Radomyslsky Zorian, Kivity Sara, Alon Yaniv, Saban Mor
Maccabi healthcare services, Tel Aviv-Jaffa, 6812509, Israel.
Department of Health system management, Ariel University, Ariel 40700, Israel.
Aging Dis. 2024 May 31;16(3):1586-1597. doi: 10.14336/AD.2024.0432.
Individuals with dementia face increased vulnerability during crises like armed conflicts. However, little is known about how conflicts affect dementia care delivery and patients' health. We conducted a longitudinal cohort study using medical record data. The study included 23,733 adults aged≥65 years with a diagnosis of dementia and 249,749 matched adults without dementia. Data were collected at baseline (March-October 2023), and two follow-up timepoints (December 2023 and February 2024), bracketing an armed conflict between Israel and Palestinian militant groups that began on October 7, 2023. We compared changes over time in clinical characteristics, medication use, healthcare utilization, costs between groups. Dementia prevalence was stable, but psychotropic medication use declined more sharply in those with dementia. Rates of depression diagnoses fell, and obesity rose in both groups. Healthcare utilization decreased substantially post-conflict, with fewer outpatient visits, hospitalizations, and emergency visits. Cost divergence between groups also increased over time. Machine learning identified shifting clusters of service users from high to mainly low users' post-conflict. The conflict severely disrupted routine dementia care and altered health behaviors. Flexible service delivery and access promotion strategies are needed to support vulnerable populations like people with dementia during crises.
患有痴呆症的人在武装冲突等危机期间面临更大的脆弱性。然而，关于冲突如何影响痴呆症护理服务的提供以及患者的健康状况，我们所知甚少。我们使用病历数据进行了一项纵向队列研究。该研究纳入了23733名年龄≥65岁且被诊断患有痴呆症的成年人以及249749名匹配的无痴呆症成年人。数据在基线期（2023年3月至10月）以及两个随访时间点（2023年12月和2024年2月）收集，这两个时间点夹在2023年10月7日以色列与巴勒斯坦激进组织之间爆发的一场武装冲突期间。我们比较了两组之间临床特征、药物使用、医疗保健利用情况、成本随时间的变化。痴呆症患病率稳定，但痴呆症患者中精神药物的使用下降更为明显。两组的抑郁症诊断率均下降，肥胖率均上升。冲突后医疗保健利用率大幅下降，门诊就诊、住院和急诊就诊次数减少。两组之间的成本差异也随时间增加。机器学习识别出冲突后服务使用者群体从高使用者向主要是低使用者的转变。这场冲突严重扰乱了常规的痴呆症护理，并改变了健康行为。在危机期间，需要灵活的服务提供和促进获得服务的策略来支持像痴呆症患者这样的弱势群体。
