Factors influencing access and utilization of health services among older people during the COVID − 19 pandemic: a scoping review

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Abstract

Background

Access to healthcare and service utilization are both considered essential factors for improving the general health and wellbeing of older people, especially at the time of COVID-19 pandemic. The aim of the study is to explore factors affecting healthcare access and health service utilization for older people during the pandemic.

Methods

PubMed, Web of Science, Scopus and Embase were systematically searched for relevant articles. Access, utilization, health, elderly and COVID-19 were used as keywords in the search strategy. A total of 4308 articles were identified through the initial database search; 50 articles were included in the review as passing the eligibility criteria. The searches were conducted up to August 2021. Data extraction was performed, and evidence was descriptively illustrated. Thematic analysis was used to explore factors influencing the elderly’s access and utilization of healthcare services, using Max QDA ₁₀, a qualitative analysis software.

Results

Among articles included in the review ( n = 50), a majority of the studies were from the United States (36%), followed by India (8%). According to the main healthcare services, a large number of articles (18%) were related to mental health services, followed by digital health services (16%). Factors were identified at an individual, provider and systems level. Seven main themes emerged from the thematic analysis, as determinants of elderly’s access and utilization of healthcare services during COVID-19 pandemic. These included: access to non-COVID related services, access to COVID-related services, literacy and education, accommodation challenges, perceived attitudes of aging, and policies and structures, and social determinants.

Conclusion

Mental health and digital health services were identified as major issues influencing or contributing to or influencing older people’s health during the COVID-19 pandemic. We also argue on the importance of a rounded view, as attention to a range of factors is vital for policy decisions towards sustainable care and equitable interventions for improving the health of older people.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00719-9.

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Most cited references 59

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Scoping studies: advancing the methodology

Danielle Levac, Heather Colquhoun, Kelly K. O’Brien (2010)

Background Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. Discussion We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Summary Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.

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A typology of reviews: an analysis of 14 review types and associated methodologies.

Maria J Grant, Andrew Booth (2009)

The expansion of evidence-based practice across sectors has lead to an increasing variety of review types. However, the diversity of terminology used means that the full potential of these review types may be lost amongst a confusion of indistinct and misapplied terms. The objective of this study is to provide descriptive insight into the most common types of reviews, with illustrative examples from health and health information domains. Following scoping searches, an examination was made of the vocabulary associated with the literature of review and synthesis (literary warrant). A simple analytical framework -- Search, AppraisaL, Synthesis and Analysis (SALSA) -- was used to examine the main review types. Fourteen review types and associated methodologies were analysed against the SALSA framework, illustrating the inputs and processes of each review type. A description of the key characteristics is given, together with perceived strengths and weaknesses. A limited number of review types are currently utilized within the health information domain. Few review types possess prescribed and explicit methodologies and many fall short of being mutually exclusive. Notwithstanding such limitations, this typology provides a valuable reference point for those commissioning, conducting, supporting or interpreting reviews, both within health information and the wider health care domain.

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Methods for the thematic synthesis of qualitative research in systematic reviews

James Thomas, Angela Harden (2008)

Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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Author and article information

Contributors

Mahnaz Samadbeik:

ORCID: http://orcid.org/0000-0002-4756-2364

mahbeik@gmail.com

Journal

Journal ID (nlm-ta): Arch Public Health

Journal ID (iso-abbrev): Arch Public Health

Title: Archives of Public Health

Publisher: BioMed Central (London )

ISSN (Print): 0778-7367

ISSN (Electronic): 2049-3258

Publication date (Electronic): 7 November 2021

Publication date PMC-release: 7 November 2021

Publication date Collection: 2021

Volume: 79

Electronic Location Identifier: 190

Affiliations

[1 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Health Human Resources Research Center, School of Management and Medical Information Sciences, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[2 ]GRID grid.413020.4, ISNI 0000 0004 0384 8939, Social Determinants of Health Research Center, , Yasuj University of Medical Sciences, ; Yasuj, Iran

[3 ]GRID grid.508728.0, ISNI 0000 0004 0612 1516, Social Determinants of Health Research Center, , Lorestan University of Medical Sciences, ; Khorramabad, Iran

[4 ]GRID grid.412571.4, ISNI 0000 0000 8819 4698, Anesthesiologist, , Shiraz University of Medical Sciences, ; Shiraz, Iran

[5 ]GRID grid.1010.0, ISNI 0000 0004 1936 7304, Adelaide Dental School, , The University of Adelaide, ; Adelaide, SA 5000 Australia

[6 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Research Fellow and Lecturer, Faculty of Medicine and Health, , The University of Sydney, ; Sydney, Australia

Author information

Mahnaz Samadbeik http://orcid.org/0000-0002-4756-2364

Article

Publisher ID: 719

DOI: 10.1186/s13690-021-00719-9

PMC ID: 8572573

PubMed ID: 34743747

SO-VID: 9751d0cf-e3a8-43b4-8bf1-d3ee7931493d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 July 2021

Date accepted : 25 October 2021

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ScienceOpen disciplines: Public health

Keywords: access,utilization,healthcare services,elderly,covid-19

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ScienceOpen disciplines: Public health

Keywords: access, utilization, healthcare services, elderly, covid-19

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Factors influencing access and utilization of health services among older people during the COVID − 19 pandemic: a scoping review

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Abstract

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Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 59

Scoping studies: advancing the methodology

A typology of reviews: an analysis of 14 review types and associated methodologies.

Methods for the thematic synthesis of qualitative research in systematic reviews

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Cited by 19

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