Dementia care shifted towards outpatient services during the COVID-19 pandemic in Germany

BackgroundThe COVID-19 pandemic disrupted healthcare systems worldwide, forcing adaptations in care pathways. A particularly vulnerable patient group are those with Alzheimer's disease and other forms of dementia who experienced unique challenges during this period.ObjectiveThis study aims to examine shifts in healthcare utilization, focusing on inpatient and outpatient services.MethodsWe retrospectively analyzed 27,240 dementia cases from 86 German hospitals, comparing inpatient and outpatient care between March 1, 2020, and December 31, 2022 to cases from 2019. Admission rates, length of stay, disease severity (case mix, comorbidities) and complications (i.e., intensive care admission, mortality) were assessed using (generalized) mixed models.ResultsOutpatient care utilization for dementia increased during the pandemic (+33%, from 11.3 before to 15.1 daily admissions during the pandemic, p < 0.001), with three outpatient admissions accompanying each lacking inpatient admission (-20%, from 6.3 before to 5.0 daily admissions during the pandemic, p < 0.001). Morbidity indicators were generally lower during the pandemic for inpatient cases, while the proportion of comorbid depression was higher.ConclusionsThe pandemic triggered a substantial redistribution of dementia care favoring outpatient over inpatients services. The shift reflects an increased need for dementia-related medical interventions during the pandemic. This was likely due to social isolation aggravating dementia symptoms as evidenced by the increased rate of depression. At the same time, fear of COVID-19 exposure in hospitals likely discouraged inpatient admissions. We conclude that flexible and integrated care pathways are essential to ensure continuity and quality of care for dementia patients, especially during public health crises.