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

Author

Listed:
  • Giacomo Pietro Vigezzi

    (Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
    Collegio Ca’ della Paglia, Fondazione Ghislieri, 27100 Pavia, Italy
    These authors contributed equally to this work.)

  • Paola Bertuccio

    (Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
    These authors contributed equally to this work.)

  • Andrea Amerio

    (Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16124 Genoa, Italy
    IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy)

  • Cristina Bosetti

    (Department of Oncology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy)

  • Davide Gori

    (Department of Biomedical and Neuromotor Science, University of Bologna, 40126 Bologna, Italy)

  • Luca Cavalieri d’Oro

    (Epidemiology Unit, Brianza Health Protection Agency, 20900 Monza, Italy)

  • Licia Iacoviello

    (Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
    Department of Epidemiology and Prevention, IRCCS Neuromed, 86077 Pozzilli, Italy)

  • David Stuckler

    (Department of Social and Political Sciences, Bocconi University, 20100 Milan, Italy)

  • Alberto Zucchi

    (Epidemiology Unit, Bergamo Health Protection Agency, 24121 Bergamo, Italy)

  • Silvano Gallus

    (Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, 20156 Milan, Italy)

  • Anna Odone

    (Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy)

  • Lost in Lombardia Project Investigators

    (The group members are listed in Appendix A.)

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.

Suggested Citation

  • Giacomo Pietro Vigezzi & Paola Bertuccio & Andrea Amerio & Cristina Bosetti & Davide Gori & Luca Cavalieri d’Oro & Licia Iacoviello & David Stuckler & Alberto Zucchi & Silvano Gallus & Anna Odone & Lo, 2022. "Older Adults’ Access to Care during the COVID-19 Pandemic: Results from the LOckdown and LifeSTyles (LOST) in Lombardia Project," IJERPH, MDPI, vol. 19(18), pages 1-14, September.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:18:p:11271-:d:909469
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    References listed on IDEAS

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    1. Tegan Podubinski & Louise Townsin & Sandra C. Thompson & Anna Tynan & Geoff Argus, 2021. "Experience of Healthcare Access in Australia during the First Year of the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(20), pages 1-15, October.
    2. Patrícia Soares & Andreia Leite & Sara Esteves & Ana Gama & Pedro Almeida Laires & Marta Moniz & Ana Rita Pedro & Cristina Mendes Santos & Ana Rita Goes & Carla Nunes & Sónia Dias, 2021. "Factors Associated with the Patient’s Decision to Avoid Healthcare during the COVID-19 Pandemic," IJERPH, MDPI, vol. 18(24), pages 1-12, December.
    3. Enrico Grande & Ugo Fedeli & Marilena Pappagallo & Roberta Crialesi & Stefano Marchetti & Giada Minelli & Ivano Iavarone & Luisa Frova & Graziano Onder & Francesco Grippo, 2022. "Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data," IJERPH, MDPI, vol. 19(2), pages 1-13, January.
    4. Georgina Pujolar & Aida Oliver-Anglès & Ingrid Vargas & María-Luisa Vázquez, 2022. "Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review," IJERPH, MDPI, vol. 19(3), pages 1-31, February.
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