Researchers said they would like to broadly investigate the level and extent of confusion in people with Parkinson’s disease and dementia who still live at home and compare the results with those before the pandemic.
Patients with Parkinson’s disease (PD), dementia, and other neurological disorders seek medical services much less frequently during the COVID-19 pandemic in Canada, according to a study published Friday, in 2020. One wave caused excessive death.
write in JAMA Health ForumThe researchers said they would like to broadly explore the level and extent of confusion in both face-to-face and virtual care for people with PD and dementia who still live at home and compare the results with those 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 make room for infected patients, selective surgery was canceled, and outpatient doctors. Services have been scaled down and nursing homes have become confused as a virus and spread within the setting of group life.
Researchers want to find out how different medical services intersect for these vulnerable people, with the goal of providing information to guide policy makers for the next pandemic. Said.
A population-based iterative cross-section analysis looks at information from a number of databases on residents of Ontario, Canada from the week of March 1st to September 20th, 2020, and looks at information from the previous year (March 3rd to September 22nd). Compared to (until the week). 2019). The main results were emergency department visits, hospitalizations, nursing home admissions, home care, virtual and face-to-face doctor visits, and weekly rates of mortality from all causes.
Sources included registrations for all Ontario citizens covered by state health insurance. Hospital records; Insurance claims; Home care database. A register of all individuals living in nursing homes in Ontario. Information from Ontario drug dispensing claims. All datasets were linked using unique encoded identifiers and analyzed by non-profit research institutes.
For each week of the pandemic period, we calculated coverage of medical services and mortality per 100 people and compared them to previous periods. The Poisson regression model calculated the weekly ratio (RR) with a 95% confidence interval (CI) comparing the pandemic week to past levels.
By age, people with dementia (131,466) were the oldest (average). [SD] Age, 80.1 [10.1] Year), followed by PD (30,606; 73.7) [10.2] Year).
Elderly people without neuropathy (2,363,742) are the youngest (74.0) [7.1] Year).
All medical services were significantly reduced at the start of the pandemic, with the largest reduction in nursing home hospitalizations and emergency department (ED) visits.
The results of nursing homes are as follows:
- Dementia RR, 0.10; 95% CI, 0.07-0.15
- PD RR, 0.03; 95% CI, 0.00-0.21
- Elderly RR, 0.11; 95% CI, 0.06-0.18
For ED visits, the results are:
- Dementia RR, 0.45; 95% CI, 0.41-0.48
- PD RR, 0.40; 95% CI, 0.34-0.48
- Elderly RR, 0.45; 95% CI, 0.44-0.47).
Home care visits had the least decline in service.
During the worst of the 2020 pandemic, visits to specialists such as neurologists and geriatricians plummeted. After the first wave, most medical services have returned to historic levels, but doctor consultation has shifted to virtual medical care. At the end of the study, medical examinations, especially family doctors with dementia (RR, 1.10; 95% CI, 1.08-1.12) and PD (RR, 1.08; 95% CI, 1.04-1.13), remain high. did.
The authors said the rapid transition to virtual care “has been endorsed by the success of the pandemic program in Ontario,” but to ensure that patients with dementia and PD receive the care they need. Warned that more work was needed.
Mortality from all causes increased in all groups (+1092 dementia; +150 PD; +1481 elderly), with the greatest relative impact in people with dementia and PD. However, there are overlapping confidence intervals for these effects, and further studies are needed to distinguish COVID-19-related deaths from deaths from other causes, the researchers said. “People with dementia may also have an increased risk of death during a pandemic in relation to community support and reduced access to hospital care,” they said.
Understanding who sought care and why it would help determine the quality of care and the outcome of service reductions in support programs, the authors said.
reference
Bronskill SE, Maclagan LC, Maxwell CJ, etc. Trends in access to medical services for Canadian adults with dementia and Parkinson’s disease during the first wave of the COVID-19 pandemic. JAMA Health Forum.. 2022; 3 (1): e214599. doi: 10.1001 / jamahealthforum.2021.4599
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