In this study we determined the prevalence of delayed care among older adults and the demographic, socioeconomic, and health factors associated with delayed care. While delaying health care during the first 6 months of the COVID-19 pandemic was highly prevalent among older adults, the type of delayed care varied. Dental and doctor appointments were frequently delayed, while filling a prescription and surgery were rarely delayed. We also observed some variation in patterns of delaying by sociodemographic and health status. Differences in delaying care by type and group may have significant implications for population health in the near future, which will most likely impact health inequalities.
The risk in delaying medical care was unevenly distributed across the population. Notably, compared to men, women were more likely to delay medical care. This finding is in line with findings from studies prior to pre-COVID 19 [8]. It is concerning that women delayed medical care during COVID-19 because prior studies have found that older women have greater health needs than men [9]. Therefore, while unmet health needs are a concern for any population group, unmet care for women during this period could have implications for diagnosis, treatment, and overall care related to chronic conditions that will impact sex inequality in health in the future.
Additionally, adults with greater levels of education were likely to delay care. This finding contradicts earlier studies that found delayed medical care tied strongly to economic resources, since adults with greater levels of education have larger socioeconomic resources [10]. Delays in medical care among adults with greater levels of education may be reflective of care needs (well-educated adults may have delayed routine appointments or elective/nonessential care rather than acute care) and/or combined with risk assessment [11, 12].
Differences in delayed care by health status are concerning. We found that older adults who reported poor self-rated health or had an ADL limitation were more likely to delay care. One potential explanation may be that older adults with pre-existing conditions may need more frequent health visits; therefore, adults with poor health status may have been more likely to experience delayed care due to mandatory appointment cancelations that occurred at the beginning of the pandemic. Another potential explanation may be that delaying medical care may have been a risk mitigation strategy, given that people with worse health are more likely to die from COVID-19 [13, 14]. Additionally, pandemic-related disruptions in public and personal transportation may have also impacted older adults’ ability to seek out care, especially among those with disabilities. Our study could not distinguish between these potential explanations. Nevertheless, the potential for chronic conditions to worsen without proper medical supervision makes the delays in medical care among older adults with worse health concerning and may lead to greater health differences by health status. Future research should evaluate whether the health of older adults with worse health was impacted by delays in care, and the potential explanations to provide better access and maintenance during large-scale healthcare disruptions.
Additionally, we observed notable differences across types of medical care that were delayed. Overall, 30% of older adults reported delaying any type of medical care. However, delayed dental and doctor appointments were the most frequently delayed, while surgery and filling a prescription were much less likely to be delayed. These differences have implications for understanding future health. Continued medication usage (as indicated by low prevalence of delay in filling a prescription) may indicate that people who had a prior diagnosis were able to maintain their medication regimes during this period. However, the greater delays among dental and doctor appointments may lead to worse health for conditions that would have been tested and diagnosed during a medical appointment. While this study cannot directly evaluate the impact of delayed care during COVID on older adults’ health, recent reports have shown fewer ER visits and fewer medical procedures to treat cardiovascular disease compared to 2019 [15,16,17]. While previous studies have evaluated the national population as whole, less is known about older adults, who may be more severely impacted overall because the increased likelihood of having health complications with age, especially from chronic conditions. Future research should evaluate whether and what kind of negative consequences older adults may have experienced during the COVID-19 pandemic, and how that may have impacted their overall health.
The study has some limitations. First, the data were collected from June to September, at a time when individuals and health care offices were adjusting to the new health guidelines resulting in temporary closures, a second peak occured in July, and the timeline of the pandemic was largely unknown; each of these conditions may have impacted decisions to delay care. Second, while we believe that risk assessment and limited healthcare appointments impacted delayed care patterns, we could not directly test these explanations. Consideration should also be given modes of access. In the HRS, respondents who replaced their physical appointments with telemedicine were not considered to have delayed care. Evaluating the use of telemedicine during this period will provide further insight into how the expansion of healthcare through technology may improve healthcare access, especially during periods of significant social disruptions. And whether telemedicine curtailed negative impacts of more limited in-person appointments. Third, beyond the broad categories of care, we could not evaluate differences by specific needs. For example, for doctor’s appointments, we could not assess whether delayed care was related to routine check-ups or more pressing medical needs. Relatedly, we could not evaluate how COVID-19-related care may have influenced these patterns; delaying medical appointments may have been even greater if COVID-19 related appointments are excluded.
