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Cognitive Decline in Long-term Care Residents Before and During the COVID-19 Pandemic in Ontario, Canada

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Long-term care (LTC) home residents experienced high infection and mortality during the COVID-19 pandemic.1 There is concern that public health restrictions to limit COVID-19 spread may have negatively affected resident cognition through increased social isolation.2 We compared the 1-year incidence of cognitive decline among LTC residents in Ontario, Canada, before and during the COVID-19 pandemic.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: September 4, 2022.

Published Online: September 12, 2022. doi:10.1001/jama.2022.17214

Corresponding Author: Colleen Webber, PhD, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada (cowebber@ohri.ca).

Author Contributions: Mr Imsirovic had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Webber, Myran, Milani, Li, Tanuseputro.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Webber.

Critical revision of the manuscript for important intellectual content: Myran, Milani, Turcotte, Imsirovic, Li, Tanuseputro.

Statistical analysis: Webber, Myran, Imsirovic, Li.

Obtained funding: Webber, Tanuseputro.

Administrative, technical, or material support: Webber, Milani, Li.

Supervision: Webber, Tanuseputro.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. This study was also supported by grants from the Bruyère Academic Medical Organization and the Canadian Institutes of Health Research project grant (funding #177916). Dr Tanuseputro is supported by a PSI Knowledge Translation Fellowship.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: Parts of this material are based on data and information compiled and provided by the Ontario Ministry of Health and the Canadian Institute for Health Information. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funders or data sources; no endorsement is intended or should be inferred. Parts of this report are based on Ontario Registrar General information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the author and do not necessarily reflect those of the Ontario Registrar General or the Ministry of Government and Consumer Services.

Data Sharing Statement: The data set from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (eg, health care organizations and government) prohibit ICES from making the data set publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at https://www.ices.on.ca/DAS (email: das@ices.on.ca). The full data set creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

References
1.
Rising from the COVID 19 crisis: policy responses in the long-term care sector. Organization for Economic Co-operation and Development. Published December 15, 2021. Accessed June 21, 2022. https://www.oecd.org/coronavirus/policy-responses/rising-from-the-covid-19-crisis-policy-responses-in-the-long-term-care-sector-34d9e049/#snotes-d4e1219
2.
Abbasi  J .  Social isolation: the other COVID-19 threat in nursing homes.   JAMA. 2020;324(7):619-620. doi:10.1001/jama.2020.13484PubMedGoogle ScholarCrossref
3.
Morris  JN , Fries  BE , Mehr  DR ,  et al.  MDS cognitive performance scale.   J Gerontol. 1994;49(4):M174-M182. doi:10.1093/geronj/49.4.M174PubMedGoogle ScholarCrossref
4.
 Changes in Health, End-Stage Disease and Signs and Symptoms (CHESS) Scale. Canadian Institute for Health Information; 2021.
5.
Austin  PC .  Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research.   Commun Stat Simul Comput. 2009;38(6):1228-1234. doi:10.1080/03610910902859574Google ScholarCrossref
6.
Lau  B , Cole  SR , Gange  SJ .  Competing risk regression models for epidemiologic data.   Am J Epidemiol. 2009;170(2):244-256. doi:10.1093/aje/kwp107PubMedGoogle ScholarCrossref
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