Visits to the emergency department by community-dwelling people with dementia during the first 2 waves of the COVID-19 pandemic in Ontario: a repeated cross-sectional analysis

Maclagan, Laura C.; Wang, Xuesong; Emdin, Abby; Jones, Aaron; Jaakkimainen, R. Liisa; Schull, Michael J.; Sourial, Nadia; Vedel, Isabelle; Swartz, Richard H.; Bronskill, Susan E.

doi:10.9778/cmajo.20210301

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…Notably, patients in the COVID-19 cohort were also less likely to have an emergency department visit that occurred prior to their rst follow-up (RR = 0.66; 95% CI 0.51-0.86). This is possibly re ective of overall emergency department avoidance during COVID-19 (57).…”

Section: Discussionmentioning

confidence: 99%

Recent functional decline and outpatient follow-up after hospital discharge: A cohort study

Bogler

Kirkwood

Austin

et al. 2023

Preprint

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Background: Functional decline is common following acute hospitalization and is associated with hospital readmission, institutionalization, and mortality. Early physician follow-up has the potential to prevent poor outcomes and is integral to high-quality transitional care. Our study sought to determine whether functional decline was associated with post-discharge follow-up and whether this association changed following COVID-19, given that both functional decline and COVID-19 may affect access to post-discharge care. Method: We conducted a retrospective cohort study using health administrative data from Ontario, Canada. We included patients over 65 who were discharged from an acute care facility during March 1st, 2019 – January 31st, 2020 (pre-COVID-19 period), and March 1st, 2020 – January 31st, 2021 (COVID-19 period), and who were assessed for home care while in hospital. Patients with and without functional decline were compared. Our primary outcome was any physician follow-up visit within 7 days of discharge. Results: Our study included 21,771 (pre-COVID) and 17,248 (COVID) hospitalized patients, of whom 15,637 (71.8%) and 12,965 (75.2%) had recent functional decline. Our propensity-weighted cohorts included 15637/15810 patients with/without function decline in the pre-COVID-19 period and 12965/13132 with/without functional decline in the COVID-19 period. Pre-COVID, there was no difference in physician follow-up within 7 days of discharge (Exposed 45.0% vs Unexposed 44.0%; RR=1.02, 95% CI 0.98 – 1.06). These results did not change in the COVID-19 period (Exposed 51.1% vs. Unexposed 49.4%; RR=1.03, 95% CI 0.99-1.08, Z-test for interaction p=0.72). In the COVID-19 cohort, functional decline was associated with having a 7-day physician virtual visit (RR 1.15; 95% CI 1.08 – 1.24) and a 7-day physician home visit (RR 1.64; 95% CI 1.10 – 2.43). Conclusions: Functional decline was not associated with reduced 7-day post-discharge physician follow-up in either the pre-COVID-19 or COVID-19 periods. In the COVID-19 period, functional decline was positively associated with 7-day virtual and home-visit follow-up.

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Section: Discussionmentioning

confidence: 99%

Recent functional decline and outpatient follow-up after hospital discharge: A cohort study

Bogler

Kirkwood

Austin

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Notably, patients in the COVID-19 cohort were also less likely to have an emergency department visit that occurred prior to their first follow-up (RR = 0.66; 95% CI 0.51–0.86). This is possibly reflective of emergency department avoidance during COVID-19 [ 61 ], particularly among those with recent functional decline.…”

Section: Discussionmentioning

confidence: 99%

Recent functional decline and outpatient follow-up after hospital discharge: a cohort study

Bogler,

Kirkwood,

Austin

et al. 2023

BMC Geriatr

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Background Functional decline is common following acute hospitalization and is associated with hospital readmission, institutionalization, and mortality. People with functional decline may have difficulty accessing post-discharge medical care, even though early physician follow-up has the potential to prevent poor outcomes and is integral to high-quality transitional care. We sought to determine whether recent functional decline was associated with lower rates of post-discharge physician follow-up, and whether this association changed during the COVID-19 pandemic, given that both functional decline and COVID-19 may affect access to post-discharge care. Method We conducted a retrospective cohort study using health administrative data from Ontario, Canada. We included patients over 65 who were discharged from an acute care facility during March 1st, 2019 – January 31st, 2020 (pre-COVID-19 period), and March 1st, 2020 – January 31st, 2021 (COVID-19 period), and who were assessed for home care while in hospital. Patients with and without functional decline were compared. Our primary outcome was any physician follow-up visit within 7 days of discharge. We used propensity score weighting to compare outcomes between those with and without functional decline. Results Our study included 21,771 (pre-COVID) and 17,248 (COVID) hospitalized patients, of whom 15,637 (71.8%) and 12,965 (75.2%) had recent functional decline. Pre-COVID, there was no difference in physician follow-up within 7 days of discharge (Functional decline 45.0% vs. No functional decline 44.0%; RR = 1.02, 95% CI 0.98–1.06). These results did not change in the COVID-19 period (Functional decline 51.1% vs. No functional decline 49.4%; RR = 1.03, 95% CI 0.99–1.08, Z-test for interaction p = 0.72). In the COVID-19 cohort, functional decline was associated with having a 7-day physician virtual visit (RR 1.15; 95% CI 1.08–1.24) and a 7-day physician home visit (RR 1.64; 95% CI 1.10–2.43). Conclusions Functional decline was not associated with reduced 7-day post-discharge physician follow-up in either the pre-COVID-19 or COVID-19 periods. In the COVID-19 period, functional decline was positively associated with 7-day virtual and home-visit follow-up.

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“…The ICD-10 codes for dementia, cirrhosis, decompensations of cirrhosis, and other conditions in the study are in the supplementary section and have been used in other studies (18)(19)(20). Covariates were extracted from the CDW, including demographic characteristics including age at baseline, sex, race/ethnicity (Whites, Hispanics, Blacks, others, and unknown), and homelessness.…”

Section: Assessment Of Dementia and Covariatesmentioning

confidence: 99%

Dementia Frequently Coexists With Hepatic Encephalopathy but Not Other Cirrhosis Complications in US Veterans

et al. 2023

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INTRODUCTION: Hepatic encephalopathy (HE) is a common decompensating event in patients with cirrhosis. Because of the aging population of patients with cirrhosis, differentiating HE from nonhepatic etiologies of cognitive impairment, such as dementia, is increasingly important. METHODS:Veterans with cirrhosis were identified via International Classification of Diseases-10 codes between October 1, 2019, and September 30, 2021, using the VA Corporate Data Warehouse. Baseline characteristics were compared between cohorts based on the presence vs absence of dementia. Factors associated with having a diagnosis of dementia were evaluated using multivariate logistic regression models, adjusting for demographics, comorbid illnesses, cirrhosis etiology, and cirrhosis complications. RESULTS:A total of 71,552 veterans with cirrhosis were identified, of which, 5,647 (7.89%) veterans had a diagnosis of dementia. Veterans with dementia were older, more frequently White, urban located, and diagnosed with alcohol-related cirrhosis, metabolic syndrome, brain trauma, and cerebrovascular disease more frequently. On multivariable analysis, the presence of any decompensating event was associated with dementia. Multivariable analysis of individual decompensating events revealed HE to be associated with a dementia diagnosis, but not ascites, independent of other risk factors analyzed. DISCUSSION:Dementia is commonly diagnosed in patients with cirrhosis and correlates with a diagnosis of HE, independent of alcohol use, brain injury, age, and other metabolic risk factors. Dementia did not correlate with other decompensating events. Increased awareness of the overlap between dementia and HE, as well as reliable diagnostic and treatment strategies, is needed for the aging population of veterans with cirrhosis.

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Visits to the emergency department by community-dwelling people with dementia during the first 2 waves of the COVID-19 pandemic in Ontario: a repeated cross-sectional analysis

Cited by 7 publications

References 39 publications

Recent functional decline and outpatient follow-up after hospital discharge: A cohort study

Recent functional decline and outpatient follow-up after hospital discharge: A cohort study

Recent functional decline and outpatient follow-up after hospital discharge: a cohort study

Dementia Frequently Coexists With Hepatic Encephalopathy but Not Other Cirrhosis Complications in US Veterans

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