Dataset Information

Changes in Site of Death Among Older Adults Without a COVID-19 Diagnosis During the COVID-19 Pandemic.

ABSTRACT:

Background

Understanding how the coronavirus disease 2019 (COVID-19) pandemic affected site of death-an important patient-centered outcome related to end-of-life care-would inform healthcare system resiliency in future public health emergencies.

Objective

To evaluate the changes in site of death during the COVID-19 pandemic among older adults without a COVID-19 diagnosis.

Design

Using a quasi-experimental difference-in-differences method, we estimated net changes in site of death during the pandemic period (March-December 2020) from the pre-pandemic period (January-February 2020), using data on the same months in prior years (2016-2019) as the control.

Participants

A 20% sample of Medicare Fee-for-Service beneficiaries aged 66 years and older who died in 2016-2020. We excluded beneficiaries with a hospital diagnosis of COVID-19.

Main measures

We assessed each of the following sites of death separately: (1) home or community; (2) acute care hospital; and (3) nursing home.

Key results

We included 1,133,273 beneficiaries without a hospital diagnosis of COVID-19. We found that the proportion of Medicare beneficiaries who died at home or in the community setting increased (difference-in-differences [DID] estimate, + 3.1 percentage points [pp]; 95% CI, + 2.6 to + 3.6 pp; P < 0.001) and the proportion of beneficiaries who died (without COVID-19 diagnosis) in an acute care hospital decreased (- 0.8 pp; 95% CI, - 1.2 to - 0.4 pp; P < 0.001) during the pandemic. We found no evidence that the proportion of deaths in nursing homes changed during the pandemic.

Conclusions

Using national data on older adults without a COVID-19 diagnosis, we found that site of death shifted toward home or community settings during the COVID-19 pandemic. Our findings may inform clinicians and policymakers in supporting end-of-life care during future public health emergencies.

SUBMITTER: Gotanda H

PROVIDER: S-EPMC10973311 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Changes in Site of Death Among Older Adults Without a COVID-19 Diagnosis During the COVID-19 Pandemic.

Gotanda Hiroshi H Zhang Jessica J JJ Saliba Debra D Xu Haiyong H Tsugawa Yusuke Y

Journal of general internal medicine 20231109 4

<h4>Background</h4>Understanding how the coronavirus disease 2019 (COVID-19) pandemic affected site of death-an important patient-centered outcome related to end-of-life care-would inform healthcare system resiliency in future public health emergencies.<h4>Objective</h4>To evaluate the changes in site of death during the COVID-19 pandemic among older adults without a COVID-19 diagnosis.<h4>Design</h4>Using a quasi-experimental difference-in-differences method, we estimated net changes in site of ...[more]

PMID: 37946020

Similar Datasets

Project description:BackgroundSpeculation on benefits and harms of prescription, over-the-counter and complementary medications has been widespread during the SARS-CoV-2 (or COVID-19) pandemic. This community-based survey assessed self-reported changes in medications including those stopped, started, or if access had been impacted.MethodsA survey was collected via Research Electronic Data Capture (REDCap). The survey was advertised in the community through social media, email lists, websites, and post-cards. Survey responses were collected between 5/21/2020 and 6/24/2020. Variables included demographic characteristics such as age, sex, race, marital status, education, employment, income, and community type. Questions related to medication changes included: "Have you started any medication due to COVID-19?", "Have you stopped any medication due to COVID-19?" and "Have you had issues getting your prescription medications?". Respondents aged 50 years or older were included.ResultsThere were N = 1397 responses of which 1169 were older adults ≥50 years-old. Of these, 1141 responded to the medication changes survey questions and 28 had missing responses and were excluded from the survey sample for this analysis. Among these, 31 (2.7%) reported a medication change included 5 (0.4%) reported stopping a medication, 18 (1.6%) reported starting a medication, and 8 (0.7%) reported trouble obtaining medications. Medications started included mostly vitamins or other supplements including zinc (n = 9), vitamin C (6), and other supplements (3). Among prescription medications, antidepressants and anti-anxiety medications (4) were reported as well as aspirin (1), losartan (1), and low dose naltrexone (1). One respondent reported unidentified homeopathy. There were no significant differences between those with medication changes and those with none.ConclusionsIn this community-based survey sample of over one thousand older adults, only a small percentage (2.7%; n = 31) reported any changes to medications during the pandemic. As essential workers during this crisis, pharmacists have played a critical role in providing medication information and continued access.

Project description:BackgroundDuring the COVID-19 pandemic, social distancing measures were imposed to protect the population from exposure, especially older adults and people with frailty, who have the highest risk for severe outcomes. These restrictions greatly reduced contacts in the general population, but little was known about behaviour changes among older adults and people with frailty themselves. Our aim was to quantify how COVID-19 measures affected the contact behaviour of older adults and how this differed between older adults with and without frailty.MethodsIn 2021, a contact survey was carried out among people aged 70 years and older in the Netherlands. A random sample of persons per age group (70-74, 75-79, 80-84, 85-89, and 90 +) and gender was invited to participate, either during a period with stringent (April 2021) or moderate (October 2021) measures. Participants provided general information on themselves, including their frailty, and they reported characteristics of all persons with whom they had face-to-face contact on a given day over the course of a full week.ResultsIn total, 720 community-dwelling older adults were included (overall response rate of 15%), who reported 16,505 contacts. During the survey period with moderate measures, participants without frailty had significantly more contacts outside their household than participants with frailty. Especially for females, frailty was a more informative predictor of the number of contacts than age. During the survey period with stringent measures, participants with and without frailty had significantly lower numbers of contacts compared to the survey period with moderate measures. The reduction of the number of contacts was largest for the eldest participants without frailty. As they interact mostly with adults of a similar high age who are likely frail, this reduction of the number of contacts indirectly protects older adults with frailty from SARS-CoV-2 exposure.ConclusionsThe results of this study reveal that social distancing measures during the COVID-19 pandemic differentially affected the contact patterns of older adults with and without frailty. The reduction of contacts may have led to the direct protection of older adults in general but also to the indirect protection of older adults with frailty.

Project description:AimsWorldwide, loneliness is one of the most common psychological phenomena among older adults, adversely affecting their physical and mental health conditions during the COVID-19 pandemic. This study aims to assess changes in the prevalence of loneliness in the two timeframes (first and second waves of COVID-19 in Bangladesh) and identify its correlates in pooled data.MethodsThis repeated cross-sectional study was conducted on two successive occasions (October 2020 and September 2021), overlapping with the first and second waves of the COVID-19 pandemic in Bangladesh. The survey was conducted remotely through telephone interviews among 2077 (1032 in the 2020-survey and 1045 in the 2021-survey) older Bangladeshi adults aged 60 years and above. Loneliness was measured using the 3-item UCLA Loneliness scale. The binary logistic regression model was used to identify the factors associated with loneliness in pooled data.ResultsWe found a decline in the loneliness prevalence among the participants in two survey rounds (51.5% in 2021 versus 45.7% in 2020; P = 0.008), corresponding to 33% lower odds in the 2021-survey (AOR 0.67, 95% CI 0.54-0.84). Still, nearly half of the participants were found to be lonely in the latest survey. We also found that, compared to their respective counterparts, the odds of loneliness were significantly higher among the participants without a partner (AOR 1.58, 95% CI 1.20-2.08), with a monthly family income less than 5000 BDT (AOR 2.34, 95% CI 1.58-3.47), who lived alone (AOR 2.17, 95% CI 1.34-3.51), with poor memory or concentration (AOR 1.58, 95% CI 1.23-2.03), and suffering from non-communicable chronic conditions (AOR 1.55, 95% CI 1.23-1.95). Various COVID-19-related characteristics, such as concern about COVID-19 (AOR 1.28, 95% CI 0.94-1.73), overwhelm by COVID-19 (AOR 1.53, 95% CI 1.14-2.06), difficulty earning (AOR 2.00, 95% CI 1.54-2.59), and receiving routine medical care during COVID-19 (AOR 2.08, 95% CI 1.61-2.68), and perception that the participants required additional care during the pandemic (AOR 2.93, 95% CI 2.27-3.79) were also associated with significantly higher odds of loneliness. However, the odds of loneliness were significantly lower among the participants with formal schooling (AOR 0.71, 95% CI 0.57-0.89) and with a family of more than four members (AOR 0.76, 95% CI 0.60-0.96).ConclusionsThe current study found a decreased prevalence of loneliness among Bangladeshi older adults during the ongoing pandemic. However, the prevalence is still very high. The findings suggest the need for mental health interventions that may include improving social interactions increasing opportunities for meaningful social connections with family and community members and providing psychosocial support to the vulnerable population including older adults during the pandemic. It also suggests that policymakers and public health practitioners should emphasise providing mental health services at the peripheral level where the majority of older adults reside.

Project description:The COVID-19 pandemic led to rapid changes in care delivery for critically ill patients, due to factors including increased numbers of ICU patients, shifting staff roles, and changed care locations. As these changes may have impacted the care of patients without COVID-19, we assessed changes in common ICU practices for mechanically ventilated patients with non-COVID acute respiratory failure at the onset of and during the COVID-19 pandemic.DesignInterrupted time series analysis, adjusted for seasonality and autocorrelation where present, evaluating trends in common ICU practices prior to the pandemic (March 2016 to February 2020), at the onset of the pandemic (April 2020) and intra-pandemic (April 2020 to December 2020).SettingPremier Healthcare Database, containing data from 25% of U.S. discharges from January 1, 2016, to December 31, 2020.PatientsPatients without COVID-19 receiving mechanical ventilation for acute respiratory failure.InterventionsWe assessed monthly rates of chest radiograph (CXR), chest CT scans, lower extremity noninvasive vascular testing (LENI), bronchoscopy, arterial catheters, and central venous catheters.Measurements and main resultsWe identified 742,096 mechanically ventilated patients without COVID-19 at 545 hospitals. At the onset of the pandemic, CXR (-0.5% [-0.9% to -0.2%; p = 0.001]), LENI (LENI: -2.1% [-3.3% to -0.9%; p = 0.001]), and bronchoscopy rates (-1.0% [-1.5% to -0.6%; p < 0.001]) decreased; use of chest CT increased (1.5% [0.5-2.5%; p = 0.006]). Use of arterial lines and central venous catheters did not change significantly. Intra-pandemic, LENI (0.5% [0.3-0.7%; p < 0.001]/mo) and bronchoscopy (0.1% [0.05-0.2%; p < 0.001]/mo) trends increased relative to pre-pandemic trends, while the remainder of practices did not change significantly.ConclusionsWe observed several statistically significant changes to practice patterns among patients without COVID-19 early during the pandemic. However, most of the changes were small or temporary, suggesting that routine practices in the care of mechanically ventilated patients in the ICU was not drastically affected by the pandemic.

Dataset Information

Changes in Site of Death Among Older Adults Without a COVID-19 Diagnosis During the COVID-19 Pandemic.

Background

Objective

Design

Participants

Main measures

Key results

Conclusions

Publications

Changes in Site of Death Among Older Adults Without a COVID-19 Diagnosis During the COVID-19 Pandemic.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets