key: cord-0806000-qqam7kid
authors: Uimonen, Mikko; Kuitunen, Ilari; Jämsen, Esa; Ponkilainen, Ville; Mattila, Ville M.
title: Emergency visits by older adults decreased during COVID‐19 but increased in the oldest old
date: 2021-03-29
journal: J Am Geriatr Soc
DOI: 10.1111/jgs.17143
sha: 04d5344ad15f0fde9981de23cc358fea16646f77
doc_id: 806000
cord_uid: qqam7kid

nan

A significant concern during the coronavirus disease 2019 (COVID-19) pandemic has been that restrictions in the availability of health care and rehabilitation services may have an adverse effect on the health of vulnerable older persons, resulting in an increased need for emergency care. This multicenter study examined the influence of restrictions on the incidence of emergency department (ED) visits and hospitalizations among adults aged 70 and older during the pandemic in Finland.

Data were gathered from the discharge registers of three Finnish public hospitals: Central Finland Hospital, Mikkeli Central Hospital, and Tampere University Hospital. These hospitals cover a total catchment population of 900,000 citizens (140,000 of whom are aged 70 and older). ED visits and subsequent hospitalizations for patients aged 70 and older were collected for the years 2017 to 2020. Furthermore, diagnoses of visits were analyzed according to ICD-10 classification groups, and population data were obtained from Statistics Finland. 1 Patients were stratified into age groups: 70-79 years, 80-89 years, and ≥90 years. The Poisson exact method was used to calculate incidences and 95% confidence intervals (CIs) of ED visits and hospitalizations. The year 2020 was compared to the reference years 2017-2019 by incidence rate ratios (IRRs), focusing on the changes in the incidence of ED visits and hospitalizations during the nationwide lockdown period (March 16 to June 1; including canceling or postponing of nonacute public health care visits and instructions to self-isolate for persons aged 70 and older) and during the period of regional restrictions (September onward; more restrained stepwise restrictions without self-isolation recommendations). Statistical analysis was performed using R 4.0.3 statistical software (R Core Team, Vienna, Austria 2020). Due to the register-based study design, ethical committee approval was not obtained nor required. 2 

There were 240,629 ED visits and 104,254 hospitalizations among people aged 70 and older during the study period. Monthly incidences of ED visits decreased in all age groups during the lockdown period ( Figure 1) . The change was similar in all diagnosis groups. Changes in hospitalizations were, however, smaller.

The greatest difference in ED visits was seen among older adults in the 80-89 age group with a decrease of 20% compared with the reference years (IRR 0.80, CI 0.78-0.82 for March to May 2020), whereas among the 70-79 and the ≥90 year age groups, the decreases were 15% (IRR 0.85, CI 0.83-0.87) and 14% (IRR 0.86, CI 0.82-0.90), respectively. During regional restrictions due to the second COVID-19 wave, there was a slighter decrease in the incidence of ED visits in the 70-79 and 80-89 year age groups. After the end of the lockdown, ED visits and hospitalizations in the ≥90 year age group remained at a higher level until November, resulting in a greater annual use of ED and hospital care in 2020 compared with 2017-2019 (IRR 1.03, CI 1.01-1.04, and IRR 1.12, CI 1.09-1.14, respectively).

The greatest decrease in ED visits was observed in the respiratory diseases, where the incidence of ED visits remained low throughout the year (IRR 0.66, CI 0.65-0.67).

Among the 70-79 and 80-89 year age groups, the incidence of ED visits due to traumas decreased during lockdown but slowly recovered thereafter. In the ≥90 year age group, no such decrease was seen, and the incidence increased after the lockdown and remained high for the rest of the year with a total annual increase of 15% in 2020 when compared with the reference years (IRR 1.15, CI 1.11-1.19). In the 70-79 (IRR 1.00, CI 0.98-1.01) and 80-89 (IRR 1.03, CI 1.01-1.05) year age groups, the annual incidence of traumas remained close to the reference levels.

This study confirms the concerns that the treatment backlog caused by the suspension of health care during the COVID-19 pandemic may result in an increased need for emergency care and hospitalizations among the older population. The prominent decrease in ED visits due to respiratory diseases is in line with previous studies [3] [4] [5] [6] [7] and suggests that the restrictions have been effective in protecting older people who are at risk for severe infection and death from hospitalization during the pandemic. 8 However, it seems that this protection has come at the cost of increased traumas, especially among the older population. These older adults may have been more F I G U R E 1 Monthly incidences of emergency department visits and hospitalizations in the three age groups. Green line shows the incidence in 2020, and the gray line shows the incidence in the reference years along with the 95% confidence interval. ED, emergency department; IRR, incidence rate ratio; CI, confidence interval dependent on physiotherapy and rehabilitation to maintain their ability to move due to the high risk of sarcopenia. 9 Indeed, the COVID-19 pandemic has been shown to decrease mobility and increase frailty before injury in patients with hip fractures. 10 These results emphasize the importance of ensuring essential services is provided to counteract the adverse consequences of immobility when restrictions are applied.

The authors have no conflict of interest. 

No sponsors were involved in conducting this study, and no funding was received for conducting this study.

ORCID Mikko Uimonen https://orcid.org/0000-0001-6609-1345

Medical Research Act, 488/1999

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