A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study

Abstract

Background: Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts.

Methods: Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown.

Results: The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68-102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown.

Conclusion: Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics.

Trial registration: The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.

Keywords: COVID-19; Dementia; Health care services; Longitudinal cohort study; Older adults.

Fig. 1

Flow-chart of the study periods

Fig. 2

Flow-chart of included participants. HUNT4 70 + : The fourth wave of the Trøndelag health study, 70 year and older cohort

Fig. 3

Mean number of registered contacts with general practitioners (GPs) per period, pre-lockdown, during lockdown and post-lockdown, including GPs at emergency rooms, for participants < 80 versus ≥ 80 years, divided in people with- or without dementia. Mean number of contacts was predicted in a mixed-effects linear regression model adjusted by period, cognitive status, sex, age, and the interaction period*cognitive status. In the predictions, the adjustment variables age and sex were fixed at the mean values

Fig. 4

Mean number of care services implemented per period, pre-lockdown, during lockdown and post-lockdown, as health care and practical assistance in the home, day- and respite services, short-term institutional stay, and nursing home admission, for participants < 80 versus ≥ 80 years, divided in people with- and without dementia. Mean number of care services implemented was predicted in a mixed-effects linear regression model adjusted by period, cognitive status, sex, age, and the interaction period*cognitive status. In the predictions, the adjustment variables age and sex were fixed at the mean values

Fig. 5

Mean number of registered contacts with somatic hospital services per period, pre-lockdown, during lockdown and post-lockdown, for participants < 80 versus ≥ 80 years, divided in people with- or without dementia. Mean number of contacts was predicted in a mixed-effects linear regression model adjusted by period, cognitive status, sex, age, and the interaction period*cognitive status. In the predictions, the adjustment variables age and sex were fixed at the mean values