Healthcare utilization among older people with intellectual disabilities compared to the general population – A Swedish register study before and during the COVID-19 pandemic

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Introduction: Older people with intellectual disabilities (ID) have higher levels of comorbidities and overall healthcare utilization than the general population. A known healthcare need would imply high levels of planned healthcare, while unplanned healthcare could be a sign of unmet healthcare needs. Thus, to understand if older people with ID are receiving the healthcare they need, different types of healthcare utilization should be investigated. The aim of this study was to assess healthcare utilization patterns among older people with ID, before and during the COVID-19 pandemic, compared to the general population. 

Methods: The ID cohort comprised 766 people 65 years or older living in Skåne, the southernmost county of Sweden, on the 1st of Jan 2014, with at least one diagnosis of ID (ICD-10 codes F70-F79), Down syndrome (DS; Q90), or at least one measure of support and/or services according to the LSS act in 2014- 2020. The general population cohort (gPop) comprised 257 285 same-aged people. Healthcare utilization data was collected from Skåne Health Care Register for 2014-2021.

Results: People with ID had higher risk for unplanned, but not planned, contacts in public primary care and somatic specialist care during both the pre-pandemic and pandemic period. They had increased risk of both unplanned and planned contacts in psychiatric specialist care during both periods. However, they had decreased risk of privately organized care during both the pre-pandemic and pandemic period.

Conclusions: The increased risk of unplanned healthcare may indicate that people with ID have unmet healthcare needs. As people with ID have higher levels of comorbidities, a similar or decreased risk of planned healthcare suggests that they are not well monitored by the health system.