Characteristics of community-dwelling older individuals who delayed care during the COVID-19 pandemic

"I just can't go back": Challenging Places for Older Americans since the COVID-19 Pandemic Onset

During the pandemic, many older adults felt 'out of place' in their home, work, and community spaces with potentially long-term consequences for health and wellbeing. Using national data from the COVID-19 Coping Study, thematic analysis of online long-answer responses (n = 1171; mean age 68 years; 71% female; 93% non-Hispanic White; 86% with at least a 4-year college degree; data collected April-June 2022) identified four themes regarding why particular places are challenging since the pandemic onset: (1) viral exposure fears, (2) frustrating regulations, (3) uncomfortable and hostile social dynamics, and (4) 'out of place' negative emotions. Participants also shared how they continuously address or adapt to place-based challenges through lifestyle adjustments and coping strategies. Novel findings may inform multi-scalar policymaking and interventions to support wellbeing in later life in times of stress and instability.

Pre-pandemic factors associated with delayed health care among US older adults during the COVID-19 pandemic

Background

During the first year of the COVID-19 pandemic, more than one-third of US older adults (aged 65 years and older) reported delaying medical care. Delayed health care may exacerbate short- and long-term health changes in older adults. Older adults more likely to delay health care may benefit from targeted follow-up to return these individuals to the health care system.

Objective

The aim of this study was to describe pre-pandemic sociodemographic, psychological, cognitive, and medical factors associated with delayed health care among US older adults during the COVID-19 pandemic.

Design

We conducted a secondary analysis of 2905 participants from the National Health and Aging Trends Study (NHATS), a nationally representative, prospective cohort of US older adult Medicare beneficiaries.

Methods

Pre-pandemic factors were reported at the Round 9 interview (2019). Delayed health care, including medical (e.g. usual doctor) and supplementary (e.g. dental) care, was reported on the COVID-19 questionnaire (2020). We calculated adjusted odds ratios using weighted logistic regression, accounting for the NHATS sampling design.

Results

Overall, 40% of participants reported delayed care. After adjustment, female participants and those reporting fair (vs good) health were consistently more likely to delay health care while persons with lower income or excellent health were less likely to delay care. Other associations varied by care type.

Conclusion

Women and those with higher income or fair health before the COVID-19 pandemic were more likely to delay care during the pandemic. Our results may inform targeted outreach to older adults who delayed care during the COVID-19 pandemic, or other disruptions to the health care system, to return these individuals to care and promote better management of their health needs.

Factors Associated with Healthcare Delays Among Adults Over 50 During the COVID-19 Pandemic

Background

Adults over 50 have high healthcare needs, but also face high coronavirus disease 2019 (COVID-19)-related vulnerability. This may result in reluctance to enter public spaces, including healthcare settings. Here, we examined factors associated with healthcare delays among adults over 50 early in the COVID-19 pandemic.

Methods

Using data from the 2020 wave of the Health and Retirement Study (N=7615), we evaluated how race/ethnicity, age, geographic region, and pandemic-related factors were associated with healthcare delays.

Results

In our sample, 3 in 10 participants who were interviewed from March 2020 to June 2021 reported delays in medical or dental care in the early stages of the COVID-19 pandemic. Non-Hispanic Whites (OR: 1.37; 95% CI: 1.19-1.58) and those of other racial/ethnic backgrounds (OR: 1.31; 95% CI: 1.02-1.67) delayed care more than Non-Hispanic Blacks. Other factors associated with delayed care included younger age, living in the Midwest or West, knowing someone diagnosed with or who died from COVID-19, and having high COVID-19-related concerns. There were no differences in care delays among adults aged >70; however, among those ≤70, those who knew someone diagnosed with COVID-19 were more likely to delay care than those who did not. Additionally, among those ≤70, Non-Hispanic Whites and those of other racial/ethnic backgrounds delayed care more than Non-Hispanic Blacks and Hispanics.

Conclusions

There is considerable heterogeneity in care delays among older adults based on age, race/ethnicity, and pandemic-related factors. As the pandemic continues, future studies should examine whether these patterns persist.