Routine Care during COVID-19 pandemic for Low-income Older Adults with Diabetes and Dementia

PROJECT SUMMARY During the early months of the COVID-19 pandemic, older adults experienced significant disruptions in routine medical care as health care providers suspended services and the population socially distanced to reduce risk of COVID-19 transmission. Even after health care facilities reopened, the volume of physician and outpatient visits increased but for several months still remained lower than levels observed prior to the pandemic. Among older adults with diabetes, this abrupt cessation and postponement of routine medical care raises alarm about potential adverse health consequences, especially for populations at higher risk of poor outcomes. Older adults may have greater difficulty navigating provider and facility changes due to dementia, living alone, or limited socioeconomic resources. Black older adults also may have experienced greater disruptions in routine medical care during the pandemic given higher infection and mortality rates among Black communities. Because the COVID-19 pandemic devastated nursing homes, assisted living facilities, and home-based caregiving arrangements, older adults with Medicaid-funded long-term services and supports faced significant risk of disruption of non-COVID-10 related health care services. This application proposes supplemental COVID-19 research for an ongoing R01 project, Diabetes, Dementia, and Aging at Home, that examines long-term services use among older Southern Community Cohort Study (SCCS) participants with diabetes and dementia. The SCCS is a longitudinal health disparities survey that recruited 84,000 white and Black adults age 40-79 between the years 2002-2009 from 12 Southern states. By updating existing SCCS Medicare and Medicaid data linkages with quarterly 2020 Medicare claims data, this project will assess whether certain populations, such as older adults with dementia or low-income older adults, were more likely to experience declines in health care services use, less substitution of telehealth services, and greater acuity upon hospital admission during the COVID-19 pandemic. For older adults at greater risk of poor outcomes, financial assistance with out-of-pocket costs may be an important safety net that protects access to routine medical care, so we will examine whether older adults who had Medicaid and Part D Low Income Subsidy benefits were less likely to experience these disruptions in health care use. This study will provide actionable, timely evidence by identifying which populations would benefit from essential support as the COVID-19 pandemic continues. 2