ABSTRACT
Background Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. Methods We investigated such impact among all adults with chronic conditions aged ≥65 years, identified through the electronic health databases of two local health agencies - ATS Brianza and ATS Bergamo - from the Lombardy region, Italy. We considered hospitalizations for 2020 compared to the average 2017-2019 and quantified differences using rate ratios (RRs). Results Overall, in 2017-2019 there were a mean of 374,855 older adults with ≥1 chronic condition per year in the two ATS and 405,371 in 2020. Hospitalizations significantly decreased from 84,624 (225.8/1000) in 2017-2019 to 78,345 (193.3/1000) in 2020 (RR 0.86). Declines were reported in individuals with many chronic conditions and for most Major Diagnostic Categories, except for diseases of the respiratory system. The strongest reductions were observed in hospitalizations for individuals with active tumours, particularly for surgical ones. Hospitalization rates increased in individuals with diabetes, likely due to COVID-19-related diseases. Conclusions Although determinants of the decrease in demand and supply for care among chronic older adults are to be further explored, this raises awareness on their impacts on chronic patients’ health in the medium and long run.
ABSTRACT
The COVID-19 pandemic and the adoption of restrictive measurements to control the SARS-CoV-2 spread disrupted general population lifestyles including dietary behaviours. However, there is poor knowledge on potential socioeconomic and gender disparities in dietary changes. We conducted a telephone-based survey during fall 2020 on a sample of 4,400 participants representative of the population aged 65-99 years living in Lombardy, Italy. Changes in a Mediterranean lifestyle were assessed retrospectively by asking participants to report modifications in the consumption of nine food groups and five diet-related behaviours (e.g., consumption of organic and local foods) compared to the previous year (2019). We then computed a Mediterranean COVID-19 Pandemic Score (MedCovid-19 Score), reflecting changes during pandemic, ranging from -14 to 14, with increasing values indicating improvements in line with a Mediterranean lifestyle. Overall, 18.3% of the study participants worsened their Mediterranean lifestyle (MedCovid-19 Score <0), 35.1% remained stable (MedCovid-19 Score = 0), while 46.6% reported improvements (MedCovid-19 Score ≥1). Predictors of favourable changes toward a Mediterranean lifestyle were educational level (OR = 1.52;95% CI 1.19-1.95 for postgraduate vs lower education), wealth (OR = 1.52;1.14-2.02 for high vs low wealth), and skilled manual occupations (OR = 1.57;1.28-1.92 vs white collars). Women were more likely than men to move away from a Mediterranean lifestyle (OR = 1.86;1.58-2.21). In conclusion, improvements in line with a Mediterranean lifestyle prevailed in almost half of a large sample of elderly Italians surveyed during the COVID-19 pandemic. However, changes towards a Mediterranean lifestyle were disproportionately distributed across gender and socioeconomic strata. These findings were similar to those from the general population of the Moli-sani study, where it was observed that healthful dietary changes were associated greater wealth.