How older adults adapted to health care challenges during the COVID-19 pandemic

Public health care emergencies, such as the COVID-19 pandemic, can drastically disrupt health care systems with long-term repercussions. The effects of such health care crises are more pronounced in the aging population, who are particularly vulnerable to chronic infections and sudden disruptions in health care.

The COVID-19 outbreak that emerged in December 2019 quickly spread worldwide, and several emergency measures were urgently implemented to curb its transmission. During the initial phase of the pandemic, stringent measures like social distancing, isolation, and mandatory wearing of masks were implemented.

Unfortunately, older individuals were at a higher risk of acquiring the infection and were more likely to experience negative outcomes. The fear of infection, coupled with the state of emergency (SoE) declarations, has led to older adults refraining from seeking necessary medical care.

While initial responses to the pandemic have been well-documented, its long-term impact on health care utilization and access among the elderly remains unclear. Furthermore, the prolonged pandemic was characterized by the spread of relatively less virulent strains, gradual relaxation of stringent measures, and widespread vaccination, with limited data on the effect of this transition.

To bridge this knowledge gap, researchers from Waseda University, Japan, sought to analyze the effects of the extended phase—from November 2021 to September 2022—on older adults in Japan, one of the world’s most aged societies with a universal health care system.

The team comprised of Associate Professor Rong Fu from the Faculty of Commerce, master’s student Sizhe Liu from the Graduate School of Commerce, Assistant Professor Masato Oikawa from the Faculty of Education and Integrated Arts and Sciences, Professor Haruko Noguchi from the Faculty of Political Science and Economics, and Professor Akira Kawamura from the Faculty of Human Sciences.

Explaining the rationale behind their research, Fu, the lead author, says, “As populations age globally, maintaining health care access during public health emergencies becomes increasingly critical. Our research addresses this challenge by providing insights into how health care systems can balance infection control with continued access to essential services for vulnerable elderly populations.” Their findings were published online in Scientific Reports on April 22, 2025.

The researchers used a comprehensive dataset of 189,841,257 medical claims linked with income tax records from the long-term care insurance system to analyze trends in health care utilization among Japan’s oldest-old population aged 75 years and above. They correlated trends in health care access and utilization with the implementation of public health measures, crisis severity, and socioeconomic status.

The analysis revealed that the implementation of precautionary measures led to a modest drop in the use of medical services and outpatient visits. Nevertheless, health care costs and services remained stable despite a decrease in patient volumes. The use of medical services varied across different residential areas depending on crisis severity and the extent of precautionary measures.

Notably, there was no difference in health care utilization across different income levels except for dental services. Dental care visits by older adults with a lower income were significantly lower than high-income groups, highlighting socioeconomic disparities in dental care during public emergencies.

Overall, these findings suggest that health care adaptations can address the needs of the elderly during medical emergencies and help avoid medical delays with dire consequences. Adaptations may include integrated monitoring systems, enhanced safety protocols to bridge gaps in preventive dental care, early warning systems, and flexible delivery options, such as remote or mobile care, to improve accessibility for vulnerable groups.

“Our findings can help inform policymakers who devise targeted interventions to prevent socioeconomic disparities in health care access from widening during crises. Additionally, for health care providers, our research demonstrates the importance of maintaining service intensity even when visit frequency fluctuates,” Fu adds.