Aging
The Impact of Crises on Delayed Healthcare Access Among Older Adults in Lebanon Mira Bekdache* Mira Bekdache Abla M Sibai Adina Zeki Al Hazzouri Amani Zaidan Martine Elbejjani
Background Delays in healthcare can have important consequences for morbidity and mortality risks, particularly among older adults, and these effects are exacerbated in contexts of crises and emergencies. During the COVID-19 pandemic, nearly one third of older persons reported postponing or forgoing necessary medical care. Lebanon, a low to middle-income country, faced the pandemic amidst multisectoral crises including a record financial collapse and the Beirut Blast, leading to immense strains on social protection and healthcare resources. This study aims to examine delays in healthcare among older adults in a polycrisis setting and to assess how various aspects of different crises (financial, pandemic, and security/humanitarian) influence these delays.
Methods Data come from a cross-sectional online survey (n= 576 individuals aged 50 and above). Delayed healthcare was evaluated across three subtypes: delayed doctor’s visit, delayed medical test (laboratory, imaging, and any other medical test), and delayed operations. We used logistic regressions to assess the relation of delayed healthcare with various crises indicators, namely the pandemic (concerns about contracting the virus, physical/social distancing, and financial hardships), the Beirut Blast (occurrence of physical injury, home damage, business loss), and financial crisis impact (decreased income). We used multiple imputation by chained equations for missing data and logistic models included adjustment for relevant confounders including sociodemographic and socioeconomic factors, living conditions, and health-related factors.
Results 47.8% of older adults reported delaying a doctor visit, 31.5% had to delay medical tests, and 11.4% had to delay medical operations. The most self-reported reason for delays was financial difficulties (59%) and the most prevalent crisis-related difficulty was decreased income due to the financial crisis (88.95%). Adjusted analyses showed that decreased income due to the financial crisis was related to higher odds of delayed doctor visits and medical tests (OR=1.50, 95% CI: [0.93-2.41] and OR=1.87, 95% CI: [1.07-3.28], respectively). Business loss (due to the Beirut blast) was associated with higher odds of delaying a doctor’s visit (OR=1.81, 95% CI: [1.02-3.22]) and pandemic related financial concerns were related to higher odds of delaying medical tests (OR=1.47, 95% CI: [1.00-2.16]).
Conclusion Results indicate that compounded crises have led to substantial delays in healthcare for older adults, with financial hardships being a predominant driver of delay across different crises indicators. Results emphasize the central role of improving financial support mechanisms for impacted populations and healthcare systems to mitigate the immediate and long-term impact of crises on health and health disparities.