Background Older adults are one of the population groups at the highest risk of severe illness from COVID-19. However, little is known about the impact of the pandemic on economic activity and healthcare utilization for reasons unrelated to COVID-19 among older adults. This study aimed to examine the prevalence and predictors of unemployment due to COVID-19 and healthcare utilization during the pandemic in a sample of older adults across 27 European countries. We examined the associations between individual and household demographic characteristics as well as country-level characteristics and the likelihood of the outcomes.

Methods We utilized cross-sectional data from the large multi-national Study of Health, Ageing and Retirement in Europe (SHARE) COVID-19 Survey, collected between June and August 2020. All participants (n = 52,061) reported whether they forwent medical treatment and whether their appointment was postponed due to COVID-19. Economically active participants (n = 10,958) reported whether they lost a job due to COVID-19. Three-level hierarchical models were estimated for each outcome to test the effects of individual, household, and country-level characteristics.

Results The mean prevalence of reported job loss, forgone, and postponed medical care were 19%, 12%, and 26%, respectively. Women we more likely to lose their job than men (OR 1.27; 95% CI 1.14–1.41 at mean age) and this effect was larger for older women. Covid-related job loss was also associated with household income (OR per 1,000 EUR was 0.84; 95% CI 0.78–0.90) and lower education (OR comparing primary vs. tertiary education was 1.27; 95% CI 1.14–1.41). Forgone and postponed medical care was associated with older age in men, female sex, and higher education. For example, women were more likely to forgo medical treatment compared to men (OR 1.63; 95% CI 1.54–1.73 at mean age). At the country level, postponed medical care was associated with more stringent governmental anti-COVID measures (OR for inter-quartile range of stringency index was 1.48; 95% CI 1.14–1.93).

Conclusion Job loss and lower healthcare utilization for non-COVID-19 related reasons were prevalent among older adults in the SHARE sample and were associated with several sociodemographic and country characteristics. Job loss appeared to disproportionally affect already economically vulnerable individuals, which may contribute to an exacerbation of social inequalities over time. Additionally, the results highlighted the importance of focusing on maintaining access to healthcare during the lockdown and following up on any missed medical appointments to prevent increased morbidity due to missed screenings and treatment.