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

This section explores COVID-19 related hospitalisations among aged care residents after their last COVID-19 diagnosis during the pre-Omicron and Omicron periods.

Summary of COVID-19 related hospitalisations among aged care residents

Figure 3.1 is an interactive chart where readers can explore differences in COVID-19 related hospitalisations among aged care residents with a COVID-19 diagnosis, by dementia status and for selected population groups: sex, age group and region of residence (state or territory, remoteness area and socioeconomic area).

Among aged care residents with a COVID-19 diagnosis in the pre-Omicron period, 29% (630) of people with a dementia record and 27% (315) of people with no dementia record had a COVID-19 related hospitalisation (Figure 3.1). Of those hospitalised, about 1 in 3 people died in hospital (30% of those with a dementia record, 28% with no dementia record).

Rates of COVID-19 related hospitalisation and deaths in hospital were lower in the Omicron period: 7.9% (2,500) of residents with a dementia record and 7.3% (1,100) of those with no dementia record had a COVID-19 related hospitalisation. Of those hospitalised, people with a dementia record:

• had a lower percentage of stays in an intensive care unit (ICU) (0.3% compared with 1.1% of people with no dementia record, Table S3.1) 
• had a higher percentage of deaths in hospital (18% compared with 15%) (Figure 3.1).

These differences were not statistically significant, however, they are consistent with findings from other studies in the United States, where COVID‐19–positive hospital patients with dementia were less likely to go to ICU, and more likely to die or be discharged to a hospice than patients without dementia (Johnson et al. 2024). Similarly, prior to the COVID-19 pandemic, people living with dementia in permanent residential aged care were more likely to die in hospital than people without dementia (AIHW 2023). 

These outcomes may be influenced by differences in comorbidities: people living with dementia have on average more comorbidities than older people without dementia (Subramaniam 2019); as well as palliative care preferences and the presence of advance care plans (Janbek 2021; Ellis et al. 2022; Johnson et al. 2024). 

The median length of hospital stays for residents with and without a dementia record was 11 days during the pre-Omicron period and 6 days during the Omicron period (Table S3.2). 

The impact of COVID-19 vaccination on COVID-19 related hospitalisations is explored in later sections.

Men with dementia had the highest rates of COVID-19 related hospitalisations and deaths in hospital

Among aged care residents with a COVID-19 diagnosis, a higher percentage of men had a COVID-19 related hospitalisation than women, particularly among those with a dementia record:

• in the pre-Omicron period: 33% of men and 27% of women 
• in the Omicron period: 10% of men and 6.4% of women (Figure 3.1a)

Of those hospitalised, a higher percentage of men with a dementia record died in hospital: 

• in the pre-Omicron period, 39% of men and 23% of women 
• in the Omicron period, 21% of men and 14% of women (Figure 3.1b).

Similar patterns were observed for all COVID-19 related hospitalisations in the Omicron period in people aged 60 and over (AIHW 2025). 

For men and women with no dementia record, there was little difference in the percentage of residents who died in hospital (about 28% in the pre-Omicron period and 15% in the Omicron period, Figure 3.1b).

Older residents had a lower percentage of COVID-19 related hospitalisations

Among aged care residents with a COVID-19 diagnosis in the pre-Omicron and Omicron periods, people in the oldest age group (90 years and over) had the lowest percentage of COVID-19 related hospitalisations (Figure 3.1a). For example, in the Omicron period, among residents with a dementia record, 8.5% of those aged 80–89 had a COVID-19 related hospitalisation compared with 6.9% of those aged 90 and over. 

COVID-19 related hospitalisations by population group

Other key findings among aged care residents with a COVID-19 diagnosis (Figure 3.1):

• In the pre-Omicron period, the majority of COVID-19 related hospitalisations were among residents in Victoria, although this represented a lower percentage of residents with a COVID-19 diagnosis than in NSW (26% and 45% of people with a dementia record, respectively). Of those hospitalised, about 1 in 3 people with a dementia record died in hospital. This rate was lower in NSW for people with no dementia record (32% in Victoria and 16% in NSW). The median length of stay was longer in NSW (about 15 days) than in Victoria (about 11 days) for people with and without a dementia record (Table S3.2).
• In the Omicron period, residents in Queensland had the highest percentage of COVID-19 related hospitalisations (13% of people with a dementia record, 12% of people with no dementia record). However, of those hospitalised, the percentage of people who died in hospital was lower in Queensland (14% and 10%, respectively) than other states and territories shown. These results are likely to reflect different state/territory policies for hospitalisation of aged care residents, such as admitting patients under the ‘maintenance’ care type. 
• Most COVID-19 related hospitalisations in the pre-Omicron period were in Major cities. Of residents with a COVID-19 related hospitalisation in the Omicron period, people in regional and remote areas had a lower percentage of deaths in hospital, particularly those with a dementia record: 20% of those in Major cities died in hospital, compared with 12% in Inner regional areas and 7.5% in Outer regional, Remote and Very remote areas.
• In the Omicron period, residents in the lowest socioeconomic areas had a higher percentage of COVID-19 related hospitalisations (11% with a dementia record, 9.6% with no dementia record) than those living in the highest socioeconomic areas (5.9% and 5.5%, respectively). In the pre-Omicron period, there was no significant difference between socioeconomic groups.

For downloadable data tables, see Table S3.1 in Data tables (Hospitalisation and mortality among aged care residents with a COVID-19 diagnosis).

COVID-19 related hospitalisations and care needs of residents

To explore the impact of care needs on COVID-19 related hospitalisations, Aged Care Funding Instrument (ACFI) care needs data were analysed. The ACFI was a tool used to allocate funding to aged care providers based on day-to-day care needs, categorised as 'nil', 'low', 'medium', or 'high', across 3 domains: Activities of daily living, Cognition and behaviour and Complex health care (see ACFI data for details). Data are only shown for the Omicron period, as counts were too small to analyse for the pre-Omicron period.

The Activities of daily living domain showed the clearest differences among residents with high and low needs, with and without a dementia record. For example, among people with a dementia record, 7.8% of residents with high needs in the Activities of daily living domain had a COVID-19 related hospitalisation, of whom 20% died in hospital, compared with 5.8% of residents with low/nil needs of whom 11% died in hospital (Figure 3.2).

Figure 3.2: Number and percentage of aged care residents with a COVID-19 diagnosis in the Omicron period (a) with a COVID-19 related hospitalisation (CRH) and (b) who died in hospital, by dementia status and level of care needs in the ACFI Activities of daily living, Cognition and behaviour and Complex health care domains (to 30 June 2022)

For downloadable data tables, see Table S3.3 in Data tables (Hospitalisation and mortality among aged care residents with a COVID-19 diagnosis).