Death risk higher among older patients likely to delay, miss medical care due to pandemic

Older patients who are strongly likely to delay or miss medical care due to the coronavirus disease 2019 (COVID-19) pandemic are at greater risk of mortality and worse outcomes, a recent study has found.

Researchers conducted a retrospective matched cohort study on 14,406 patients (aged >65 years) with at least two chronic conditions. Participants had at least 1 year’s worth of baseline data and up to 9 months of postpandemic follow-up. A matched control cohort of 14,406 elderly adults, whose data were collected 2 years before the pandemic, was also included.

The risk of delayed or missed care (DMC) was assessed using 13 indicators: chronic conditions, frailty, disability that affected the use of telehealth, recent unplanned acute care, prior missed care, and other social determinants of health. The effects of DMC risk on the outcome measures of mortality, inpatient events, and healthcare utilization were evaluated.

Of all DMC indicators, polypharmacy (≥5 medications) was the most common, present in 79 percent of participants, followed by cardiovascular diseases (77 percent) or stroke (78 percent) and frailty (13 percent).

Researchers found that participants who had at least four DMC indicators saw significantly greater mortality (p=0.025). Healthcare utilization dropped during the pandemic, but this effect was most apparent in participants with four or more DMC indicators.

“These patients may benefit from outreach and care coordination to ensure proactive management of their chronic conditions, particularly as future pandemic scenarios suggest that countries, communities, and individuals may need to cope in the longer-term with the possibility of a continued threat from COVID-19 and its variants,” the researchers said.