National Bureau of Economic Research, Cambridge, MA, 02138, USA.
Institute for Social Research and Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48106, USA.
BMC Geriatr. 2024 Sep 2;24(1):727. doi: 10.1186/s12877-024-05298-2.
During the COVID-19 pandemic, patients with Alzheimer's disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes.
Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors' office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January-December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths - due to COVID and non-COVID causes - and changes in care use in the beneficiary's state of residence.
Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p < .001). Emergency/inpatient visits declined (by 9 percent, p < .001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p < .001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49).
Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits.
在 COVID-19 大流行期间，阿尔茨海默病和相关痴呆症（ADRD）患者尤其脆弱，医疗保健模式迅速转变。本研究评估了大流行对 ADRD 患者护理的影响，考察了初级保健、急诊和长期护理的使用情况，以及 COVID 和其他原因导致的死亡情况。
在传统医疗保险中，有 420 万 66 岁及以上患有 ADRD 的受益人的每月死亡人数和常规护理（医生办公室和远程医疗就诊）、住院/急诊部（ED）就诊和长期护理机构使用情况，与 2019 年 1 月至 12 月的每月预测率进行比较，使用 OLS 和逻辑/负二项回归。相关分析检查了因 COVID 和非 COVID 原因导致的超额死亡人数与居住州护理使用变化之间的关联。
远程医疗就诊次数的增加大大抵消了办公室就诊次数的减少，整体而言初级保健就诊次数增加（与 2019 年相比，自 2020 年 6 月以来增加了 9%，p<0.001）。急诊/住院就诊次数下降（下降 9%，p<0.001），长期护理机构使用率下降，自 2020 年 6 月以来仍比 2019 年趋势低 14%（p<0.001）。COVID 和非 COVID 死亡人数均有所上升，有 23.1 万人超额死亡（比 2019 年预测值高出 16%），其中 80%归因于 COVID。超额死亡人数在女性、非白人患者、农村和偏远邮政编码的患者以及社会剥夺指数得分较高的患者中更高。初级保健就诊次数增加最多的州的超额死亡人数最低（相关系数-0.49）。
在 COVID-19 大流行期间，患有 ADRD 的老年人的死亡人数大大超过了大流行前的预测值，其中 80%归因于 COVID-19。由于远程医疗就诊次数的急剧增加，常规护理总体上有所增加，但各州之间的情况并不均衡，且就诊次数高于大流行前的州的死亡率显著降低。
