TOPLINE:

During the COVID-19 pandemic, 40% of older adults in Italy reported skipping medical visits, with fear of infection and service disruptions reported as main reasons. Women, those with economic difficulties, and those with chronic conditions were more likely to forgo care.

METHODOLOGY:

• Researchers analysed data from the Italian national surveillance system between August 2020 and December 2021 to assess healthcare renunciation among older adults (aged ≥ 65 years) during the COVID-19 pandemic.
• A total of 10,827 participants who needed medical visits or diagnostic examinations were included in the analysis.
• Participants were asked whether they had forgone any medical or diagnostic examination in the past 12 months using structured questionnaires, and reasons for renunciation included fear of COVID-19, difficulty accessing services, and service disruptions due to the emergency.
• Responses were collected directly from the participants or through a person close to the older adult, ensuring comprehensive data collection.
• Sociodemographic variables such as age, sex, education, economic difficulties, and area of residence were considered in the analysis, and Poisson regression models were used to identify factors associated with healthcare renunciation.

TAKEAWAY:

• Healthcare renunciation was reported by 4364 participants, with fear of COVID-19 cited by 33% and service disruptions cited by 29%.
• Women were more likely to forgo healthcare (adjusted prevalence ratio [aPR], 1.17; 95% CI, 1.08-1.26). Economic difficulties were also associated with renunciation, with an aPR of 1.15 (95% CI, 1.02-1.28) for some difficulties and 1.46 (95% CI, 1.29-1.66) for many difficulties.
• Renunciation due to service interruptions was more common among older adults with significant economic difficulties (aPR, 1.87; 95% CI, 1.50-2.33), two or more chronic diseases (aPR, 1.25; 95% CI, 1.01-1.56), and at least one sensory problem (aPR, 1.30; 95% CI, 1.13-1.50).
• Fear of COVID-19 was strongly associated with being female (aPR, 1.32; 95% CI, 1.13-1.54), highly educated (aPR, 1.35; 95% CI, 1.14-1.60), and economically disadvantaged. The renunciation levels due to service interruptions and fear decreased during 2021.

IN PRACTICE:

"Strengthening healthcare infrastructure, improving communication, and supporting healthcare professionals with tools like telemedicine are key to building a more equitable and resilient healthcare system. Continuous monitoring is essential to respond to shifting reasons behind care renunciation and to guide effective, inclusive health strategies," the authors wrote.

SOURCE:

This study was led by Benedetta Contoli, National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. It was published online on October 13, 2025, in the European Journal of Public Health.

LIMITATIONS:

This study relied on self-reported data. The timing of the questions on healthcare renunciation may not have aligned perfectly with the COVID-19 emergency for all respondents. The coverage of the surveillance was lower in Northern regions, particularly Lombardy that did not participate, potentially affecting the generalisability of the findings.

DISCLOSURES:

This study did not receive any external financial support. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.