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Improving Health Care Quality

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The Impact of COVID-19 on Older Adults

Findings from the 2021 International Health Policy Survey of Older Adults

senior man sits in chair waiting in line for vaccine

Residents wait in line to receive the COVID-19 vaccine at St. Johns Missionary Baptist Church on January 10, 2021, in Tampa, Fla. The Florida Department of Health is targeting the underserved populations that are most vulnerable to getting the coronavirus, specifically people of color. Black and Latinx/Hispanic older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences during the pandemic. Photo: Octavio Jones via Getty Images

Residents wait in line to receive the COVID-19 vaccine at St. Johns Missionary Baptist Church on January 10, 2021, in Tampa, Fla. The Florida Department of Health is targeting the underserved populations that are most vulnerable to getting the coronavirus, specifically people of color. Black and Latinx/Hispanic older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences during the pandemic. Photo: Octavio Jones via Getty Images

Introduction

It became evident early in the coronavirus pandemic that older age is a risk factor for becoming severely ill with COVID-19. But the virus’s impact on older adults goes beyond a higher risk for serious infection: it also includes limited access to care for all health conditions, as well as considerable social and economic hardships.

Drawing on findings from a survey of more than 18,000 adults age 65 and older in 11 high-income countries, we show how COVID-19 has affected the economic security of older adults as well as their access to health care and supportive services for chronic conditions. We also highlight the state of vaccination for older adults during the first quarter of 2021.

Conducted with the research firm SSRS and the Commonwealth Fund’s international partners, the survey took place between March and June 2021. It was the latest in the Commonwealth Fund’s series of International Health Policy Surveys, conducted annually to enable cross-national comparisons between the United States and other high-income countries.

Survey Highlights

  • Compared to their counterparts in the other survey countries, older adults in the U.S. have suffered the most economically from the COVID-19 pandemic, with more losing a job or using up all or most of their savings.
  • Latino/Hispanic and Black older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences.
  • COVID vaccination rates for older adults were highest in countries where vaccines were most widely available when the survey was fielded. In the United Kingdom, nearly all older adults (97%) had already been vaccinated. The U.S. had the largest percentage of older adults who were not planning to get vaccinated.

Findings

Williams_older_adults_survey_exhibit_01

The percentage of older adults in the U.S. reporting that they used up all or most of their savings or that they lost their job or source of income because of the pandemic were four to six times those for Germany, Switzerland, the Netherlands, Norway, and Sweden.

In the U.S., Latino/Hispanic and Black older adults were far more likely than white older adults to report economic hardships related to the pandemic.

Williams_older_adults_survey_exhibit_02

Chronic illness is prevalent in the United States: 68 percent of U.S. survey respondents reported they had two or more chronic conditions, while 42 percent reported three or more — significantly higher rates than in the other 10 countries (see appendix of demographic data).

More than one-third of U.S. older adults with multiple chronic conditions reported pandemic-related disruptions in their care, slightly more than rates in Canada, the Netherlands, and the U.K. In Germany, only 11 percent had canceled or postponed appointments.

Williams_older_adults_survey_exhibit_03

Many older adults need help with instrumental activities of daily living (IADLs) such as housework, meal preparation, medication management, or shopping. Older adults in the U.S., Australia, and the Netherlands are the most likely to need such help (see appendix of demographic data).

Among survey respondents requiring help with IADLs, those in Canada, the U.K., the U.S., and Australia were the most likely to report not receiving help — either from professional caregivers or from informal caregivers like family or friends — because services were cancelled or very limited during the pandemic. The problem has been less severe in the other eight countries, with older adults in the Germany and the Netherlands reporting the least difficulty getting help with IADLs.

Williams_older_adults_survey_exhibit_04

Across the survey countries, very few older adults said they were not planning to get vaccinated. But vaccination rates varied, likely based on vaccine availability at the time of the survey. When this survey came out of the field in the U.K. in late May 2021, 97 percent of older adults there had received the vaccine, by far the highest rate among the countries. And while vaccination rates in Australia and New Zealand lag the other countries, the majority of older adults said they plan to get vaccinated when they are able to.

Respondents in Australia, New Zealand, Switzerland, and the U.S. were most likely to say they did not plan to get vaccinated (7% to 10%, compared with 6% or less in other countries).

Williams_older_adults_survey_exhibit_05

Among the 10 percent of older Americans who do not plan to get vaccinated, a quarter said they did not trust the government to make sure the vaccines are safe, while one in five worried about possible side effects. Generally, in Canada, France, Sweden, Switzerland, and the U.S., older adults who did not plan to get vaccinated cited lack of trust in the government and concerns with side effects as their main reasons.

Conclusion

Survey findings indicate that older adults in the United States have faced greater economic challenges and disruptions in their care throughout the coronavirus pandemic than their peers in other high-income countries have. As the nation with the highest gross domestic product (GDP) overall — and that spends the highest percentage of its GDP on health care — the U.S. has the means to take steps to reduce this burden on older Americans and to ensure that their health care needs are met.

Reducing care barriers. The findings of this survey are consistent with those of previous Commonwealth Fund international surveys, which have found that U.S. seniors are sicker than their counterparts in other countries and, despite the universal coverage provided by the Medicare program, faced more financial barriers to receiving health care. Because people with multiple chronic conditions account for a disproportionate share of total health spending, ensuring that they have timely, affordable access to care is increasingly a priority for policymakers and care delivery systems. Timely access to primary care is particularly important for older adults with multiple chronic conditions, because effective treatment requires coordination and follow-up plans.

Role of telemedicine. Disruptions in health care because of COVID-19 may have been partly overcome by the availability of virtual care, both in the U.S. and abroad. Further investigation of the nature and effectiveness of telemedicine use during the pandemic will be needed, but countries clearly have an opportunity to improve care delivery to older adults through the expansion of virtual care services for those unable or resistant to receiving care in a clinician’s office. In addition to helping reduce risks associated with receiving in-person care, especially for the unvaccinated, expanded access to telemedicine also might mitigate some of the lasting effects of care that was missed or postponed during the pandemic.

Expanding vaccination. Vaccination of older adults is largely on track in high-income countries, where vaccines were made readily available earlier in the pandemic. For older adults who said they were not planning to get vaccinated, limited trust in government to ensure vaccine safety and concerns with side effects were the most cited reasons. To increase uptake in this population, messaging campaigns should address their apprehension by engaging a wide range of voices, from clinicians and scientists to community members and local, state, and federal government agencies, to get the word out. Ensuring that people see themselves represented in these messages is essential to raising vaccination rates.

What the U.S. can do. The pandemic has harshly exposed the economic vulnerability of older adults in the United States. Our survey findings show that the U.S. can do more to help older adults’ meet their care needs. For example, steps could be taken to improve access to telehealth services and integrate them fully with regular primary care. There is also a clear need to further improve the economic security of older Americans while addressing the racial and ethnic inequities the pandemic has exacerbated.

Williams_older_adults_survey_appendix

How We Conducted This Study

The 2021 Commonwealth Fund International Health Policy Survey of Older Adults was conducted from March 1 to June 14, 2021, by SSRS, a U.S. survey research firm, and contractors in the other countries. The survey was administered to a nationally representative sample of adults age 65 and older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom and of adults age 60 and older in the United States.

A total of 18,477 interviews of adults age 65 and older were completed for the 2021 survey. The full U.S. sample included 360 adults ages 60–64 or who reported being older than age 60 but did not give an exact age. These responses were not included in this analysis. Final country samples (age 65 and older) ranged from 500 to 4,332. Interviews were completed either online or using computer-assisted telephone interviews.

In Australia, France, Germany, the Netherlands, New Zealand, Norway, the United Kingdom, and the United States, samples were generated using probability-based overlapping landline and mobile phone sampling designs. Both mobile and landline telephone numbers were included to improve representativeness. The sample in Canada was generated using a probability-based landline-only sampling design. Standard within-household selection procedures were used to increase the likelihood of reaching an eligible respondent for landline samples.

In Germany, respondents were randomly selected from a public list of phone numbers, landline as well as mobile phones, flagged as belonging to households with at least one adult age 65 or older. In Norway, respondents were randomly selected from a listed registry, and interviews were completed via landline and mobile phones. In Sweden and Switzerland, respondents were selected via nationwide population registries, recruited via postal mail, and invited to participate in an online or phone version of the survey.

A common questionnaire was developed, translated, adapted, and adjusted for country-specific wording as needed. Not all questions were asked in each country (noted in the exhibits). Interviewers were trained to conduct interviews using a standardized protocol. Response rates varied from 7.2 percent in the United Kingdom to 47.7 percent in Switzerland.

International partners joined with the Commonwealth Fund to sponsor surveys, and some countries supported the use of expanded samples to enable within-country analyses. Data were weighted to ensure that the final outcome was representative of the adult population in each country. Weighting procedures considered the sample design, probability of selection, and systematic nonresponse across known population parameters including region, sex, age, education, and other demographic characteristics deemed consistent with standards for each country. In the U.S., the weighted variables also included race and ethnicity.

The margin of sample error for the 2021 International Health Policy Survey of Older Adults was approximately +/– 2 percent for Canada and Sweden; +/– 3 percent for France, Germany, Switzerland, and the United States; +/– 4 percent for the Netherlands and the United Kingdom; +/– 5 percent for Australia and New Zealand; and +/– 6 percent for Norway, all at the 95 percent confidence interval.

Acknowledgments

The authors thank Robyn Rapoport, Sarah Glancey, Rob Manley, and Christian Kline of SSRS, as well as Chris Hollander, Jen Wilson, and Paul Frame of the Commonwealth Fund.

Publication Details

Date

Contact

Reginald D. Williams II, Vice President, International Health Policy and Practice Innovations, The Commonwealth Fund

[email protected]

Citation

Reginald D. Williams II et al., The Impact of COVID-19 on Older Adults: Findings from the 2021 International Health Policy Survey of Older Adults (Commonwealth Fund, Sept. 2021). https://doi.org/10.26099/mqsp-1695