ICES, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
J Am Med Dir Assoc. 2021 Nov;22(11):2258-2262.e1. doi: 10.1016/j.jamda.2021.08.031. Epub 2021 Sep 6.
To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata.
Population-based time series analysis.
Community-dwelling adults with dementia in Ontario, Canada, from January 2019 to September 2020.
We used health administrative databases (Ontario Registered Persons Database and Home Care Database) to measure home care services used by participants. Poisson regression models were fit to compare weekly rates of home care services during the pandemic to historical trends with rate ratios (RRs) and 95% confidence intervals (CIs) stratified by service type (nursing, personal care, therapy), sex, rurality, and neighborhood income quintile.
During the first wave of the pandemic, personal care fell by 16% compared to historical levels (RR 0.84, 95% CI 0.84, 0.85) and therapies fell by 50% (RR 0.50, 95% CI 0.48, 0.52), whereas nursing did not significantly decline (RR 1.02, 95% CI 1.00, 1.04). All rates had recovered by September 2020, with nursing and therapies higher than historical levels. Changes in services were largely consistent across sociodemographic strata, although the rural population experienced a larger decline in personal care and smaller rebound in nursing.
Personal care and therapies for individuals with dementia were interrupted during the early months of the pandemic, whereas nursing was only minimally impacted. Pandemic responses with the potential to disrupt home care for individuals living with dementia must balance the impacts on individuals with dementia, caregivers, and providers.
研究 COVID-19 大流行如何影响不同服务类型和社会人口阶层中痴呆症患者的家庭护理服务使用情况。
基于人群的时间序列分析。
加拿大安大略省的社区居住的痴呆症成年人，时间为 2019 年 1 月至 2020 年 9 月。
我们使用健康管理数据库（安大略省注册人员数据库和家庭护理数据库）来衡量参与者使用的家庭护理服务。使用泊松回归模型比较大流行期间每周家庭护理服务的使用率与历史趋势，使用率比（RR）和 95%置信区间（CI）按服务类型（护理、个人护理、治疗）、性别、农村地区和社区收入五分位数分层。
在大流行的第一波期间，与历史水平相比，个人护理下降了 16%（RR 0.84，95%CI 0.84，0.85），治疗下降了 50%（RR 0.50，95%CI 0.48，0.52），而护理则没有明显下降（RR 1.02，95%CI 1.00，1.04）。到 2020 年 9 月，所有的服务使用率都已恢复，护理和治疗的使用率高于历史水平。服务的变化在社会人口统计学阶层中基本一致，尽管农村人口的个人护理下降幅度较大，而护理的反弹幅度较小。
痴呆症患者的个人护理和治疗在大流行的早期几个月受到干扰，而护理的影响则较小。可能干扰痴呆症患者家庭护理的大流行应对措施必须平衡对痴呆症患者、护理人员和提供者的影响。
