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Puerto Rico’s health care system is strained and fragmented, due to longstanding political and economic turmoil, recent natural disasters, and, currently, COVID-19. Older adults are more likely to have chronic diseases and functional limitations that increase their vulnerability. During the pandemic, people have been more reluctant to seek medical care for non-COVID-19-related problems and were advised to postpone care so as not to overburden health care systems. However, delaying care can worsen health, especially for high-risk groups. Using a knowledge, attitudes, and practices framework, we explored: (1) characteristics of older adults in Puerto Rico who delayed or did not access care during COVID-19 and (2) factors associated with delayed care. We hypothesized that healthy people would be more likely to delay care and those with better knowledge and attitudes about COVID-19 would be less likely to delay care.
Methods
Data are from a cross-sectional study on knowledge, attitudes, and practices toward COVID-19 with a nonprobability sample of 213 adults aged ≥60 years in Puerto Rico. We conducted 62 telephone and 151 in-person interviews over January–December 2021 (N = 213). Age ranged from 60 to 99 years (M = 71.9, SD = 8.7); 55.9% were female. Delayed care was assessed as postponing or not being able to receive needed health care (medications, medical visit, dental care) since COVID-19 began (yes/no). Predictors included sociodemographics (age, gender, income, living arrangement), health factors (self-rated health, BMI, presence of chronic diseases, mental health, and health literacy), and COVID-19 knowledge (general knowledge, knowledge of risk and protective factors) and attitudes (confidence in experts/government, concern about COVID-19). Multiple logistic regression analysis was used.
Results
One fourth (25.8%) of participants reported delaying or not being able to access needed care. Regression results showed that those who were overweight or obese (OR = 2.45, p = .038) and those with worse mental health (OR = 1.13, p = .008) were more likely to delay care. Conversely, those with ≥1 chronic disease (OR = 0.45, p = .045) and those with greater confidence in experts/government (OR = 0.89, p = .013) were less likely to delay care.
Conclusions and Implications
As COVID-19 persists, it is imperative to identify and implement strategies to mitigate risk and promote healthy behaviors. Delaying care for existing and emergent conditions poses significant risk. Our findings on older adults who delayed care in Puerto Rico can inform intervention and health promotion. Individuals with chronic diseases were less likely to delay care, while those with worse mental health and who were overweight/obese were more likely to do so. These latter groups may not perceive their conditions as health problems, leading them to underestimate potential risks of delaying care. As positive attitudes were associated with a lower likelihood of delaying care, targeted public health messaging may facilitate appropriate health seeking. Health outreach, including telehealth, should target educational and intervention needs of overweight older adults and those with mental health problems. Research should continue to examine reasons for delayed health care, including systemic barriers to access.