Public health emergencies, particularly pandemics such as COVID-19, exert severe pressure on healthcare systems, often leading to long-term structural and operational disruptions. These disruptions are especially consequential for older adults, who are more susceptible to chronic diseases and are particularly vulnerable when routine medical services are interrupted. As the COVID-19 virus emerged in December 2019 and rapidly escalated into a global crisis, it triggered a cascade of emergency responses intended to limit transmission. However, while crucial for infection control, these measures inevitably created barriers to healthcare access for the ageing population, a demographic already facing challenges in navigating healthcare services even in stable times.
In Japan, which has one of the most aged populations globally, the early phase of the pandemic saw the swift adoption of stringent measures, including enforced social distancing, mandatory mask-wearing, and government-mandated lockdowns. These were accompanied by repeated declarations of a state of emergency (SoE). While these interventions were essential in curbing viral spread, they unintentionally discouraged many older adults from seeking medical attention due to the dual pressures of fear and logistical difficulty. As a result, necessary care was often deferred or avoided, exacerbating the health risks faced by this vulnerable group. Although many studies have explored these early responses and their immediate impacts, there remains a notable lack of research examining how older adults engaged with the healthcare system during the prolonged, later stages of the pandemic, particularly as less virulent strains emerged and containment measures were gradually lifted.
To address this knowledge gap, a team of researchers from Waseda University undertook a comprehensive study to assess healthcare utilisation patterns among Japan’s older adult population during the extended pandemic phase, specifically between November 2021 and September 2022. The research was conducted by a multidisciplinary team including Associate Professor Rong Fu, Assistant Professor Masato Oikawa, Professors Haruko Noguchi and Akira Kawamura, and master’s student Sizhe Liu. Their study is especially significant given Japan’s unique context: a super-aged society with a universal healthcare system, where the balance between public health interventions and uninterrupted access to care becomes complex and essential.
The research team drew on a vast dataset comprising nearly 190 million medical claims, all linked to income tax data from Japan’s long-term care insurance system. This approach enabled them to track trends in healthcare access and service usage among individuals aged 75 and older. By comparing this data with indicators of crisis severity, regional public health policies, and socioeconomic stratification, the study aimed to understand whether access changed and how those changes were distributed across the population. Lead researcher Rong Fu emphasised the broader implications of the work, noting that as global populations continue to age, ensuring equitable healthcare access during emergencies is a pressing international concern.
Their analysis revealed a nuanced picture. Implementing precautionary health measures was associated with a moderate reduction in medical visits and outpatient appointments. However, despite the decline in patient volumes, healthcare costs and the overall provision of services remained broadly stable. This suggests that fewer people were visiting healthcare facilities, the intensity or complexity of care per visit may have increased, or systems adapted to deliver essential services more efficiently. Interestingly, the study found no significant disparities in general healthcare access across different income levels, with one notable exception: dental services. Lower-income older adults were significantly less likely to access dental care, underscoring the persistence of inequality in certain types of healthcare even under a universal system.
Ultimately, the study illustrates that health systems can adapt to protect older populations during extended crises. Still, gaps remain, particularly in areas like preventive dental care, where socioeconomic factors play a larger role. The authors propose that more robust systems—such as integrated early warning mechanisms, mobile or telehealth service delivery models, and targeted safety protocols—can help safeguard access to care in future emergencies. Fu and colleagues stress the need for policymakers to design interventions that mitigate inequality and ensure continuity of care, even during protracted public health disruptions. Their findings, published in Scientific Reports by Nature Research in April 2025, offer crucial insights for governments and healthcare providers as they prepare for future challenges in a world increasingly shaped by ageing populations and potential health crises.
More information: Rong Fu et al, Healthcare utilization among Japanese older adults during later stage of prolonged pandemic, Scientific Reports. DOI: 10.1038/s41598-025-98908-x
Journal information: Scientific Reports Provided by Waseda University
