Health outcomes in aged care residents with dementia during the COVID-19 pandemic

The COVID-19 pandemic represented an unprecedented health emergency in Australia and around the world, with substantial individual and health system impacts (Moynihan et al 2021). COVID-19 is a communicable respiratory disease caused by SARS-CoV-2, a member of the coronavirus family. It commonly causes fevers and cough that can lead to pneumonia and respiratory distress.

COVID-19 in Australia

The first confirmed case of COVID-19 was reported in Australia on 25 January 2020 (Hunt 2020). By 12 March 2020, 140 cases had been confirmed in Australia (WHO 2020). A human biosecurity emergency response was subsequently issued, and a range of public health and social measures were implemented with the aim of containing the spread of SARS-CoV-2.

There have been several COVID-19 ‘waves’ corresponding to the emergence of different variants and sub-variants of SARS-CoV-2 as it adapts and changes over time (Figure A2). In the first 3 years of the pandemic, the majority of COVID-19 notifications occurred from early 2022 onwards when the Omicron variant dominated (AIHW 2024b; Department of Health, Disability and Ageing 2025b).

Although the end of the emergency response was declared on 20 October 2023, COVID-19 remains an important issue particularly with older and at-risk individuals, with a large wave occurring at the end of 2023 and into 2024 (VRDEST 2024).

Figure A2: Timeline of the COVID-19 response in Australia, 2020 to 2023

Sources: ABS 2022; ANAO 2022; Andrews 2022; COVID-19 Epidemiology and Surveillance Team 2024; Department of Health 2020, 2021a, 2021b; Department of Health and Aged Care 2023a, 2024b; Government of Western Australia 2022; Parliament of Australia 2020; Prime Minister of Australia 2022; TGA 2024.

See the AIHW’s COVID-19 topic summary (AIHW 2024b) for more information on the impact of COVID-19 in Australia.

Defining the Pre-Omicron and Omicron periods in this report

In this report, the first 2 years of the COVID-19 pandemic (25 January 2020 to 14 December 2021) are referred to as the “pre-Omicron period” and cover 3 COVID-19 waves (see Figure A2).

Most COVID-19 diagnoses in residential aged care occurred when the Omicron variant dominated – in this report, this is referred to as the “Omicron period” (15 December 2021 to 31 December 2022).

COVID-19 in residential aged care

Residential aged care services provide care and accommodation in residential facilities, both for permanent and short-term respite stays. Australian Government-subsidised aged care services are generally provided based on need: the majority of people using residential aged care services are aged 65 and over, but younger people can also access them – see People using aged care for more information.

Infectious disease outbreaks are a hazard of communal living, and the adverse health outcomes of COVID-19 were exacerbated among people living in residential aged care due to older age, the presence of comorbidities and higher levels of frailty (Gilbert 2020; Liu 2021; Ellis et al. 2022; Russell et al. 2023).

During the early waves of the pandemic in 2020, people living in residential aged care accounted for only 7.2% of COVID-19 cases in Australia but 75% of deaths due to COVID-19 (Table A1). As new variants spread in the broader community, the percentage of cases that were among aged care residents decreased to 1.1% in 2022, while the percentage of deaths that were in aged care residents also decreased but remained relatively high (34% in 2022, Table A1).

While there was a lower clinical severity observed during the Omicron period, there was a higher overall volume and therefore burden of cases and deaths (Muleme et al. 2023). In 2022, there were about 109,430 cases and 3,550 deaths among aged care residents (Table A1).

Since the start of the Omicron period, most of Australia’s residential aged care facilities have experienced one or more COVID-19 outbreaks each year (Department of Health, Disability and Ageing 2024).

Notes and data sources:

1. A ‘COVID-19 case’ refers to people with a COVID-19 notification reported to state and territory notifiable disease registers. See Definition of a COVID-19 diagnosis for more information.
2. The total number of COVID-19 notifications in Australia were sourced from the National Notifiable Disease Surveillance System: National Communicable Disease Surveillance Dashboard (Department of Health, Disability and Ageing 2025b), accessed 19 August 2025.
3. The total number of deaths due to COVID-19 which occurred in Australia in 2020, 2021 and 2022 were sourced from the AIHW National Mortality Database. Year refers to year the death occurred. Deaths due to COVID-19 include deaths with an underlying cause of U07.1, U07.2, U10.9. Deaths registered in 2021 and earlier are based on the final version of cause of death data; deaths registered in 2022 are based on the revised version. Revised versions are subject to further revision processes by the Australian Bureau of Statistics.
4. The number of COVID-19 notifications and deaths among aged care residents were calculated from cumulative totals reported in the COVID-19 outbreaks in Australian residential aged care facilities weekly reports, using the last report in December of each year, 2020 to 2022 (Department of Health, Disability and Ageing 2025a).

Management of outbreaks in residential aged care

To help prevent and control COVID-19 outbreaks, a range of public health measures were applied to facilities and residents. These included lockdowns with restrictions on visiting, isolation and quarantine measures, social distancing and the use of personal protective equipment.

While these measures aimed to reduce rates of infection, morbidity and mortality, they were also associated with reductions in physical, mental and emotional wellbeing amongst aged care residents, their families and aged care staff (Gilbert 2020; Numbers et al. 2021; Royal Commission 2022; Thomas et al. 2022). Exploring these factors is beyond the scope of this report. Agencies have developed revised guidelines that aim to reduce these impacts in future outbreak scenarios (CDNA 2024).

For further information on aged care services and the COVID-19 pandemic, see the Report on the Operation of the Aged Care Act and the COVID-19 outbreaks in Australian residential aged care facilities weekly report.

COVID-19 in people living with dementia in residential aged care

Dementia is a term used to describe a group of conditions characterised by gradual impairment of brain function, which may impact memory, speech, cognition (thought), personality, behaviour, and mobility (AIHW 2025a). For more information, see Dementia in Australia – Summary.

Increasing age is the most significant risk factor for dementia, and in 2021–22, over half (54%) of people living in permanent residential aged care were living with dementia (AIHW 2025a).

Australian and international studies have shown that people living with dementia have an increased risk of morbidity and mortality from COVID-19 (Damayanthi et al. 2021; Chung et al. 2022; Department of Health, Disability and Ageing 2022; Ellis et al. 2022; Kostev et al. 2023; Johnson et al. 2024).

The prevalence of dementia is expected to increase 2.5-fold to over 1 million people by 2065 (AIHW 2025a). Understanding service use and health outcomes during the COVID-19 pandemic among people living with dementia in residential aged care is an important step in informing future outbreak prevention and management.

The COVID-19 Register: using linked data to monitor COVID-19

The pandemic demonstrated the need for strengthened national data infrastructure in Australia to inform decision making and assist with current and future evidence-based planning and policy setting (Basseal et al. 2023). Through data linkage, the health service use and health outcomes of individuals affected by COVID-19 can be monitored and tracked over time.

The COVID 19 Register is the largest source of linked COVID 19 case information in Australia that researchers can access to explore these questions in an Australian setting. It consists of de-identified COVID-19 case data from the National Notifiable Diseases Surveillance System (NNDSS) derived from state and territory notifiable disease registers (from 7 out of 8 participating states and territories) linked to a range of administrative health and aged care data sets, including the National Death Index (NDI), the National Hospital Morbidity Database (NHMD), the Australian Immunisation Register (AIR), the Medicare Benefits Schedule (MBS), the Pharmaceutical Benefits Scheme (PBS, including Repatriation Pharmaceutical Benefits Scheme (RPBS) information), the National Aged Care Data Clearinghouse (NACDC) and several others (AIHW 2024a). See Scope of the COVID-19 Register for more details.

Large health databases that link COVID 19 case information to administrative datasets have been used in international studies to assess the impacts of COVID-19, including health care utilisation and mortality (Murch et al. 2022).

About this report

The recent report, Hospitalisations and deaths following COVID-19, 2020–2022: a linked data analysis (AIHW 2025b), demonstrated the utility of the COVID-19 Register for examining health outcomes across the Australian population. This report uses similar methods but focuses on people living in residential aged care (aged 50 and over), and particularly those living with dementia.

The report firstly provides an overview of changes in the use of selected health services by dementia status for people living in residential aged care during the first 3 years of the COVID-19 pandemic (2020 to 2022) compared with a pre-pandemic year (2019). This includes:

• Medicare-subsidised general practitioner (GP) and specialist attendances by mode of delivery (face-to-face and telehealth)
• the dispensing of selected medicines through the PBS: antipsychotics, antidepressants, benzodiazepines, opioids and dementia-specific medications.

The report then focuses on hospitalisation and mortality outcomes by dementia status following the latest recorded COVID-19 diagnosis in people living in residential aged care between January 2020 and December 2022:

• the number of COVID-19 diagnoses by age, sex, state / territory, remoteness area and socioeconomic area of residence
• COVID-19 related hospitalisations and severe hospital outcomes (intensive care unit stays, died in hospital)
• deaths due to COVID-19
• whether COVID-19 vaccination modified hospitalisation and mortality outcomes
• whether COVID-19 antiviral use modified mortality outcomes.

There are several considerations to note when interpreting information in this report, such as data quality and data availability. See A guide to the data used in this report and the Technical notes for more information.

A guide to the data used in this report

Residential aged care

This study focuses on people living in residential aged care facilities (both permanent and respite admissions) in all Australian states and territories except Western Australia, as the COVID-19 Register does not have data from this jurisdiction. Data were also not available for some specialised aged care services, including the Multi-Purpose Services Program and the National Aboriginal and Torres Strait Islander Flexible Aged Care Program.

Place of residence data were primarily based on a person’s latest SA2 information in the Medicare Consumer Directory in the COVID-19 Register. It should be noted that the remoteness area or socioeconomic area of a person’s residential aged care facility may not be the same as the area/s they previously lived in.

See the Technical notes for more information.

Exploring outcomes after a person’s latest COVID-19 diagnosis in residential aged care

Rather than looking at all COVID-19 diagnoses among people living in residential aged care, this report focuses on hospitalisation and mortality outcomes after a person’s latest COVID-19 diagnosis while living in residential aged care up to the end of 2022.

During the pre-Omicron period, there were very few aged care residents who had more than one COVID-19 diagnosis recorded (counts were too low to publish).

During the Omicron period, 6.4% of residents (3,610 people) with a dementia record, and 5.7% of residents (1,800 people) with no dementia record had more than one COVID-19 diagnosis recorded (Table S-A2).

People with a dementia record are a subset of all people living with dementia

In this study, aged care residents identified as having dementia are only those with a record of dementia in one of the administrative data sets in the COVID-19 Register, including data on medications dispensed, public hospital admissions, aged care assessments, causes of death and National Disability Insurance Scheme (NDIS) diagnoses. Therefore, in this report, the ‘dementia record’ group does not include all people who were living with dementia in residential aged care.

Conversely, ‘people with no dementia record’ may include residents who either had undiagnosed dementia or had a dementia diagnosis that was not recorded in any of the available data sets. See Defining the study cohort for more information.

Data suppression

Publication of small counts may lead to identification of an individual. Therefore, counts under 6 were suppressed, as per the COVID-19 Register governance requirements. See the Technical notes for more information.