Changes in the Emergency Department Visits Among the Older Adults With Dementia Before, and After the Nationwide Social Distancing Measures: An Interrupted Time Series Analysis

Abstract

Objectives: Social isolation is a well-known risk factor for dementia, particularly among the older adults. The recent global health crisis, coupled with prolonged social distancing, leading to unprecedented disruptions in social interactions and raising concerns about unforeseen impacts on vulnerable populations, particularly older individuals with dementia. This study examines the impact of extended social isolation on dementia patients receiving emergency care.

Methods: We conducted a nationwide study of emergency department (ED) visits among dementia patients aged 65+ during various phases of pandemic-related social distancing. Segmented quasi-Poisson regression models were used to determine changes in ED visits during and after social distancing compared to pre-social distancing.

Results: From 2017 to 2022, there were 203,772 ED visits by patients with dementia among older patients. The proportion of ED visits by patients with dementia decreased from 17% pre-pandemic to 15% during social isolation. Interrupted time series analysis revealed a decline in ED visits during social distancing (step change: 0.849, 95% confidence interval [CI] 0.804-0.897; slope change: 1.000, 95% CI 0.996-1.003) followed by a rebound after restrictions were lifted (step change: 1.076, 95% CI 1.024-1.131; slope change: 1.009, 95% CI 0.994-1.025). However, monthly admission and mortality rates increased during social distancing.

Conclusion: This study observed a decline in ED visits by patients with dementia among older patients during social distancing, followed by a rebound after restrictions were lifted. However, the social distancing period was associated with increased hospitalization and mortality. These findings underscore the importance of maintaining healthcare accessibility for vulnerable older adults.