Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: a cross-sectional study in eastern Nepal

• Published in: BMJ open Vol. 12; no. 2; p. e056342
• Main Authors: Ghimire, Saruna, Shrestha, Aman, Yadav, Uday Narayan, Mistry, Sabuj Kanti, Chapadia, Bunsi, Yadav, Om Prakash, Ali, ARM Mehrab, Rawal, Lal B, Yadav, Priyanka, Mehata, Suresh, Harris, Mark
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 03.02.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Aged; Aging; Chronic illnesses; Coronaviruses; COVID-19; Cross-Sectional Studies; Data collection; Epidemiology; Global Health; Growth rate; Health care; health policy; Health services; Health Services Accessibility; Humans; Nepal - epidemiology; Older people; Pandemics; Population; Pre-existing conditions; Preexisting Condition Coverage; Public health; SARS-CoV-2; Variables; Nepal; India; COVID-19; epidemiology; health policy; public health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-056342

BackgroundCOVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic.MethodsA cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ2 tests and binary logistic regressions determined inferences.ResultsNearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds.ConclusionsOlder adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.