How Japan’s older adults adapted to healthcare challenges during the COVID-19 pandemic

Public healthcare emergencies, such as the COVID-19 pandemic, can drastically disrupt healthcare systems with long-term repercussions. The effects of such healthcare crises are more pronounced in the aging population, who are particularly vulnerable to chronic infections and sudden disruptions in healthcare.

The COVID-19 outbreak that emerged in December 2019 quickly spread worldwide, and several emergency measures were urgently implemented to curb its transmission. During the initial phase of the pandemic, stringent measures like social distancing, isolation, and mandatory wearing of masks were implemented. Unfortunately, older individuals were at a higher risk of acquiring the infection and were more likely to experience negative outcomes. The fear of infection, coupled with the state of emergency (SoE) declarations, has led to older adults refraining from seeking necessary medical care.

While initial responses to the pandemic have been well-documented, its long-term impact on healthcare utilization and access among the elderly remains unclear. Furthermore, the prolonged pandemic was characterized by the spread of relatively less virulent strains, gradual relaxation of stringent measures, and widespread vaccination, with limited data on the effect of this transition.

To bridge this knowledge gap, researchers from Waseda University, Japan, sought to analyze the effects of the extended phase—from November 2021 to September 2022—on older adults in Japan, one of the world’s most aged societies with a universal healthcare system. The team comprised of Associate Professor Rong Fu from the Faculty of Commerce, master’s student Sizhe Liu from the Graduate School of Commerce, Assistant Professor Masato Oikawa from the Faculty of Education and Integrated Arts and Sciences, Professor Haruko Noguchi from the Faculty of Political Science and Economics, and Professor Akira Kawamura from the Faculty of Human Sciences.

Explaining the rationale behind their research, Fu, the lead author, says, “As populations age globally, maintaining healthcare access during public health emergencies becomes increasingly critical. Our research addresses this challenge by providing insights into how healthcare systems can balance infection control with continued access to essential services for vulnerable elderly populations.” Their findings were published online in Scientific Reports by Nature Research on April 22, 2025.

The researchers used a comprehensive dataset of 189,841,257 medical claims linked with income tax records from the long-term care insurance system to analyze trends in healthcare utilization among Japan’s oldest-old population aged 75 years and above. They correlated trends in healthcare access and utilization with the implementation of public health measures, crisis severity, and socioeconomic status.

The analysis revealed that the implementation of precautionary measures led to a modest drop in the use of medical services and outpatient visits. Nevertheless, healthcare costs and services remained stable despite a decrease in patient volumes. The use of medical services varied across different residential areas depending on crisis severity and the extent of precautionary measures. Notably, there was no difference in healthcare utilization across different income levels except for dental services. Dental care visits by older adults with a lower income were significantly lower than high-income groups, highlighting socioeconomic disparities in dental care during public emergencies.

Overall, these findings suggest that healthcare adaptations can address the needs of the elderly during medical emergencies and help avoid medical delays with dire consequences. Adaptations may include integrated monitoring systems, enhanced safety protocols to bridge gaps in preventive dental care, early warning systems, and flexible delivery options, such as remote or mobile care, to improve accessibility for vulnerable groups.

“Our findings can help inform policymakers who devise targeted interventions to prevent socioeconomic disparities in healthcare access from widening during crises. Additionally, for healthcare providers, our research demonstrates the importance of maintaining service intensity even when visit frequency fluctuates,” Fu adds.

Newly confirmed COVID-19 cases and governmental emergency responses. Notes: COVID-19 case data were obtained from the official governmental website. Data collection ended on May 7, 2023, due to the reclassification of COVID-19 to a Category V Infectious Disease. Information regarding the enforcement of SoE and SoPE policies was gathered from the official website of the Cabinet Agency for Infectious Diseases Crisis Management. The gray shaded area in both graphs denotes the study period.

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Reference

Authors: Rong Fu¹, Sizhe Liu², Masato Oikawa³, Haruko Noguchi⁴, and Akira Kawamura⁵

Title of original paper: Healthcare utilization among Japanese older adults during later stage of prolonged pandemic

Journal: Scientific Reports                                                         

DOI: 10.1038/s41598-025-98908-x

Affiliations         

¹Faculty of Commerce, Waseda University, Shinjuku, Japan

²Graduate School of Commerce, Waseda University, Shinjuku, Japan ³Faculty of Education and Integrated Arts and Sciences, Waseda University, Shinjuku, Japan

⁴Faculty of Political Science and Economics, Waseda University, Shinjuku, Japan

⁵Faculty of Human Sciences, Waseda University, Tokorozawa, Japan

About Waseda University

Located in the heart of Tokyo, Waseda University is a leading private research university that has long been dedicated to academic excellence, innovative research, and civic engagement at both the local and global levels since 1882. The University has produced many changemakers in its history, including nine prime ministers and many leaders in business, science and technology, literature, sports, and film. Waseda has strong collaborations with overseas research institutions and is committed to advancing cutting-edge research and developing leaders who can contribute to the resolution of complex, global social issues. The University has set a target of achieving a zero-carbon campus by 2032, in line with the Sustainable Development Goals (SDGs) adopted by the United Nations in 2015. 

To learn more about Waseda University, visit https://www.waseda.jp/top/en  

About Associate Professor Rong Fu from Waseda University

Dr. Rong Fu is an Associate Professor at the Faculty of Commerce, Waseda University. Her research focuses on health economics and policy, with particular emphasis on healthcare utilization patterns among elderly populations and the socioeconomic determinants of health disparities. She has authored several publications spanning these research areas.