Learning from the national management of the pandemic: The health economic impact of COVID-19 on care and support for people over 65 years old

End of project summary:

What we did and why we did it 

In March 2020, across the world governments introduced measures to try to stop the spread of COVID-19. People were asked to stay at home, and health and social care was disrupted. We wanted to find out the unplanned consequences of these measures on older people in Wales. Firstly, informed by our advisory group, we chose a group of people who were affected badly by the lockdown measures – People living with dementia aged 65 years and over (PLWD65+). Next, we looked at the impact of different lockdown scenarios on PLWD65+ by building a health economic. We explored different lockdown strategies adopted around the UK and in two extreme scenarios during the COVID-19 pandemic and their impact on PLWD65+ in Wales. Carers of PLWD and PLWD65+ were interviewed about their experiences during the pandemic. Finally, we brought all the results together from our research to form an ethical framework. In the future, this exploratory research could help inform and guide future decisions for any health crises.  

What we found  

• Wales' approach was initially estimated to be cheaper than other parts of the UK, but people had worse outcomes. As time progressed, the outcomes for PLWD65+ in Wales improved potentially showing signs that the Welsh strategy was cost-effective after the first year. 

• Comparison of the Welsh strategy to the elimination strategy adopted in countries such as New Zealand, and the public health strategy to allow community transmission to occur adopted by countries such as Sweden showed that even though both extreme strategies cost more to care for PLWD65+, they produced better outcomes for PLWD65+ and fewer people died. 

• Interviews with participants revealed issues like harm, unmet needs, and changes in dementia symptoms due to social isolation and other factors, and this was incorporated into the health economic model.  

• The practical ethical framework was produced focusing on minimising harm, fair access to services, responsible resource use, and trustworthy decision-making during health emergencies. 

• In future pandemics it is vital that the rules put in place by the government consider both protecting everyone and addressing the specific needs of vulnerable groups.