Reduced access to care among older American adults during CoVID-19 pandemic: Results from a prospective cohort study

  1. Research Group, The World Bank, Washington DC, USA
  2. Ashis Kumar Das
  3. Devi Kalyan Mishra
  4. Department of Community Medicine, Hitech Medical College, Rourkela, India
  5. Saji Saraswathy Gopalan
  6. Human Development Department, The World Bank, Washington DC, USA

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Abstract

Background: Reduced access to routine care can lead to higher morbidity and mortality among older adults. We assessed the extent of reduced access to care among older American adults during the COVID-19 pandemic, identified predictors and reasons for reduced access. Materials and methods: Using publicly available data from the COVID-19 module (interim release) of the Health and Retirement Study, we undertook descriptive analyses of older adults stratified by socio-demographic characteristics. Associations between reduced access to care and predictors were estimated using a multivariable logistic regression model. Results: 30.2% of respondents delayed or avoided care during the pandemic. Reduced access was more likely to be reported by respondents that were female, younger, educated, not receiving social security benefits, with limitations in daily activities and three preexisting conditions. In terms of the reasons, the majority of the respondents (45.9%) reported that their visit was either cancelled or rescheduled by the provider; 13.9% thought they could wait, 10.9% could not get an appointment, 9.1% found it unaffordable, and 7.4% were afraid to visit the provider. Respondents reported of reduced access to doctor’s visits, surgery, prescription filling, and dental care. Conclusions: We suggest urgent attention on improving access to care for older adults during the pandemic. For nonemergency conditions and routine care that can be delivered virtually, telehealth services can be strengthened. Additionally, health messaging can reemphasize that neglecting medical care might lead to increased morbidity and mortality among older adults from preexisting illnesses. Keywords: Older adults; Access to care; COVID-19; Health and retirement study

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  1. Version published to 10.52768/2766-7820/1240
  2. ScreenIT

    SciScore for 10.1101/2020.11.29.20240317: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationThis was done over two phases using two randomly halved subsamples during June and September.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    (StataCorp LLC.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Moreover, reduced access was more likely to be reported by respondents that were female, younger, educated, not receiving social security benefits, with limitations in daily activities and three preexisting conditions. In a web-based survey administered to American adults, the prevalence of reduced access among older adults over 65 years was 33.5 per cent.15 This study also found females, multiple preexisting medical conditions, higher education and having health insurance were significantly associated with reduced access among all age groups. The Research and Development Survey (RANDS) undertaken by the National Center for Health Statistics during COVID-19 shows 39.5 per cent of older adults had reduced access to care.16 Overall, females and education of above bachelor’s degree were more likely to report missing care. Additionally, about 31 per cent of older adults reported to have scheduled at least one telehealth appointment. The proportion of respondents reporting reduced access to care in these studies are higher than our study. The differences in the reduced access to care are possibly due to differing methodologies and recall periods. For instance, our study includes a nationally representative sample of older adults, whereas it was not the case with other studies. However, in line with these similar studies, our study finds female respondents and those with higher education levels tend to report reduced access to care during the pandemic. Among the elderly, research s...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.29.20240317v1 on medRxiv