- Researchers say people with disabilities who develop COVID-19 tend to have longer hospital stays and more frequent hospital readmissions.
- However, they report that people with disabilities don’t have higher rates of in-hospital death or admission to intensive care units.
- Experts say medical staff should have detailed plans when releasing a person with disabilities from a hospital.
- They add that caregivers should instruct people with disabilities on safety protocols such as mask wearing and physical distancing.
The idea of developing COVID-19 can be scary, especially for people at high risk of serious illness.
However, a study published Jan. 31 reports that people with disabilities have an elevated risk of more serious illness if they develop COVID-19.
The researchers said people with disabilities are more likely to die, have more extended hospital stays, and have more hospital readmissions.
The researchers looked at 1,279 hospital admission records of people over 18 who had COVID-19.
Of those, 285 had a recorded disability, which is close to the 20 percent rate prevalence rate in North America. About
The disabilities of people in the study included physical, hearing, and vision impairments, as well as traumatic brain injuries and intellectual and developmental disabilities.
The breakdown of disabilities in the study was:
- 212 with a physical disability
- 18 with a hearing or vision impairment
- 24 with a traumatic brain injury or a developmental disability
- 31 with multiple disabilities
The researchers compared admissions for people with a disability with those without a disability, looking at different possible outcomes, including:
- in-hospital death
- admission to an intensive care unit (ICU)
- length of hospital stay
- unplanned readmission within 30 days, excluding transfers from one facility to another
The results were adjusted for numerous socioeconomic factors, including zip code, age, sex, residence in long-term care, dementia, and psychiatric disorders.
The researchers found that after adjustments, people with disabilities had more extended hospital stays and an elevated risk of readmission within 30 days.
However, the researchers did not see a significant difference in-hospital deaths or ICU admission.
Dr. Michael M. McKee, MPH, an associate professor of family medicine and co-director of the University of Michigan Center for Disability Health and Wellness, told Healthline that the study observations coincide with what he has seen in his work.
“The findings parallel what we have seen [in other] healthcare based outcomes,” McKee said. “COVID is just another example of higher health burdens that these individuals struggle with. This is complicated further with a healthcare system that is not well designed to care for their needs.”
Gail Trauco, a registered nurse and patient advocate, told Healthline that the higher readmission rate may be caused by the need of a person with disabilities to see a specialist.
“The Canadian healthcare system treats patients seen in the [emergency room] requiring emergent care immediately,” Trauco explained.
“However, there may be a delay in specialist care, which impacted outcome data collected for this publication. Canadian patients might have been referred to receive outpatient physical therapy or respiratory therapy rehabilitative services. Delay in the initiation of this type of discharge follow-up care would be a factor requiring readmission secondary to clinical decline.”
The researchers recommend that medical staff consider disability-related needs when creating plans for people with COVID-19.
Discharge instructions might include:
- community supports
- community resources
- special accommodations based on individual limitations
Trauco also suggests that discharge instructions advise people to:
- limit exposure to people and places outside of the hospital setting
- use telemedicine and mobile nursing for interval healthcare follow-ups with medical staff when possible
In addition, McKee advises, “We need to make sure that these patients are provided accessible and effective care, health information, and vaccine and treatment centers.”
“Anything short of this,” he said, “creates another barrier that increases readmission risk. Discharge instructions need to be clearly stated, which may require certain communication principles (e.g., plain language, visuals), assistive devices (amplifiers), or interpreters. I also strongly recommend incorporating teach-back to ensure that they understand. For some, support individuals also need to be informed.”
“People with disabilities should be keenly alert to the initial symptoms of COVID and COVID variants and seek medical care immediately to ensure early diagnosis and intervention,” added Trauco. “Delays in diagnosis and treatment increase the risk of severe illness.”
Not everyone with a disability is at high risk of developing a serious case of COVID-19, according to the Centers for Disease Control and Prevention (CDC).
Those who are at a
- people with limited mobility
- people who routinely come into close contact with others, such as direct support providers and family member
- people who have trouble understanding information or practicing preventive measures such as handwashing and physical distancing
- people who have trouble communicating symptoms of illness
The CDC says caregivers should stress the importance of wearing a mask, physically distancing, washing hands, using hand sanitizer often, and avoiding crowds and poorly ventilated spaces.
If the primary caregiver becomes ill, there should be a plan for creating a contact list of family, friends, and neighbors who are willing to step in, at least temporarily.