Older Adults' Perspectives on Emergency Department Costs During COVID-19

OBJECTIVES: COVID-19 has strained the household finances of many Americans who are already experiencing increasing health care expenses. Concerns about the cost of care may deter patients from seeking even urgent care from the emergency department (ED). This study examines predictors of older Americans' concerns about ED visit costs and how cost concerns may have influenced their ED use in the early stages of the pandemic.STUDY DESIGN: This was a cross-sectional survey study using a nationally representative sample of US adults aged 50 to 80 years (N = 2074) in June 2020.METHODS: Multivariate logistic regressions assessed the relationships of sociodemographic, insurance, and health factors with cost concerns for ED care.RESULTS: Of the respondents, 80% were concerned (45% very, 35% somewhat) about costs of an ED visit and 18% were not confident in their ability to afford an ED visit. Of the entire sample, 7% had avoided ED care because of cost concerns in the past 2 years. Of those who may have needed ED care, 22% had avoided care. Predictors of cost-related ED avoidance included being aged 50 to 54 years (adjusted odds ratio [AOR], 4.57;95% CI, 1.44-14.54), being uninsured (AOR, 2.93;95% CI, 1.35-6.52), having poor or fair mental health (AOR, 2.82;95% CI, 1.62-4.89), and having an annual household income of less than $30,000 (AOR, 2.30;95% CI, 1.19-4.46).CONCLUSIONS: During the early COVID-19 pandemic, most older US adults expressed concerns about the financial impact of ED use. Further research should examine how insurance design could alleviate the perceived financial burden of ED use and prevent cost-related care avoidance, especially for those at higher risk in future pandemic surges.Am J Manag Care. 2023;29(4):204-208. doi:10.37765/ajmc.2023.89282

JOY AND STRESS DURING THE COVID-19 PANDEMIC: FINDINGS FROM THE NATIONAL POLL ON HEALTHY AGING

This poll aimed to better understand the complex impacts of the COVID-19 pandemic on the emotional and mental health of older adults. In August 2021, the National Poll on Healthy Aging surveyed a national sample of adults age 50–80 about joys, stresses, and resilience during the pandemic. Most reported feeling a lot (30%) or some (53%) joy these days, while 17% reported feeling very little or no joy. Reports of joy and stress differed substantially by age, sex, physical health, mental health, and household income. For example, people age 50–64 were more likely to report feeling a lot of stress compared with those age 65–80 (25% vs 13%), as were women compared with men (24% vs 15%). The findings may inform public health and policy efforts to support older adults at-risk for poor emotional and mental health, and help cultivate resilience during and after the pandemic.

LESSONS FROM FIVE YEARS OF POLLING THROUGH THE NATIONAL POLL ON HEALTHY AGING

Since 2017, the National Poll on Healthy Aging (NPHA) has surveyed older adults on a vast array of topics related to health, health care and health policy. With robust nationally representative samples of 2,000 adults age 50-80, the poll's format allows for the fielding of timely questions with important public health and policy implications. For example, polls examining delayed care during the COVID-19 pandemic and experiences of physical deconditioning and falls helped to demonstrate the ways in which the pandemic may have long-lasting effects if strategies are not implemented to address them. In this presentation we will discuss how the NPHA has increased awareness of the facilitators and barriers to healthy aging and where gaps exist in supporting older adults to live with optimal health and well-being. This presentation will also describe how researchers can access publicly available NPHA data to inspire their own future research.

HEALTHY AGING DURING THE PANDEMIC AND BEYOND: LESSONS FROM FIVE YEARS OF THE NATIONAL POLL ON HEALTHY AGING AND AARP

The past five years have brought enormous changes in the lives of older adults and their families. During this time the University of Michigan National Poll on Healthy Aging (NPHA), co-sponsored by AARP and Michigan Medicine, has gathered the experiences and perspectives from nationally representative samples of US adults age 50-80 on a range of topics related to healthy aging. These polls have been used to elevate the voices of the older adults in the development of policies and practices to improve the health of people as they age. During the past two years, poll reports have captured how changes in lifestyle and behaviors during the COVID-19 pandemic have impacted the health and well-being of older adults. Members of the NPHA team from the University of Michigan and AARP will begin with an overview of the poll including its goals and methods. The session will then highlight key findings from the first five years of the NPHA that have important implications during and beyond the COVID-19 pandemic, with special attention to poll findings related to joys and stresses and aging in place. The presenters will also discuss how to access publicly available NPHA data. The session will wrap up with a discussion of how the perspectives and experiences of older adults gathered through the NPHA and AARP polling can be used to inform policy and advocacy to support healthy aging.