Open Access
Open access
Public Library of Science (PLoS)
PLoS ONE
,  volume 19 ,  issue 7 ,  pages e0306569

Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?

Colleen J. Maxwell 1
, 
Eric McArthur 2
, 
David B Hogan 3
, 
Hana Dampf 4
, 
Jeffrey Poss 5
, 
Joseph E Amuah 6
, 
Susan E. Bronskill 7
, 
Erik Youngson 8
, 
Zoe Hsu 8
, 
Matthias Hoben 9
1
 
2
 
London Health Sciences Centre, London, Ontario, Canada | 
3
 
4
 
5
 
6
 
7
 
ICES, Toronto, Ontario, Canada, | 
8
 
Provincial Research Data Services, Alberta Health Services, Alberta, Canada, | 
9
 
Publication type: Journal Article
Publication date: 2024-07-12
Public Library of Science (PLoS)
scimago Q1
wos Q2
SJR: 0.803
CiteScore: 5.4
Impact factor: 2.6
ISSN: 19326203
Abstract
Background

COVID-19 and resulting health system and policy decisions led to significant changes in healthcare use by nursing homes (NH) residents. It is unclear whether healthcare outcomes were similarly affected among older adults in assisted living (AL). This study compared hospitalization events in AL and NHs during COVID-19 pandemic waves 1 through 4, relative to historical periods.
Methods

This was a population-based, repeated cross-sectional study using linked clinical and health administrative databases (January 2018 to December 2021) for residents of all publicly subsidized AL and NH settings in Alberta, Canada. Setting-specific monthly cohorts were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. Monthly rates (per 100 person-days) of all-cause hospitalization, hospitalization with delayed discharge, and hospitalization with death were plotted and rate ratios (RR) estimated for period (pandemic wave vs historical comparison), setting (AL vs NH) and period-setting interactions, using Poisson regression with generalized estimating equations, adjusting for resident and home characteristics.
Results

On March 1, 2020, there were 9,485 AL and 14,319 NH residents, comparable in age (mean 81 years), sex (>60% female) and dementia prevalence (58–62%). All-cause hospitalization rates declined in both settings during waves 1 (AL: adjusted RR 0.60, 95%CI 0.51–0.71; NH: 0.74, 0.64–0.85) and 4 (AL: 0.76, 0.66–0.88; NH: 0.65, 0.56–0.75) but unlike NHs, AL rates were not significantly lower during wave 2 (and increased 27% vs NH, January 2021). Hospitalization with delayed discharge increased in NHs only (during and immediately after wave 1). Both settings showed a significant increase in hospitalization with death in wave 2, this increase was larger and persisted longer for AL.
Conclusions

Pandemic-related changes in hospitalization events differed for AL and NH residents and by wave, suggesting unique system and setting factors driving healthcare use and outcomes in these settings in response to this external stress.

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GOST |
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GOST Copy
Maxwell C. J. et al. Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises? // PLoS ONE. 2024. Vol. 19. No. 7. p. e0306569.
GOST all authors (up to 50) Copy
Maxwell C. J., McArthur E., Hogan D. B., Dampf H., Poss J., Amuah J. E., Bronskill S. E., Youngson E., Hsu Z., Hoben M. Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises? // PLoS ONE. 2024. Vol. 19. No. 7. p. e0306569.
RIS |
Cite this
RIS Copy
TY - JOUR
DO - 10.1371/journal.pone.0306569
UR - https://dx.plos.org/10.1371/journal.pone.0306569
TI - Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?
T2 - PLoS ONE
AU - Maxwell, Colleen J.
AU - McArthur, Eric
AU - Hogan, David B
AU - Dampf, Hana
AU - Poss, Jeffrey
AU - Amuah, Joseph E
AU - Bronskill, Susan E.
AU - Youngson, Erik
AU - Hsu, Zoe
AU - Hoben, Matthias
PY - 2024
DA - 2024/07/12
PB - Public Library of Science (PLoS)
SP - e0306569
IS - 7
VL - 19
PMID - 38995897
SN - 1932-6203
ER -
BibTex |
Cite this
BibTex (up to 50 authors) Copy
@article{2024_Maxwell,
author = {Colleen J. Maxwell and Eric McArthur and David B Hogan and Hana Dampf and Jeffrey Poss and Joseph E Amuah and Susan E. Bronskill and Erik Youngson and Zoe Hsu and Matthias Hoben},
title = {Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?},
journal = {PLoS ONE},
year = {2024},
volume = {19},
publisher = {Public Library of Science (PLoS)},
month = {jul},
url = {https://dx.plos.org/10.1371/journal.pone.0306569},
number = {7},
pages = {e0306569},
doi = {10.1371/journal.pone.0306569}
}
MLA
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MLA Copy
Maxwell, Colleen J., et al. “Comparison of hospitalization events among residents of assisted living and nursing homes during COVID-19: Do settings respond differently during public health crises?.” PLoS ONE, vol. 19, no. 7, Jul. 2024, p. e0306569. https://dx.plos.org/10.1371/journal.pone.0306569.