Older adults with anxiety have higher avoidance of in-person medical visits during the covid-19 pandemic

ABSTRACT

Background: The COVID-19 pandemic continues to have detrimental effects on older adults' mental health while rapidly transforming access to medical care. Our objective was to determine if anxiety surrounding the pandemic may be associated with increased avoidance of in-person medical visits, even when visits were perceived as needed. Methods: We conducted phone-based surveys from April 7th, 2020 to October 27th, 2020 with 155 older adults age ≥60 from two community sites and an academic geriatrics outpatient clinical practice. Healthcare system access was assessed with questions on telehealth use, the number of delayed in-person medical appointments or procedures, and avoidance due to fear of the coronavirus of in-person medical visits participants perceived as 'needed'. Anxiety was measured with the Generalized Anxiety Disorder 2-item (GAD-2) scale. We used bivariate statistics to determine the association between the rate of healthcare utilization and anxiety. We also assessed freetext comments for expression of anxiety or concerns about access to medical care. Results: Participants were on average 75 years old (SD=10), 50% of whom had hearing or vision impairment, 26% had difficulty bathing, 64% lived alone, and 92% had accessed telehealth clinical services. Approximately 52% reported worries about delayed medical care and 41% reported avoiding an in-person medical visit that they felt was needed due to fear of COVID-19;55% of avoided visits were routine or preventive, 43% specialist appointments, and 8% urgent care/ED visits. Individuals screening positive for anxiety were more likely to avoid in-person medical visits (60% versus 47%, p=0.006). Open-ended responses revealed worries about delays in routine medical care (e.g. injections, vaccines, dental visits), fears that non-COVID health needs were deemed non-essential, and difficulty accessing the health system due to restrictions. Conclusion: Older adults who screened positive for anxiety were more likely to avoid needed in-person medical visits, and had a broad range of visit types they felt were needed. Clinicians should work with older patients, particularly those who are anxious, to provide safe and accessible options for seeking in-person care and reassure patients that non-COVID related health concerns are still a priority.