Post-acute care transitions during COVID-19: Racial, ethnic, and socioeconomic differences in older adults with Alzheimer's disease and related dementia.

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  • Additional Information
    • Source:
      Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
    • Publication Information:
      Publication: Malden, MA : Blackwell Science
      Original Publication: New York [etc.]
    • Subject Terms:
      COVID-19*/ethnology ; COVID-19*/epidemiology ; Alzheimer Disease*/ethnology ; Alzheimer Disease*/epidemiology ; Subacute Care*/statistics & numerical data ; Medicare*/statistics & numerical data ; Ethnicity*/statistics & numerical data; Humans ; Aged ; Male ; United States/epidemiology ; Female ; Aged, 80 and over ; SARS-CoV-2 ; Skilled Nursing Facilities/statistics & numerical data ; Dementia/ethnology ; Dementia/epidemiology ; Socioeconomic Factors ; Independent Living/statistics & numerical data ; Patient Discharge/statistics & numerical data ; Pandemics ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data
    • Abstract:
      Background: Differences in the post-acute care (PAC) destinations among racial, ethnic, and socioeconomic groups have been documented before the COVID-19 pandemic. Yet, the pandemic's impact on these differences remains unknown. We examined the impact of the COVID-19 pandemic on PAC destinations and its variation by individual race, ethnicity, and socioeconomic status among community-dwelling older adults with Alzheimer's disease and related dementia (ADRD).
      Methods: We linked 2019-2021 national data (Medicare claims, Minimum Data Set, Master Beneficiary Summary File) and several publicly available datasets, including Provider of Services File, Area Deprivation Index, Area Health Resource File, and COVID-19 infection data. PAC discharge destinations included skilled nursing facilities (SNFs), home health agencies (HHA), and homes without services. Key variables of interest included individual race, ethnicity, and Medicare-Medicaid dual status. The analytic cohort included 830,656 community-dwelling Medicare fee-for-service beneficiaries with ADRD who were hospitalized between 2019 and 2021. Regression models with hospital random effects and state-fixed effects were estimated, stratified by the time periods, and adjusted for the individual, hospital, and county-level covariates.
      Results: SNF discharges decreased while home and HHA discharges increased during the pandemic. The trend was more prominent among racial and ethnic minoritized groups and even more so among dual-eligible beneficiaries. For instance, the reduction in the probabilities of SNF admissions between the pre-pandemic period and the 2nd year of COVID was 4.6 (White non-duals), 18.5 (White duals), 8.7 (Black non-duals), and 20.1 (Black duals) percentage-point, respectively. We also found that non-duals were more likely to replace SNF with HHA services, while duals were more likely to be discharged home without HHA.
      Conclusions: The COVID-19 pandemic significantly impacted PAC destinations for individuals with ADRD, especially among socioeconomically disadvantaged and racial and ethnic minoritized populations. Future research is needed to understand if and how these transitions may have affected health outcomes.
      (© 2024 The American Geriatrics Society.)
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    • Grant Information:
      RF1 AG063811 United States AG NIA NIH HHS; RF1 AG073052 United States AG NIA NIH HHS; RF1AG063811 United States AG NIA NIH HHS; RF1AG073052 United States AG NIA NIH HHS
    • Contributed Indexing:
      Keywords: Alzheimer's disease and related dementia; COVID‐19; care transitions; post‐acute care; racially and ethnically minoritized
    • Publication Date:
      Date Created: 20240328 Date Completed: 20240705 Latest Revision: 20240707
    • Publication Date:
      20240707
    • Accession Number:
      PMC11226367
    • Accession Number:
      10.1111/jgs.18884
    • Accession Number:
      38539279