Canadian Study: Nursing Home, ER Admissions Dropped During Pandemic

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Early on in the COVID-19 pandemic, there was a sharp drop in admissions to nursing homes and emergency rooms among adults with Parkinson’s disease and those with dementia, according to a new study from Canada.

The study also suggests that virtual visits with doctors have become much more common since the pandemic began.

The study, “Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic,” was published in JAMA Health Forum.

Individuals with chronic diseases like Parkinson’s have been among the hardest hit by the COVID-19 pandemic — not just by the disease, but also by disruptions in healthcare systems.

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“Health service disruptions and communication challenges introduced by the pandemic have the potential to create gaps in care that could be challenging for persons with dementia, persons with PD [Parkinson’s disease], and their caregivers,” the researchers wrote.

However, they added, “to our knowledge, there has not yet been a comprehensive assessment quantifying the magnitude of service disruptions among individuals with dementia and PD during the first wave of the pandemic across a spectrum of services, including in-person and virtual services.”

To fill in this gap, the team conducted a series of analyses using health administrative data from Ontario, Canada.

For the period from March to September of 2020 (around when the pandemic first hit Canada), the team identified data for 30,606 people with Parkinson’s, 131,466 with dementia, and 2,363,742 older adults, all of whom lived in their communities. For comparison, the researchers also analyzed the period from March to September of 2019; numbers of people and demographics were similar in both time periods.

Analyses showed a sharp drop in healthcare usage shortly after the pandemic hit, with the lowest usage rates for most services across most patient groups in late March or early April 2020.

The most dramatic decline was in nursing home admissions, which “all but ceased through May and June 2020” in all groups analyzed, the researchers reported. Emergency room admissions also saw large declines.

Total visits to physicians also declined, though to a lesser extent. The researchers noted that rates of decline generally were lower for family doctors than for specialists. They stressed a need to conduct more studies using more detailed data to examine these trends.

“In-depth studies within dementia and PD populations should examine the characteristics of those who sought care, reasons for their visits, and whether changes in later care needs were observed,” the team wrote.

By the end of the period studied, usage of most healthcare resources had increased back to around historic levels. The exception was nursing home admissions, which remained low.

At the end of the study period, physician visits were somewhat higher than historical norms, particularly for those with Parkinson’s or dementia. The researchers noted there was “a rapid shift toward virtual visits across all physician specialties” after the onset of the pandemic.

“This dramatic and rapid shift suggests willingness among both physicians and patients to engage in virtual care,” the team wrote. However, they noted that the “initial shift to virtual physician care requires support to ensure ongoing equitable and effective care to prevent persons with dementia and PD from experiencing unintended consequences owing to lack of in-person visits.”