Report examines extent of health service disruption for patients with PD and dementia in Ontario

The researchers said they wanted to look generally at the level and extent of disruption for people with Parkinson’s disease and dementia still living at home and compare the results with those before the pandemic.

In Canada, patients with Parkinson’s disease (PD), dementia and other neurological conditions have sought health care services significantly less often during the COVID-19 pandemic, leading to excess deaths during the first wave in 2020, according to a study published Friday.

write in JAMA Health Forum, the researchers said they wanted to examine in detail the level and extent of disruption of in-person and virtual care for people with PD and dementia still living at home, and compare the results with those of before the pandemic.

As in the United States, when the pandemic began to spread in March 2020, hospitals began to discharge patients when they could to make room for infected patients, elective surgeries were canceled and physician services Outpatient clinics have been reduced, and nursing homes have been catapulted into disarray as the virus spreads through group living settings.

The researchers said they wanted to examine how different health care services intersect for these vulnerable populations, with the aim of providing information to guide policy makers for the next pandemic.

The population-based repeated cross-sectional analysis examined information from numerous databases for residents of Ontario, Canada, from March 1 to the week of September 20, 2020, and compared it to the previous year ( from March 3 to the week of September 22, 2020). 2019). Primary outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person medical visits, and all-cause mortality.

Sources of information included the registry of all Ontarians eligible for provincial health insurance; hospital records; insurance claims; a home care database; a register of all persons residing in nursing homes in Ontario; and information on Ontario drug claims. All datasets were linked using unique coded identifiers and analyzed at a non-profit research institute.

Health service utilization and mortality rates per 100 people were calculated for each week of the pandemic period and compared to the previous period. Poisson regression models calculated weekly rate ratios (RR) with 95% confidence intervals (CI) comparing pandemic weeks to historical levels.

By age, people with dementia (131,466) were the oldest (mean [SD] age, 80.1 [10.1] years), followed by those with PD (30,606; 73.7 [10.2] year).

Older adults without neurological disorders (2,363,742) were the youngest (74.0 [7.1] year).

All health services saw steep declines at the start of the pandemic, with the biggest reductions occurring in nursing home admissions as well as emergency room visits.

For nursing homes, the results were:

  • Dementia RR, 0.10; 95% CI, 0.07-0.15
  • PD RR, 0.03; 95% CI, 0.00-0.21
  • Older adults RR, 0.11; 95% CI, 0.06-0.18

For emergency department visits, the results were:

  • RR dementia, 0.45; 95% CI, 0.41-0.48
  • PD RR, 0.40; 95% CI, 0.34-0.48
  • Older adults RR, 0.45; 95% CI, 0.44-0.47).

Home care visits saw the smallest decline for services.

At the low point of the pandemic in 2020, visits to specialists, such as neurologists and geriatricians, plummeted. After the first wave, most health care services returned to historic levels, but doctor visits shifted to virtual care. At the end of the study, doctor visits remained high, especially family doctor visits for people with dementia (RR, 1.10; 95% CI, 1.08-1, 12) and PD (RR, 1.08; 95% CI, 1.04-1.13).

The authors said the rapid shift to virtual care “has been touted as a success of pandemic planning in Ontario,” but cautioned that more work is needed to ensure that patients with dementia and PD receive the care they need.

All-cause mortality was high in all groups (+1092 dementia; +150 PD; +1481 elderly), with the largest relative effect occurring in those with dementia and PD. However, these effects had overlapping confidence intervals, the researchers said, and more research is needed to differentiate COVID-19-related deaths from deaths from other causes. They said it is possible that “people with dementia also had a higher risk of mortality during the pandemic associated with reduced access to community support and hospital care”.

Understanding who sought care and why will help judge the quality of care as well as the outcomes of service cuts in support programs, the authors said.

Reference

Bronskill SE, Maclagan LC, Maxwell CJ, et al. Trends in health service utilization for Canadian adults with dementia and Parkinson’s disease during the first wave of the COVID-19 pandemic. JWADA Health Forum. 2022;3(1):e214599. doi:10.1001/jamahealthforum.2021.4599

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