Elderly People’s Access to Emergency Departments during the COVID-19 Pandemic: Results from a Large Population-Based Study in Italy

Abstract

Across the world, people have avoided seeking medical attention during the coronavirus pandemic, resulting in a marked reduction in emergency department (ED) visits. This retrospective cohort study examines in detail how the present pandemic affects ED use by the elderly. The regional database on ED visits in Veneto (northeastern Italy) was consulted to extract anonymous data on all ED visits during 2019 and 2020, along with details concerning patients’ characteristics (access mode, triage code, chief complaint, and outcome). A year-on-year comparison was drawn between 2019 and 2020. There was a 25.3% decrease in ED visits in 2020 compared to the previous year. The decrease ranged from −52.4% in March to −18.4% in September when comparing the same months in the two years. This decrease started in late February 2020, with the lowest numbers of visits recorded in March and April 2020 (during the “first wave” of the COVID-19 pandemic in Italy), and in the autumn (during the “second wave”). The proportion of visits to the ED by ambulance has increased sharply since March 2020, and patients arrived more frequently with severe conditions (red or yellow triage tags) that often required a hospitalization. The greatest decrease was in fact observed for non-urgent complaints. This decreased concerned a wide range of conditions, including chest pain and abdominal pain. The sharp reduction observed in the present study is unlikely to be attributed entirely to the effect of lockdown measures. Individual psychological and media-induced fear of contagion most likely played a relevant role in leading people to avoid seeking medical attention.

The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department

“…Garaffa et al, in their recent study evaluating ED accesses during the first COVID-19 wave (February 2020 - June 2020), reported a decrease in accesses triaged as non-urgent compared to the same period in 2019 (p < 0.001) [7] . Bardin et al, considering only the elderly population (over 65 years) assessed during the first and second pandemic waves described substantial stability in non-urgent priority codes with comparable ED access rates between 2019 and 2020 (38.6% vs 37.0%) [21] . Analysis of individual months, however, shows that towards the end of the lockdown restrictions, non-urgent accesses begin to rise again, gradually tending towards pre-pandemic levels [7] , [21] .…”

“…Bardin et al, considering only the elderly population (over 65 years) assessed during the first and second pandemic waves described substantial stability in non-urgent priority codes with comparable ED access rates between 2019 and 2020 (38.6% vs 37.0%) [21] . Analysis of individual months, however, shows that towards the end of the lockdown restrictions, non-urgent accesses begin to rise again, gradually tending towards pre-pandemic levels [7] , [21] .…”

“…Also in the present study, ED accesses with non-urgent codes appear to be strongly associated with different changes (openings/closings) of governmental regulations introduced to control subsequent pandemic waves. There seems to be a consensus in the literature that visits the ED dropped dramatically upon the introduction of government restriction measures and that the increase in visits is related to general re-openings [1] , [7] , [21] , [22] . The many available analyses that have generally considered ED flows, therefore, agree in correlating the various observed fluctuations with both increases in the incidence of new COVID-19 cases and government-imposed measures restricting movement and sociality [1] , [2] , [7] , [21] , [22] .…”

“…There seems to be a consensus in the literature that visits the ED dropped dramatically upon the introduction of government restriction measures and that the increase in visits is related to general re-openings [1] , [7] , [21] , [22] . The many available analyses that have generally considered ED flows, therefore, agree in correlating the various observed fluctuations with both increases in the incidence of new COVID-19 cases and government-imposed measures restricting movement and sociality [1] , [2] , [7] , [21] , [22] . The current study, however, for the first time to the best of our knowledge, focuses only on non-urgent codes and shows that they are strongly influenced by all those determinants (incidence, restriction period, opening period) of the pandemic itself.…”

Impact of COVID-19 on hospital visits for non-traumatic dental conditions in Ontario, Canada

“…The researchers concluded that COVID-19 related fears have resulted in fewer visits to the ED for emergent health conditions (18). A study from Italy also showed a 25.3% decrease in ED visits in 2020 compared to 2019, with the highest decrease in March 2020, by 52.4% (19). Similarly, a study from Taiwan witnessed a 33.4% decrease in non-traumatic ED visits during February to April 2020 compared to the same time frame of 2019 (20).…”