Impact of the COVID-19 Pandemic on Mortality and Health Resource Use in an Aged Population and Differences According to Frailty Status

Background: The COVID-19 pandemic severely affected the aged population and healthcare system functioning. Aim: To evaluate the impact of COVID-19 on mortality and health resource use in an aged population and to determine whether the impact differed according to frailty status. Methods: A population-based observational longitudinal study comparing pre-pandemic and pandemic variables was performed using data retrospectively collected from computerized clinical histories. The study population included all inhabitants aged =65 years corresponding to three primary care centres in Barcelona province (Spain). Data were collected on mortality, institutionalization, hospital admissions, emergency visits, outpatient visits, primary care visits, and day hospital sessions in the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Frailty status was established according to the Electronic Screening Index of Frailty (e-SIF). Results: 9315 individuals were included in the pre-pandemic cohort (75.4 years, 56% women) and 9774 in the pandemic cohort (73.3 years, 56% women). Compared with the pre-pandemic period, in the pandemic period, mortality overall increased by 21.7% (14.7% for non-frail and 33.0% for frail individuals); emergency visits, hospitalizations, and day hospital sessions decreased by 23.1%, 12.1%, and 3.7%, respectively, and primary care visits increased by 15.0%. Conclusions: For the population aged =65 years in the COVID-19 pandemic period, the mortality of frail individuals was greater than overall mortality for this population, and frailty prevalence overall decreased by 5%. In terms of resource use, use of hospital services decreased and of primary care services increased.