Association between self-perceptions of aging,care deferrals,and change in health status among US adults aged ≥ 50 years during the COVID-19 pandemic: A cross-sectional study
Restricted accessResearch articleFirst published online December, 2025
Association between self-perceptions of aging,care deferrals,and change in health status among US adults aged ≥ 50 years during the COVID-19 pandemic: A cross-sectional study
The study aimed to examine the association between self-perceptions of aging (SPA) and delayed and/or forgone care (DFC) among older adults in the US during the COVID-19 pandemic, and to assess how SPA and DFC are associated with change in self-rated health status. A cross-sectional study of community-dwelling US adults (≥50 years) was conducted using the 2020 Health and Retirement Study data. Two separate multivariable logistic regression models were conducted to assess the study objectives. The final unweighted sample was 4079. Negative SPA were associated with DFC (adjusted odds ratio (aOR): 1.03, 95% CI: 1.01–1.04). DFC and negative SPA were associated with worsened health status compared to respondent’s previous interview wave (aOR: 1.44, 95% CI: 1.10–1.87 and aOR: 1.06, 95% CI: 1.04–1.08, respectively). Health promotion efforts should be implemented to foster positive SPA among older adults in the US to encourage timely use of healthcare.
AndersenR (1968) A Behavioral Model of Families’ Use of Health Services. Research series (University of Chicago. Center for Health Administration Studies). Chicago: Center for Health Administration Studies, University of Chicago.
2.
AyalonL (2020) There is nothing new under the sun: Ageism and intergenerational tension in the age of the COVID-19 outbreak. International Psychogeriatrics32(10): 1221–1224.
3.
BeckerNVKoripellaSKarmakarM, et al. (2022) Rates of delayed care among Detroit residents during the COVID-19 pandemic. Journal of General Internal Medicine37(10): 2611–2613.
BeydounHABeydounMAAlemuBT, et al. (2022) Determinants of COVID-19 outcome as predictors of delayed healthcare services among adults ≥50 years during the pandemic: 2006–2020 health and retirement study. International Journal of Environmental Research and Public Health19(19): 12059.
6.
BeyerA-KWolffJKFreibergerE, et al. (2019) Are self-perceptions of ageing modifiable? Examination of an exercise programme with vs. without a self-perceptions of ageing-intervention for older adults. Psychology and Health34(6): 661–676.
7.
BlayJYBoucherSLe VuB, et al. (2021) Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France. ESMO Open6(3): 100134.
8.
BradleyEHMcGrawSACurryL, et al. (2002) Expanding the Andersen model: The role of psychosocial factors in long-term care use. Health Services Research37(5): 1221–1242.
9.
BrothersAKornadtAENehrkorn-BaileyA, et al. (2021) The effects of age stereotypes on physical and mental health are mediated by self-perceptions of aging. Journals of Gerontology Series B76(5): 845–857.
10.
ChanACYSneedRS (2022) Factors associated ith health care delays among adults over 50 during the COVID-19 pandemic. Journals of Gerontology Series A78(4): 630–636.
11.
ChengGJWagnerALO’SheaBQ, et al. (2022) Multimorbidity and mental health trajectories among middle-aged and older U.S. adults during the COVID-19 pandemic: Longitudinal findings from the COVID-19 coping study. Innovation in Aging6(5): igac047.
12.
CzeislerMÉMarynakKClarkeKEN, et al. (2020) Delay or avoidance of medical care because of COVID-19–related concerns — United States, June 2020. MMWR Morbidity and Mortality Weekly Report69(36): 1250–1257.
13.
DiehlMBrothersAWahlHW (2021) Self-perceptions and awareness of aging: Past, present, and future. In: SchaieKWWillisSL (eds) Handbook of the Psychology of Aging, 9th edn.London: Academic Press, pp.155–179.
14.
DiehlMNehrkorn-BaileyATsengHY (2022) Psychological interventions targeting adults’ subjective views of aging. In: PalgiYShriraADiehlM (eds) Subjective Views of Aging: Theory, Research, and Practice. International Perspectives on Aging. Cham: Springer International Publishing, pp.309–327.
FarinaMPAilshireJA (2022) Sociodemographic and health status differences in delaying medical care during the COVID-19 pandemic among older adults: Findings from the health and retirement study. BMC Public Health22(1): 1720.
17.
FinlayJMeltzerGO’SheaB, et al. (2024) Altered place engagement since COVID-19: A multi-method study of community participation and health among older Americans. Wellbeing, Space and Society6: 100184.
Health and Retirement Study. (n. d.) (2020 HRS Final Core public use dataset. Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740). Ann Arbor, MI.
20.
HRS Staff. (n. d.) HRS Core Interview Sample Sizes and Response Rates. Ann Arbor, MI: Survey Research Center, Institute for Social Research, University of Michigan. Available at: https://hrs.isr.umich.edu/documentation/survey-design/response-rates (accessed 15 January 2024).
21.
JannB (2004) ALPHAWGT: Stata module to compute Cronbach’s alpha for weighted data. Statistical Software Components S4444101. Boston College Department of Economics.
22.
KesslerE-MBowenCE (2020) COVID ageism as a public mental health concern. The Lancet Healthy Longevity1(1): e12.
23.
KlusmannVNotthoffNBeyerA-K, et al. (2020) The assessment of views on ageing: A review of self-report measures and innovative extensions. European Journal of Ageing17(4): 403–433.
24.
KornadtAEAlbertIHoffmannM, et al. (2021) Perceived ageism during the Covid-19-crisis is longitudinally related to subjective perceptions of aging. Frontiers in Public Health9: 679711.
25.
LawtonMP (1975) The Philadelphia geriatric center morale scale: A revision. Journal of Gerontology30(1): 85–89.
26.
LeiLMaustDT (2022) Delayed care related to COVID-19 in a nationally representative sample of older Americans. Journal of General Internal Medicine37(5): 1337–1340.
27.
LevyB (2009) Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science18(6): 332–336.
28.
LevyBRMyersLM (2004) Preventive health behaviors influenced by self-perceptions of aging. Preventive medicine39(3): 625–629.
29.
LiangJBollenKA (1983) The structure of the Philadelphia geriatric center morale scale: A reinterpretation. Journal of Gerontology38(2): 181–189.
30.
LiYChengZCaiX, et al. (2022) Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic. International Journal of Geriatric Psychiatry37(3): 1–10.
31.
LohKPDubersteinPZittelJ, et al. (2020) Relationships of self-perceived age with geriatric assessment domains in older adults with cancer. Journal of Geriatric Oncology11(6): 1006–1010.
32.
Losada-BaltarAJiménez-GonzaloLGallego-AlbertoL, et al. (2021) “We are staying at home.” Association of self-perceptions of aging, personal and family resources, and loneliness with psychological distress during the lock-down period of COVID-19. Journals of Gerontology Series B76(2): e10–e16.
33.
LuoMSLiLWHuRX (2021) Self-perceptions of aging and domain-specific health outcomes among midlife and later-life couples. Journal of Aging and Health33(1–2): 155–166.
34.
LuoY (2021) The association of delayed care with depression among US middle-aged and older adults during the COVID-19 pandemic: Cross-sectional analysis. JMIR aging4(4): e29953.
35.
MorrisonBANicholsonJWoodB, et al. (2023) Life after lockdown: The experiences of older adults in a contactless digital world. Frontiers in Psychology13: 1100521.
36.
Morrow-HowellNGaluciaNSwinfordE (2020) Recovering from the COVID-19 pandemic: A focus on older adults. Journal of Aging & Social Policy32(4–5): 526–535.
37.
MoserCSpagnoliJSantos-EggimannB (2011) Self-perception of aging and vulnerability to adverse outcomes at the age of 65–70 years. Journals of Gerontology Series B66B(6): 675–680.
38.
MyersLCLiuVX (2022) The COVID-19 pandemic strikes again and again and again. JAMA network open5(3): e221760.
39.
NaL (2022) Characteristics of community-dwelling older individuals who delayed care during the COVID-19 pandemic. Archives of Gerontology and Geriatrics101: 104710.
40.
PeckhamAMaxfieldMGuestM (2024) [It’s the] first time I have felt so acutely that I am ‘less’ because of my age.”: Aging in the time of COVID-19. Aging and Health Research4(3): 100203.
SarkisianCAHaysRDMangioneCM (2002) Do older adults expect to age successfully? The association between expectations regarding aging and beliefs regarding healthcare seeking among older adults. Journal of the American Geriatrics Society50(11): 1837–1843.
43.
SeifertA (2021) Impact of the COVID-19 pandemic on self-perception of aging among older adults. Gerontology and Geriatric Medicine7: 2333721421999320.
44.
SmithMVaughan SarrazinMWangX, et al. (2022) Risk from delayed or missed care and non-COVID-19 outcomes for older patients with chronic conditions during the pandemic. Journal of the American Geriatrics Society70(5): 1314–1324.
45.
SonnegaAFaulJDOfstedalMB, et al. (2014) Cohort Profile: The health and retirement study (HRS). International Journal of Epidemiology43(2): 576–585.
46.
SunJKSmithJ (2017) Self-perceptions of aging and perceived barriers to care: Reasons for health care delay. Gerontologist57(l_2): S216–S226.
47.
TapperEBAsraniSK (2020) The COVID-19 pandemic will have a long-lasting impact on the quality of cirrhosis care. Journal of Hepatology73(2): 441–445.
48.
TettehJFordjourGEkem-FergusonG, et al. (2020) Visual impairment and social isolation, depression and life satisfaction among older adults in Ghana: Analysis of the WHO’s Study on global AGEing and adult health (SAGE) Wave 2. BMJ Open Ophthalmology5(1): e000492.
49.
Tully-WilsonCBojackRMillearPM, et al. (2021) Self-perceptions of aging: A systematic review of longitudinal studies. Psychology and Aging36(7): 773–789.
50.
VelaithanVTanM-MYuT-F, et al. (2023) The association of self-perception of aging and quality of life in older adults: A systematic review. Gerontologist64(4): gnad041.
51.
von ElmEAltmanDGEggerM, et al. (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet370(9596): 1453–1457.
52.
WarmothKTarrantMAbrahamC, et al. (2016) Older adults’ perceptions of ageing and their health and functioning: A systematic review of observational studies. Psychology Health & Medicine21(5): 531–550.
53.
WettsteinMWahlH-W (2021) Trajectories of attitude toward own aging and subjective age from 2008 to 2020 among middle-aged and older adults: Partial evidence of a “COVID-19 effect”. Psychology and Aging36(7): 790–805.
WymanMFShiovitz-EzraSBengelJ (2018) Ageism in the health care system: Providers, patients, and systems. In: AyalonLTesch-RömerC (eds) Contemporary Perspectives on Ageism. International Perspectives on Aging. Cham: Springer International Publishing, pp.193–212.
56.
ZhongSHuisingh-ScheetzMHuangES (2022) Delayed medical care and its perceived health impact among US older adults during the COVID -19 pandemic. Journal of the American Geriatrics Society70(6): 1620–1628.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
