Older Adults’ Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project

Abstract

The COVID-19 pandemic disproportionally affected older people in terms of clinical outcomes and care provision. We aimed to investigate older adults’ changes in access to care during the pandemic and their determinants. We used data from a cross-sectional study (LOST in Lombardia) conducted in autumn 2020 on a representative sample of 4400 older adults from the most populated region in Italy. Lifestyles, mental health, and access to healthcare services before and during the pandemic were collected. To identify factors associated with care delays, reduction in emergency department (ED) access, and hospitalisations, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) using multivariable log-binomial regression models. During the pandemic, compared to the year before, 21.5% of the study population increased telephone contacts with the general practitioner (GP) and 9.6% increased self-pay visits, while 22.4% decreased GP visits, 12.3% decreased outpatient visits, 9.1% decreased diagnostic exams, 7.5% decreased ED access, and 6% decreased hospitalisations. The prevalence of care delays due to patient’s decision (overall 23.8%) was higher among men (PR 1.16, 95% CI 1.05–1.29), subjects aged 75 years or more (PR 1.12, 95% CI 1.00–1.25), and those with a higher economic status (p for trend < 0.001). Participants with comorbidities more frequently cancelled visits and reduced ED access or hospitalisations, while individuals with worsened mental health status reported a higher prevalence of care delays and ED access reductions. Access to care decreased in selected sub-groups of older adults during the pandemic with likely negative impacts on mortality and morbidity in the short and long run.

Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project

“…extensive evidence has been produced on the changes in access to care during the cOVID-19 emergency in terms of generalised reductions in the use of healthcare services [19,29]. however, to the best of our knowledge, very few studies have investigated the impact of the pandemic on changes in the use of home services among community-dwelling older adults [10,30,31].…”

“…In Italy, the cOVID-19 pandemic greatly impacted frailer older adults (i.e. with co-morbidities and mental health disorders [17][18][19]) who more frequently experienced increased use of health and social services.…”

“…this study aims at describing the influence of the cOVID-19 pandemic and the resulting restrictions on the changes in the use of help from domestic workers, non-familiar caregivers and medical home visits. We also investigated potentially related factors using data from a cross-sectional study on a large representative sample of people aged 65 years or more from the lombardy region [14][15][16][17][18][19][20][21][22], an area of 10 million inhabitants at the centre of the european cOVID-19 emergency.…”

The Mediating Role of Digital Competence in the Associations Between the Factors Affecting Healthcare Utilization and Access to Care

“…Previous studies have shown that they are the same disadvantaged groups such as those with low socioeconomic status, health problems, mental illness, loneliness, and physiological or cognitive dysfunction as well as older adults, who are also more susceptible to poor access to healthcare compared to their more privileged counterparts [18][19][20][21][22]. For example, in Italy during the COVID-19 pandemic, it was found that care delays, reduction in emergency department access, and hospitalisations were more common among older adults with higher number of chronic diseases [22]. In addition, care delays and reduction in emergency department access was more common among older adults with anxiety and depressive symptoms [22].…”

The Effect of COVID-19 Pandemic on Overall and Cause-Specific Mortality in Pavia, Northern Italy: Updated Estimates for the Year 2021

“…Quantifying the burden and population impact of the COVID-19 pandemic is challenging [ 3 ]. Direct measures of COVID-19 morbidity and mortality are affected by varying testing rates, capabilities and strategies, heterogeneous COVID-19 death definitions and surveillance systems [ 4 , 5 , 6 ]. Overall excess mortality is considered a key measure to understand, compare and monitor the impact of the COVID-19 pandemic over time, both from an epidemiological and public health perspective [ 7 , 8 ].…”