Declines in intensive care unit admissions in early COVID-19 pandemic among persons with dementia in three Canadian provinces
Bibliographic record
Abstract
Context: Providing critical care for people living with dementia (PLWD) during the COVID-19 pandemic outbreak was raised as a global concern. A task force commissioned by the Alzheimer Society of Canada published 7 principles to consider when planning access to scarce resources to ensure that respect for the dignity of PLWD is preserved. Objective: To measure the impact of the first two waves of the pandemic on intensive care unit (ICU) use among PLWD. Study Design: Retrospective historically controlled cohort study using population-level administrative health data. Setting: Alberta, Ontario, Quebec. Population: PLWD aged 65+. Methods: We identified two closed cohorts of PLWD on March 3, 2019 (pre-pandemic) and March 1, 2020 (pandemic) and stratified them by community and nursing home settings Outcome measures: Rates of intensive care unit admissions. Analysis: We used a 2-step meta-analytical approach. Step 1: Compared rates of ICU admissions in three 2020 periods (1st wave; interim period; 2nd wave) to the corresponding 2019 periods. Step 2: Conducted random effect meta-analyses on the provincial incident rate ratios (IRR) and 95% CIs. Results: Community cohorts included 160,288 (pre-pandemic) and 166,392 (pandemic) individuals. Nursing home cohorts included 91,646 (pre-pandemic) and 90,727 (pandemic) individuals. The rates of ICU admissions in the community were 25% (IRR=0.75 [0.69–0.82]) lower in the interim period and 24% lower in the second wave (IRR=0.76 [0.74–0.78]). Pre-pandemic rates of ICU admissions from nursing homes were higher than expected, showing differences between provinces (from 0.01 to 0.06 per 100-person week). In nursing homes, rates of ICU admissions were lower throughout the pandemic year: 29% (IRR=0.71 [0.69–0.73]) less in the first wave, 32% (IRR=0.68 [0.57–0.82]) less in the interim period, and 24% (IRR=0.76, [0.63–0.93]) less in the second wave. Conclusions: There is a need for a single hospital/ICU triage protocol, particularly for very frail older adults such as PLWD. Pre-pandemic high use of ICU from nursing homes is unexpected given that PLWD have advanced stage of dementia. This speaks to the need for better practices for advance care planning and for a global consensus on the level of frailty making the use of ICU futile. In the community, lower ICU admissions during the pandemic periods are surprising given that PLWD had more severe COVID infections. Future studies should explore provincial practices and policies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.011 |
| Bibliometrics | 0.004 | 0.008 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".