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. 2022 Jan 21;3(1):e214599.
doi: 10.1001/jamahealthforum.2021.4599. eCollection 2022 Jan.

Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic

Susan E Bronskill  1   2   3   4 , Laura C Maclagan  1 , Colleen J Maxwell  1   5 , Andrea Iaboni  6   7 , R Liisa Jaakkimainen  1   3   8 , Connie Marras  1   9 , Xuesong Wang  1 , Jun Guan  1 , Daniel A Harris  2 , Abby Emdin  2 , Aaron Jones  1   10 , Nadia Sourial  11 , Claire Godard-Sebillotte  12 , Isabelle Vedel  13 , Peter C Austin  1   3   4 , Richard H Swartz  1   3   14
Affiliations

Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic

Susan E Bronskill et al. JAMA Health Forum. .

Abstract

Importance: Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services.

Objective: To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic.

Design setting and participants: Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada.

Exposures: COVID-19 pandemic as of March 1, 2020.

Main outcomes and measures: Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels.

Results: Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts.

Conclusions and relevance: In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bronskill reported receiving grants from the Ontario Neurodegenerative Disease Research Initiative through the Ontario Brain Institute and Drs Bronskill and Vedel reported receiving a grant from the Canadian Institutes of Health Research (CIHR VR5-172692) during the conduct of the study. Dr Jones and Mr Harris reported postdoctoral and doctoral fellowships, respectively, from the Alzheimer Society of Canada during the conduct of the study. Dr Swartz reported receiving personal fees (administrative stipend) from the Ontario Brain Institute/Ontario Neurodegenerative Disease Research Initiative during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Rates of Hospital Use by Community-Dwelling Persons With Dementia, Persons With Parkinson Disease, and Older Adults, 2019-2020
aOlder adults are defined as persons aged 65 years and older without a diagnosis of neurodegenerative disease.
Figure 2.
Figure 2.. Rates of Health Service Use and Mortality by Community-Dwelling Persons With Dementia, Persons With Parkinson Disease, and Older Adults, 2019-2020
aOlder adults are defined as persons aged 65 years and older without a diagnosis of neurodegenerative disease.
Figure 3.
Figure 3.. Rates of Physician Visits by Community-Dwelling Persons With Dementia, Persons With Parkinson Disease, and Older Adults, 2019-2020
aOlder adults are defined as persons aged 65 years and older without a diagnosis of neurodegenerative disease.
See this image and copyright information in PMC

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