School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
PLoS One. 2024 Jul 12;19(7):e0306569. doi: 10.1371/journal.pone.0306569. eCollection 2024.
COVID-19 and resulting health system and policy decisions led to significant changes in healthcare use by nursing homes (NH) residents. It is unclear whether healthcare outcomes were similarly affected among older adults in assisted living (AL). This study compared hospitalization events in AL and NHs during COVID-19 pandemic waves 1 through 4, relative to historical periods.
This was a population-based, repeated cross-sectional study using linked clinical and health administrative databases (January 2018 to December 2021) for residents of all publicly subsidized AL and NH settings in Alberta, Canada. Setting-specific monthly cohorts were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. Monthly rates (per 100 person-days) of all-cause hospitalization, hospitalization with delayed discharge, and hospitalization with death were plotted and rate ratios (RR) estimated for period (pandemic wave vs historical comparison), setting (AL vs NH) and period-setting interactions, using Poisson regression with generalized estimating equations, adjusting for resident and home characteristics.
On March 1, 2020, there were 9,485 AL and 14,319 NH residents, comparable in age (mean 81 years), sex (>60% female) and dementia prevalence (58-62%). All-cause hospitalization rates declined in both settings during waves 1 (AL: adjusted RR 0.60, 95%CI 0.51-0.71; NH: 0.74, 0.64-0.85) and 4 (AL: 0.76, 0.66-0.88; NH: 0.65, 0.56-0.75) but unlike NHs, AL rates were not significantly lower during wave 2 (and increased 27% vs NH, January 2021). Hospitalization with delayed discharge increased in NHs only (during and immediately after wave 1). Both settings showed a significant increase in hospitalization with death in wave 2, this increase was larger and persisted longer for AL.
Pandemic-related changes in hospitalization events differed for AL and NH residents and by wave, suggesting unique system and setting factors driving healthcare use and outcomes in these settings in response to this external stress.
COVID-19 及其导致的卫生系统和政策决策导致养老院（NH）居民的医疗保健使用发生了重大变化。尚不清楚在辅助生活（AL）中的老年人中是否同样受到医疗保健结果的影响。本研究比较了 COVID-19 大流行波 1 至 4 期间 AL 和 NH 中的住院事件，与历史时期相比。
这是一项基于人群的重复横断面研究，使用链接的临床和健康管理数据库（2018 年 1 月至 2021 年 12 月），用于加拿大艾伯塔省所有公共补贴的 AL 和 NH 场所的居民。为大流行（从 2020 年 3 月 1 日开始）和可比历史（2018/2019 年合并）时期分别确定了特定于设置的每月队列。绘制了所有原因住院、延迟出院的住院和死亡的住院的每月发生率（每 100 人-天），并使用泊松回归和广义估计方程估计了时期（大流行波与历史比较）、设置（AL 与 NH）和时期-设置相互作用的比率比（RR），调整了居民和家庭特征。
2020 年 3 月 1 日，有 9485 名 AL 和 14319 名 NH 居民，年龄（平均 81 岁）、性别（>60%为女性）和痴呆症患病率（58-62%）相似。在波 1（AL：调整后的 RR 0.60，95%CI 0.51-0.71；NH：0.74，0.64-0.85）和 4（AL：0.76，0.66-0.88；NH：0.65，0.56-0.75）期间，两个设置中的所有原因住院率均下降，但与 NH 不同，AL 率在波 2 期间没有明显降低（并且与 NH 相比增加了 27%，2021 年 1 月）。只有 NH 中的延迟出院的住院人数增加。两个设置在波 2 中都显示出与死亡相关的住院人数显著增加，这种增加对于 AL 更大且持续时间更长。
与 AL 和 NH 居民以及波相关的住院事件变化因波而异，这表明在应对这种外部压力时，独特的系统和设置因素推动了这些设置中的医疗保健使用和结果。
