Parkinson’s Disease: Admissions to York Hospital during the COVID Pandemic

Introduction

The COVID-19 pandemic has had a significant impact on healthcare in the UK, disproportionately affecting the elderly and those with chronic illness. Frailty is prevalent amongst people with Parkinson’s (PwP). They are at risk of deconditioning, adverse effects of medication and morbidity from other illnesses. PwP are at risk of significant morbidity and mortality directly from COVID-19 but also indirectly due to a lack of access to medical and social services as well as the effect of isolation and lack of exercise during lockdown.1

Objective

How has COVID, both directly and through the effects of lockdown, affected admissions to hospital? The objective of this project was to assess the effect of COVID-19 on admissions of PwP to York Teaching Hospital (YTH) in 2020.

Methodology

PwP inpatient spells in 2019 and 2020 were identified and compared using clinical coding. Data was analysed using Microsoft Excel™. An iterative method was used to look for patterns. Data included age, date of admission and length of stay, discharge destination, date of death and all diagnoses identified during that inpatient spell. A number of outcomes were identified. Those related to COVID-19 were the number and timing of admissions and the outcome. For those admitted for reasons other than COVID-19, a comparison was made between 2019 and 2020 including the total number of admissions, the average age, primary diagnosis, discharge destination and all-cause mortality.

Results

There were 15 inpatient spells for PwP with a diagnosis of COVID-19. Their average age was 82 and 93% had complex Parkinson’s. 15% were discharged to 24h care and the mortality rate was 54%. All deaths were attributed to COVID-19 directly. For those admitted for other reasons there were 630 admissions in 2020 compared to 721 in 2019. There were significantly fewer admissions in March and April. Length of stay was reduced from 8.5 to 6 days and the only significant difference in primary diagnosis was a reduction in rates of infection. There was an increase in all-cause mortality from 23% to 28% and there are still 9 months of 2021 to measure this.

Conclusions

There was a reduction in total admissions in 2020 likely due to the effect of lockdown. People were afraid to attend hospital due to the risk of catching COVID. However, for those admitted in 2020 the mortality rate is already higher. This could be attributed to late presentation of disease or increased degree of frailty due to deconditioning during lockdown.