Effect of the COVID-19 Lockdown on Disease Recognition and Utilization of Healthcare Services in the Older Population in German: A Cross-sectional Study

Michalowsky, Bernhard; Hoffmann, Wolfgang; Bohlken, Jens; Kostev, Karel

BACKGROUND: There is little evidence about the utilization of healthcare services and disease recognition in the older population, which was urged to self-isolate during the COVID-19 lockdowns. OBJECTIVES: We aimed to describe the utilization of physician consultations, specialist referrals, hospital admissions, and the recognition of incident diseases in Germany for this age group during the COVID-19 lockdown. DESIGN: Cross-sectional observational study. SETTING: 1,095 general practitioners’ (GPs) and 960 specialist practices in Germany. SUBJECTS: 2.45 million older patients aged 65 or older. METHODS: The number of documented physician consultations, specialist referrals, hospital admissions, and incident diagnoses during the imposed lockdown in 2020 was descriptively analyzed and compared to 2019. RESULTS: Physician consultations decrease slightly in February (−2%), increase before the imposed lockdown in March (+9%), and decline in April (−18%) and May (−14%) 2020 compared to the same periods in 2019. Volumes of hospital admissions decrease earlier and more intensely than physician consultations (−39% vs. -6% respectively). Overall, 15%, 16%, and 18% fewer incident diagnoses were documented by GPs, neurologists, and diabetologists respectively in 2020. Diabetes, dementia, depression, cancer, and stroke were diagnosed less frequently during the lockdown (−17% to −26%), meaning that the decrease in the recognition of diseases was greater than the decrease in physician consultations. CONCLUSION: The data suggest that organizational changes were adopted quickly by practice management, but also raise concerns about the maintenance of routine care. Prospective studies should evaluate the long-term effects of lockdowns on patient-related outcomes.