Health outcomes in aged care residents with dementia during the COVID-19 pandemic

Specialist attendances for aged care residents decreased early in the pandemic

Previous reports have shown that among aged care residents, a lower percentage of people with a dementia record have at least one Medicare-subsidised specialist attendance than people with no dementia record. See Dementia in Australia – Primary health care services for more information.

Early in the COVID-19 pandemic, between the December 2019 and June 2020 quarters, there was a decrease in the percentage of aged care residents who had at least one specialist attendance:

• from 18% to 14% for people with a dementia record
• from 24% to 19% for people with no dementia record (Figure 1.3, ‘Percentage’).

During this time, there was a steep decrease in face-to-face specialist attendances:

• from 18% to 11% of residents with a dementia record
• from 24% to 13% of residents with no dementia record (Figure 1.3).

This decrease was somewhat offset by the uptake of telehealth items after their introduction in March 2020. The percentage of residents with a telehealth specialist attendance peaked in the June 2020 quarter at 4.3% of people with a dementia record and 8.7% of people with no dementia record (Figure 1.3, ‘Percent’). 

From the September 2020 quarter, total specialist attendances for residents with and without a dementia record increased to just below 2019 levels. The use of telehealth specialist attendances fluctuated with COVID-19 waves (see Figure A1), with an inverse pattern to changes in face-to-face attendances (Figure 1.3, ‘Percentage’).

The number of telehealth specialist attendances per person increased in the Omicron period

The following rates refer to aged care residents with at least one specialist attendance, by dementia status; rates for all residents can be found in Table S1.2. 

Between the June 2020 and December 2021 quarters, the average number of face-to-face and telehealth specialist attendances per resident per quarter remained steady for people with and without a dementia record (Figure 1.3, ‘Number’). 

From the start of the Omicron period (December 2021):

• the average number of telehealth specialist attendances per resident increased 
• the average number of face-to-face specialist attendances per resident decreased
• the average number of all specialist attendances per resident remained relatively steady at about 1.6 per quarter for people with a dementia record and 1.7 per quarter for people with no dementia record (Figure 1.3).

Figure 1.3: Specialist services provided to aged care residents: (a) percentage of residents with at least one specialist attendance, (b) average number of specialist attendances per resident, by dementia status, mode of service delivery and calendar year quarter, 2019 to 2022

Notes: 

1. Data were not available for Western Australia.
2. Quarters of a calendar year are used in the report. For example: Sep 2020 or ‘the September 2020 quarter’ refers to July to September 2020. 
3. ‘Telehealth’ includes specialist attendances by telephone and video conference.
4. The ‘average number of specialist services per resident’ was calculated for aged care residents with at least one specialist attendance in that quarter; rates for all residents can be found in Table S1.2. 

For downloadable data tables, see Table S1.2 in Data tables (Changes in health service use by aged care residents).

Differences in specialist attendances by population group

Figure 1.4 is an interactive chart where readers can explore differences in specialist attendances, by dementia status and for selected population groups: sex, age group and region of residence (state or territory, remoteness area and socioeconomic area). 

Some key findings are:

• From the start of the Omicron period (March 2022), the percentage of aged care residents who had a telehealth specialist attendance, and the average number of services per resident, was higher in Outer regional, remote and very remote areas than in Inner regional areas and Major cities (Figure 1.4)
• During the pre-Omicron period, the percentage of aged care residents who had a telehealth specialist attendance was highest in higher socioeconomic (least disadvantaged) areas and lowest in lower socioeconomic (most disadvantaged) areas (Figure 1.4, ‘Percent’). From December 2022 (the Omicron period), there was less difference between socioeconomic areas in rates of telehealth use, while the average number of telehealth specialist attendances per resident was highest for residents in lower socioeconomic areas (Figure 1.4, ‘Number).

Figure 1.4: Specialist services provided to aged care residents: (a) percentage of residents with at least one specialist attendance, (b) average number of specialist attendances per resident, by dementia status, mode of service delivery, population group and calendar year quarter, 2019 to 2022

Notes: 

1. Quarters of a calendar year are used in the report. For example: Sep 2020 or ‘the September 2020 quarter’ refers to July to September 2020. 
2. ‘Telehealth’ includes specialist attendances by telephone and video conference.
3. The ‘average number of specialist services per resident’ was calculated for aged care residents with at least one specialist attendance in that quarter; rates for all residents can be found in Table S1.2. 
4. Place of residence data were primarily based on a person’s latest SA2 information in the Medicare Consumer Directory in the COVID-19 Register (excluding Western Australia). 
5. Analysis by socioeconomic area was based on the 2021 Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-economic Disadvantage (IRSD) quintiles, where 1 is the most disadvantaged area and 5 is the least disadvantaged area. The socioeconomic area of a person’s residential aged care facility may not be the same as the socioeconomic area/s they previously lived in.
6. Abbreviations: ACT: Australian Capital Territory, NSW: New South Wales, NT: Northern Territory, QLD: Queensland, SA: South Australia, TAS: Tasmania, VIC: Victoria. Some data points for the ACT and NT were suppressed due to data confidentiality rules for small counts.

For downloadable data tables, see Table S1.2 in Data tables (Changes in health service use by aged care residents).