Middle-aged adults with frailty had more challenges accessing healthcare in pandemic

Thursday, January 5, 2023

Middle-aged adults living with frailty in the community were more likely to suffer challenges accessing healthcare during the first year of the COVID-19 pandemic than their older counterparts, says McMaster University researcher Lauren Griffith.

Her summary comes from her analysis of data from nearly 24,000 participants across Canada aged 50 to 90, participating in the Canadian Longitudinal Study on Aging COVID-19 Questionnaire Study. The findings were published in the journal Age and Ageing.

Griffith said her team was interested in examining pandemic-related impacts with a frailty lens because many of the public health measures to reduce the spread of COVID-19 were based on age.

“Frailty is a multidimensional syndrome associated with poorer health and function that is marked by increased vulnerability to stressors, like those experienced during the pandemic,” Griffith said. "Frailty and age, while related, are often separate, with many people enjoying good health into their eighties and nineties.”

In fall 2020, study participants completed surveys about their physical and mental health and were asked about consequences of the pandemic, such as challenges accessing healthcare and overall impacts on their relationships, financial resources and health.

The research team then split participants into four groups, called quartiles, based on their level of frailty. They found that as the level of frailty increased, so did the number of people suffering negative health, social, and healthcare access impacts during the pandemic, which could not be explained by other factors such as sex, age or health behaviours, such as smoking.

“While this finding was not completely surprising, things were more interesting when we looked at the impact of frailty by age group. Across all levels of frailty we kept seeing people in the youngest age category as being the ones experiencing the most challenges, especially with accessing healthcare. This was particularly true for with those with the highest levels of frailty,” said Griffith, first author of the study and an associate professor of the Department of Health Research Methods, Evidence, and Impact.

For example, in the group with the highest level of frailty, nearly 30 per cent of people aged 50-55 reported challenges accessing specialist care compared to 12.7 per cent of those aged 75 years and older. 

“More research is needed to determine what drives these findings,” Griffith said. “But it does seem that we did relatively better addressing the healthcare needs of people over 75 years.” We did not find technology as a large barrier to accessing care with less than 2% of people reporting they were unable to access videoconferencing technology.”

In previous research, Griffith and her colleagues found that in the younger age groups, psychological and cognitive deficits were most highly associated with overall frailty levels. They also found a link between increasing frailty and lower income, suggesting that younger participants are more psychologically and socially vulnerable, Griffith said.

“While measuring frailty is a tool to inform estimates of COVID-19 risk, our data suggests it may have a broader role in primary care and public health by identifying people who may benefit from interventions to reduce the health and social impacts of both COVID-19 and future pandemics,” she said.

External funding for the study was received from the Public Health Agency of Canada and the Nova Scotia COVID-19 Health Research Coalition.