Abstract

Background: The COVID-19 pandemic impacted older people's care use worldwide. To protect older people, transitions between the care sites and access to outpatient care were restricted in Finland in spring 2020. At the beginning of the COVID-19 pandemic, the infection spread in some long-term care facilities, which may have influenced people's desire to use round-the-clock long-term care. The restrictions have likely affected the care use of people with dementia as they were considered to be at high risk of the severe infection and death.

Objectives: This study explores the changes in the use of round-the-clock long-term and health care among people 70+ years with dementia between 2018, 2019, and 2020.

Methods: The study population for this register-based study was retrieved from the Finnish Population Register and consisted of all people aged 70 and older in Finland in 2018, 2019, and 2020 (N 1 032 000). For these individuals, data were linked from care registers, including information on their health care visits and inpatient and long-term care days. Dementia diagnoses were identified from the care register and causes of death register when applicable. Descriptive statistical analyses were performed separately for each month in the study years and three age groups (70 to 79, 80 to 89, and 90+).

Results: Of the total study population, 12.2% had a dementia diagnosis. Preliminary results show their average number of long-term care days was higher in 2020 than in previous years, and the highest in the oldest age group. In 2020, the average number of long-term care days in each month was slightly higher in all age groups than in the same month in previous years. Only in the oldest age group, the average number of days in November and December in 2020 was slightly lower than in November and December in 2019. The situation was different in health care. Across the study population with dementia, inpatient care days decreased sharply in March 2020 compared to March 2018 and 2019. The most evident decrease in inpatient days was among people aged 90+ . Outpatient health care visits also decreased drastically in March 2020 but increased again towards the end of the year. However since March, the visits among those aged 90+ with dementia were clearly at a lower level for the whole year 2020 compared to previous years.

Conclusions: The COVID-19 pandemic decreased the use of health care services among people with dementia in Finland, especially among the oldest. This may have caused delays in care and could have led to fatal effects. The potential fear of being infected did not reduce the use of long-term care in people with dementia. It may be that the decline in the use of health care services was partly reflected in the increase in long-term care days, especially among long-term care residents.