Impact of the COVID-19 pandemic on care-quality outcomes in older adults admitted to hospital with altered mental status

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY International Journal of Geriatric Psychiatry Pub Date : 2024-07-18 DOI:10.1002/gps.6125

Adam Fluck, Christopher H. Fry, Jonathan Robin, David Fluck, Thang S. Han

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Abstract

Objectives

During the coronavirus disease (COVID-19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality-care outcomes, including length of stay (LOS), in-hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic.

Methods

Chi-squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre-pandemic data, were conducted to examine the impact of the pandemic on outcomes.

Design

Prospective data of 21,192 non-COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021).

Results

There were 10,173 (47.7% men) from the pre-pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3–16.2] vs 15.5 days [IQR = 6.2–25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12–0.57). In-hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11–0.96).

Conclusions

This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission-discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID-19 pandemic on healthcare delivery to individuals with AMS.

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COVID-19 大流行对因精神状态改变而入院的老年人护理质量结果的影响

目的在冠状病毒病（COVID-19）大流行期间，精神状态改变（AMS：痴呆、谵妄和谵妄叠加痴呆）患者受到医疗系统突然转变的深刻影响。在此，我们评估了大流行期间因精神状态改变而入院的老年人的护理质量结果，包括住院时间（LOS）、院内死亡率、早期再入院率和出院后死亡率，并与大流行前入院的患者进行了比较。方法采用卡方检验和费雪精确检验来研究大流行前和大流行期间因急性呼吸系统综合症入院患者的变化及其结果。参照大流行前的数据进行逻辑回归分析，以研究大流行对结果的影响。设计收集了英国萨里郡一家医院急诊普通内科的 21,192 例非 COVID 入院患者的前瞻性数据，这些患者分别在大流行前（2019 年 4 月 1 日至 2020 年 2 月 29 日）和大流行期间（2020 年 3 月 1 日至 2021 年 3 月 31 日）入院。大流行期间，急性髓系白血病患者的入院率明显更高（1.1% vs 0.6%，P <0.001）。然而，住院时间中位数较短（9.0 天 [IQR = 5.3-16.2] vs 15.5 天 [IQR = 6.2-25.7], P <0.001），因此住院 3 周的可能性较低：调整后 OR = 0.26 (95%CI = 0.12-0.57)。在大流行期间，住院死亡率和出院后 28 天内的再入院率没有变化，但出院后 30 天内死亡的可能性较低：调整 OR = 0.32（95%CI = 0.11-0.96）。结论较高的入院率、较短的生命周期和不变的早期再入院率表明，不同的急性髓系白血病患者的入院-出院周转率较高，这为了解 COVID-19 大流行对急性髓系白血病患者医疗服务的潜在影响提供了重要信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.