of COVID-19 death than younger adults), lung diseases like COPD, obesity (especially with BMI over 40), chronic kidney disease, and conditions that weaken the immune system. Many of these are common in people with dementia, creating a 'perfect storm' for severe COVID-19.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

Monitor for sudden confusion, agitation, or drowsiness (delirium) and seek urgent medical care if these appear.
Follow strict infection control: hand hygiene, masking, and limiting visitors for the person with dementia.
Ensure COVID-19 vaccination and boosters are up to date for the person with dementia and all caregivers.
Prepare a written emergency plan including medication lists, advance directives, and hospital contact preferences.

What not to do

Do not assume delirium is just part of dementia; it may indicate COVID-19 or other acute illness requiring immediate evaluation.
Do not delay COVID-19 testing or medical attention due to fear of behavioral challenges.
Do not rely solely on verbal reminders for safety measures; use visual cues, structured routines, and direct assistance.

Practical tools

Delirium recognition checklist
A brief tool (e.g., CAM or 4AT) to quickly identify sudden changes in attention, confusion, or drowsiness vs. baseline dementia.
Emergency information card
Pre-printed card with the patient's diagnosis, medications, allergies, and advance directives to hand to EMS or hospital staff.

What preventive actions and vaccines should high-risk older adults use against COVID-19?

Talk to your loved one's doctor about staying up-to-date on all recommended COVID-19 vaccines and boosters, as they are the most powerful protection for someone with dementia.

Does mild COVID-19 cause brain shrinkage, cognitive decline, depression, or anxiety?

Research is still evolving, but you can protect your loved one's brain health by watching for any sudden confusion or sleepiness after illness, and contacting their doctor right away if you see changes.

Who is at higher risk for severe COVID-19?

People with dementia are at higher risk for severe COVID-19, even after accounting for age, so it's vital to keep up with vaccinations, masks, and a written emergency plan.

How should caregivers think about COVID risk in dementia care — reducing rather than eliminating it?

Instead of aiming for zero risk, focus on practical steps like vaccination, mask-wearing in crowded places, and having a backup caregiver plan—small consistent actions make a real difference.

Discuss with your clinician

Ask your doctor: 'Given my loved one's dementia and other health conditions, should they get an additional COVID-19 booster or the new variant vaccine?'

Ask: 'What are the early signs of COVID-19 I should watch for in someone with dementia, especially if they can't tell me they feel sick?'

Ask: 'If my loved one gets COVID-19, what treatments (like antivirals or monoclonal antibodies) are safe for them, given their dementia and other medications?'

Ask: 'How can we manage other health conditions (like diabetes or heart disease) to lower their risk of severe COVID-19?'

Ask: 'If my loved one develops delirium from COVID-19, what should I do at home before calling 911? Are there any medications that can help without making confusion worse?'