Excess deaths from all causes, involving and with dementia as the underlying cause: Scotland 2020-2022

Executive summary

COVID-19 disproportionally affected individuals with pre-existing medical conditions, and dementia is the most common pre-existing condition in deaths involving COVID-19. Secondary analysis of National Records of Scotland mortality data in this report demonstrates that in 2020 excess deaths involving dementia (where dementia was either a contributory or an underlying cause of death) was proportionally greater than excess deaths from all causes. This highlights the devastating impact of COVID-19 on individuals with dementia, particularly early in the pandemic in care homes.

Statistics suggest that excess deaths involving dementia in 2020 could be attributed almost wholly to COVID-19 infection. However, it is important to note that this analysis does not establish whether these deaths were avoidable.

The data for 2021 show that excess deaths from all causes increased in line with deaths involving COVID-19. In contrast, deaths with dementia as the underlying cause dropped to below average levels in 2021, demonstrating mortality displacement. While deaths involving dementia reduced in number, they remained above average in 2021. This finding is likely to be a result of continuing deaths involving COVID-19.

However, deaths involving dementia and from all causes reduced to below average levels in care homes. In addition to mortality displacement, the reduction in excess deaths involving dementia in care homes that has taken place over the course of the pandemic may relate to improved measures to reduce infection in care homes and the prioritisation of care home residents and staff in the vaccination programme.

Further, it is important to note that the high number of deaths that occurred in early stages of the pandemic is likely to have impacted the size of the care home population. This has happened in the wider context of a long-term reduction in the number of residents in care homes. Care homes were subsequently under-occupied and hence the total number of deaths would be expected to be lower. This will impact the statistics for later periods when we compare excess deaths between 2020 and 2021.

While fewer deaths involving dementia were registered in hospital compared to care homes for 2020 and 2021, an increased proportion of all deaths involving dementia in Scotland were registered in hospital in 2021 compared to 2020. This proportional increase may reflect changed approaches to treatment for COVID-19 later in the pandemic: it is possible that care home residents who were severely ill were more likely to be transferred to hospital for treatment and end of life care.

Similarly to deaths from all causes, deaths involving dementia at home or non-institutional settings continued to remain at above average levels in 2021.