Associations of cognitive impairment with self-isolation and access to health and care during the COVID-19 pandemic in England.

This research explored experiences across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to shielding (either self-isolating or staying at home), COVID-19 infection, and access to health/care services during the COVID-19 pandemic. Analyses were conducted using data from the English Longitudinal Study of Ageing (ELSA) COVID-19 sub-study collected in 2020. We report bivariate estimates across our outcomes of interest by cognitive function group along with multivariate regression results adjusting for demographic, socioeconomic, geographic, and health characteristics. Rates of shielding were high across all cognitive function groups and three measured time points (April, June/July, and Nov/Dec 2020), ranging from 74.6% (95% confidence interval 72.9-76.2) for no impairment in Nov/Dec to 96.7% (92.0-98.7) for dementia in April (bivariate analysis). 44.1% (33.5-55.3) of those with dementia experienced disruption in access to community health services by June/July compared to 34.9% (33.2-36.7) for no impairment. A higher proportion of those with mild impairment reported hospital-based cancellations in June/July (23.1% (20.1-26.4)) and Nov/Dec (16.3% (13.4-19.7)) than those with no impairment (18.0% (16.6-19.4) and 11.7% (10.6-12.9)). Multivariate adjusted models found that those with dementia were 2.4 (1.1-5.0) times more likely than those with no impairment to be shielding in June/July. All other multivariate analyses found no statistically significant differences between cognitive function groups. People with dementia were more likely than people with no impairment to be shielding early in the pandemic, but importantly they were no more likely to experience disruption to services or hospital treatment.

Slowdown in Life Expectancy Improvements for European Countries From 2000 to 2019

Life expectancy improvements have slowed across Europe since around 2010 for unknown reasons. We aimed to assess the contribution of specific conditions and risk factors to changes in life expectancy. We compared Global Burden of Disease (GBD) 2019 estimates for life expectancy at birth, years of life lost to premature mortality (YLLs) and population attributable fractions (PAFs) for risk factors, for 17 European Economic Area (EEA) countries from 2000 to 2010 and from 2010 to 2019. All 17 countries experienced a slowdown in life expectancy improvements after 2010, after decades of improvement. Denmark experienced the smallest drop in improvement from 2000 to 2010 compared to 2010 to 2019 (0.75 years drop), followed by Norway (0.79), Iceland (0.86), Finland and Sweden (both 0.89). The 5 countries with the largest drop in improvement were Spain (1.6 years drop), the Netherlands (1.88), Portugal (1.92), the United Kingdom (UK) (2.13), and Ireland (2.77). Ischaemic heart disease and stroke made the biggest contribution to the slowdown in life expectancy. Important risk factors for mortality varied by country and included tobacco, drug and alcohol use, and high fasting plasma glucose. The Nordic countries have maintained improvements in life expectancy substantially better than other European countries. The different patterns in different countries suggest multiple factors are contributing to the changes, including specific conditions, risks and behaviours, and broader societal determinants of health. Large scale, international, co-ordinated research is needed to better understand these changes and inform policy actions, particularly as the COVID-19 pandemic will increase international differences.

Digital exclusion during the COVID-19 pandemic in the English longitudinal study for ageing population

BackgroundThe NHS long term plan commits to ‘digital first primary care’ by 2024. Increasing reliance on digital access may disadvantage those who do not use the internet. We aimed to assess changes in internet use in adults over 50 years of age before and during the coronavirus pandemic.MethodsParticipants in the English Longitudinal Study for Ageing were asked how often they used the internet or email in Wave 9 (W9) from June 2018 to June 2019 and COVID Wave 1 (CW1) from June to July 2020. Response options were daily, weekly, monthly, every 3 months or never. Multivariate logistic regression on weighted data was performed to assess variation by sex, age group (50 to state pension age (SPA), SPA to 74, 75 and over), and wealth quintile.Results5,142 core participants responded to both W9 and CW1. Of these, 553 (10.75%;95% confidence interval (CI) 9.71 to 11.89) reported never using the internet in W9 and 733 (14.26%;13.05 to 15.57) in CW1. Of those aged 75 and older, 320 (30.64%;26.87 to 34.87) were ‘never users’ in W9 and 419 (40.03%;35.51 to 45.03) in CW1. Univariate analysis found that the odds of reporting ‘never use’ were higher for women than men (W9 odds ratio (OR) 1.39;(CI) 1.11 to 1.73, CW1 1.35;1.11 to 1.66), older age groups (W9 4.21;3.36 to 5.27, CW1 4.24;3.50 to 5.14), and less wealthy quintiles (W9 1.18;1.10 to 1.26, CW1 1.19;1.11 to 1.27). Multivariate analysis found that age was the most important predictor of never using the internet. The odds for older age groups were 4.73;3.81 to 5.89 (W9) and 4.93;4.09 to 5.93 (CW1). The differences between women and men, and between wealth quintiles, were no longer statistically significant.ConclusionThe proportion of participants reporting that they never used the internet increased slightly during the pandemic and included 4 in every 10 of those aged 75 and older. A limitation is that W9 data were collected using a paper survey delivered by an interviewer, and CW1 were administered over the phone or internet. Overall, there is a substantial risk that a ‘digital first primary care’ policy will create barriers for those aged over 75 years. It will be important to maintain alternative access routes to avoid increasing barriers to health care access and subsequent inequalities in the care provided to older people in England.