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Addressing Healthcare Inequities for Older Adults: Challenges and Pathways to Equitable Healthcare Services

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences".

Deadline for manuscript submissions: closed (31 August 2025) | Viewed by 4879

Special Issue Editors


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Guest Editor
Faculty of Medicine and Science, Universidad San Sebastián, Los Leones Campus, Santiago 7510157, Chile
Interests: ageing; disability; social epidemiology; access to healthcare; health inequities; sustainable development

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Guest Editor
Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
Interests: disability in older people; public policy; programs and services for older people; multicomponent interventions in older people; comprehensive gerontological assessment; physical activity and exercise; sustainability in older people; telehealth in older people

Special Issue Information

Dear Colleagues,

This Special Issue focuses on the intersection of health inequities and equitable access to healthcare services for older people, with a particular emphasis on the social determinants of health. Older people face unique challenges in accessing equitable healthcare services, which can lead to worse health outcomes for this population. Factors, such as declining physical and cognitive abilities, the increased prevalence of chronic conditions, geriatric syndromes, disability, and a greater dependency on long-term care, place older adults at a higher risk of encountering healthcare barriers. Additionally, socioeconomic disparities, rural isolation, and limited access to digital technologies, such as telehealth, further exacerbate these challenges. The social determinants of health—including income, education, housing, and social support—also play a crucial role in shaping the healthcare experiences of older adults, often contributing to the creation of health inequities. Addressing these barriers requires tailored health policies, improved care coordination and accessible healthcare solutions to ensure that older individuals can receive the necessary care and support to maintain their well-being.

The Special Issue will explore themes such as economic disparities, sociocultural aspects that have an impact on older people's access to healthcare services, and the effect of multiple structural disadvantages—such as disability, race, and migration status—on the creation and perpetuation of health inequities for older people. It will also explore the barriers and facilitators in accessing healthcare services, as well as policies that can promote equity in healthcare. The goal is to shed light on the systemic factors contributing to health inequities and propose solutions for more inclusive healthcare for older people.

Dr. Elena S. Rotarou
Dr. Rafael Pizarro-Mena
Guest Editors

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Keywords

  • ageing
  • older people
  • disability
  • health inequity
  • access to healthcare services
  • social determinants of health

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Published Papers (5 papers)

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Research

18 pages, 332 KB  
Article
Older Adults’ Perceptions of Health, Quality of Life, and Access to Health Promotion Initiatives for Active Aging: A Qualitative Approach
by José Antonio Bicca Ribeiro, Breno Berny Vasconcelos, Kamila Bierhals Fernandes, Inácio Crochemore-Silva and Cristine Lima Alberton
Int. J. Environ. Res. Public Health 2025, 22(12), 1796; https://doi.org/10.3390/ijerph22121796 - 27 Nov 2025
Viewed by 343
Abstract
(1) Background: Health promotion initiatives based on physical activity (PA) play a crucial role in fostering active aging. However, engagement in such initiatives is related to individual subjectivities that vary according to different social backgrounds among older adults. This study aims to explore [...] Read more.
(1) Background: Health promotion initiatives based on physical activity (PA) play a crucial role in fostering active aging. However, engagement in such initiatives is related to individual subjectivities that vary according to different social backgrounds among older adults. This study aims to explore older adults’ perceptions of their health and quality of life after participation in a PA program, as well as the factors influencing their access to health promotion services and initiatives. (2) Methods: This is a qualitative study based on two focus groups conducted in June 2025 at the University involving 14 older adults (11 women; mean age: 68 years), participating in a supervised PA program in a city in southern Brazil. (3) Results: The themes identified from the Thematic Analysis were Health, aging, and quality of life; Engagement with PA; and Perspectives on health promotion strategies. A positive perception of health and quality of life was identified as being related to participation/engagement in a PA program. Access to health services is facilitated; however, waiting times for care are long, especially for more specific diseases. (4) Conclusions: Although participation in a structured PA program influences the positive perception of health and quality of life, socioeconomic and structural barriers limit equitable access to these services, revealing the need for integrated public policies to address health inequalities and support active aging. Full article
15 pages, 279 KB  
Article
Influence of Social Determinants on Physical Performance and Geriatric Syndromes in Community-Dwelling Older Adults
by Roberto Israel Vázquez-Garza, Armando Martin Moreno-Amador, Carlos de la Cruz-de la Cruz and Karina Alejandra Rodriguez-Quintanilla
Int. J. Environ. Res. Public Health 2025, 22(11), 1726; https://doi.org/10.3390/ijerph22111726 - 14 Nov 2025
Viewed by 303
Abstract
Background: Healthy aging involves ensuring a good quality of life and maintaining autonomy. Physical performance is a key indicator of health and autonomy in old age, and it is influenced by social determinants of health. The aim of this study was to evaluate [...] Read more.
Background: Healthy aging involves ensuring a good quality of life and maintaining autonomy. Physical performance is a key indicator of health and autonomy in old age, and it is influenced by social determinants of health. The aim of this study was to evaluate differences in physical performance and geriatric health outcomes among older adults attending a community center, according to their educational level, pension status, and access to health services. Methods: An observational, descriptive, retrospective and cross-sectional study was carried out using the database of subjects aged 60 and over who attend a community gerontological center. Results: A total of 536 older adults (mean age 70.7 ± 8.4 years, 71.5% women, 86.9% with public health coverage) with an average age of 70.7 ± 8.4 years were included; subjects with higher education had higher weight, as well as better indicators of physical functionality: higher scores in the Barthel and Lawton–Brody indices, greater walking speed, less time in the test to get up from the chair and in the test “Time Up and Go” (TUG), and increased prehensile strength. Conclusion: Social determinants, including education, economic independence, health coverage, and pension status, significantly influence physical performance and geriatric syndromes in older adults. Full article
19 pages, 312 KB  
Article
Violence, Inequity, and Their Impact on Health and Access to Healthcare Services Among the Elderly Population of Bogotá
by Carlos Alberto Cano-Gutiérrez, Diego Andrés Chavarro-Carvajal and Julián Andrés Sucerquia-Quintero
Int. J. Environ. Res. Public Health 2025, 22(10), 1555; https://doi.org/10.3390/ijerph22101555 - 13 Oct 2025
Viewed by 772
Abstract
Objective: This study explores the prevalence of violence and forced displacement as indicators of inequity among Bogotá’s elderly population, with a particular focus on how these factors affect their health and access to healthcare services. Methods: This is a subsidiary analysis of the [...] Read more.
Objective: This study explores the prevalence of violence and forced displacement as indicators of inequity among Bogotá’s elderly population, with a particular focus on how these factors affect their health and access to healthcare services. Methods: This is a subsidiary analysis of the SABE-Bogotá survey. The design was a probabilistic cluster sample of 2000 people aged 60 and over. The study was carried out by the Pontificia Universidad Javeriana’s Institute on Aging and cosponsored by Colciencias. The variables of interest were displacement and experiences of violence, assessed through self-reporting. A descriptive analysis of all variables was performed, calculating simple frequency distributions. Subsequently, dependency and association analyses were performed using Chi-square, T-tests, and multivariate logistic regressions, depending on each case. Results: 43.32% of the subjects were victims of some type of violence in the last year, among which offensive language was one of the most frequent. Individuals with severe depression (OR 2.10 [1.21–3.65]) and those who had been victims of displacement (OR 2.55, CI 95% [1.65–3.95]) had the highest risk of violence. The results reveal a direct correlation between these experiences and pre-existing health conditions. For instance, severe depression and a history of displacement were associated with a higher risk of experiencing violence, while the risk of displacement was higher among individuals with diabetes, severe depression, and, crucially, those who lacked access to health insurance. Conclusion: A high percentage of the elderly population in the city of Bogotá has been victims of different types of violence, including ones related to armed conflict and forced displacement, which is a particular and exclusive form of violence suffered by this group of people. These findings suggest that violence and displacement are social determinants of health that exacerbate inequities, underscoring the need for more inclusive health policies and improved access to medical care for this vulnerable population. Full article
15 pages, 1393 KB  
Article
Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool
by Paula Schmidt Azevedo, Juli Thomaz de Souza, Alessandro Ferrari Jacinto, Déborah Oliveira, Fania Cristina dos Santos, Marcos Ferreira Minicucci, Paulo José Fortes Villas Boas, Wilco Achterberg and Patrick Alexander Wachholz
Int. J. Environ. Res. Public Health 2025, 22(9), 1324; https://doi.org/10.3390/ijerph22091324 - 26 Aug 2025
Viewed by 1340
Abstract
Background: Pain detection and management in older people with impaired cognition is an unmet need, leading to healthcare inequalities. This study aimed to enhance pain detection by translating and culturally adapting the PAIC-15 questionnaire into Brazilian Portuguese, establishing its content validity and comparing [...] Read more.
Background: Pain detection and management in older people with impaired cognition is an unmet need, leading to healthcare inequalities. This study aimed to enhance pain detection by translating and culturally adapting the PAIC-15 questionnaire into Brazilian Portuguese, establishing its content validity and comparing findings with a similar Dutch study. Methods: Following the same international standards used in the English-to-Dutch validation, we translated and culturally adapted PAIC-15 for Brazil. Content validity was assessed using two questions: (A) whether the item indicated pain and (B) whether it was specific to pain. An online form was distributed to ‘target users’ (nurses and geriatricians in LTCFs or other settings) and other healthcare professionals (HCPs) experienced in pain assessment in people with cognitive decline. Results were compared with the English-to-Dutch validation. Results: A total of 103 HCPs responded (mean age 45.2 ± 11.4 years)—76 (74%) were female and 54 (52%) had previously used pain assessment tools. Among the 63 target users, 13 items (87%) were validated as indicative and/or specific to pain. Comparing Brazilian and Dutch users, 10 items (67%) showed agreement on pain specificity. Conclusions: The Brazilian Portuguese PAIC-15 is now available, showing acceptable content validity. Linguistic challenges highlight the need for training and further validation in larger samples. Full article
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17 pages, 1011 KB  
Article
Satisfaction with Health Facility Personnel Among Older People with Disabilities in Chile: An Observational Study Based on the 2024 DISCA Survey
by Elena S. Rotarou, Dikaios Sakellariou and Rafael Pizarro-Mena
Int. J. Environ. Res. Public Health 2025, 22(7), 1103; https://doi.org/10.3390/ijerph22071103 - 13 Jul 2025
Viewed by 1044
Abstract
Achieving health equity for people with disabilities requires addressing the barriers that they face when accessing healthcare. Older adults with disabilities may experience compounded disparities, yet little research has explored their satisfaction with health facility personnel, including non-healthcare staff. This study examines differences [...] Read more.
Achieving health equity for people with disabilities requires addressing the barriers that they face when accessing healthcare. Older adults with disabilities may experience compounded disparities, yet little research has explored their satisfaction with health facility personnel, including non-healthcare staff. This study examines differences in satisfaction with health facility personnel between younger (18–59 years) and older (60+) adults with disabilities in Chile. Data from the 2024 Disability and Citizenship (DISCA) survey were analysed using chi-square tests to examine differences between younger and older people with disabilities with regard to their satisfaction with health facility personnel. Ordered logistic regressions were employed to predict high satisfaction, given socioeconomic and health-related variables. Findings indicated that a higher percentage of older adults with disabilities reported high satisfaction with health facility personnel compared to younger adults. Ordered logistic regressions confirmed that older adults had greater odds of reporting high satisfaction with doctors (OR: 3.83), other health professionals (OR: 4.66), paramedical technicians (OR: 4.31), and administrative staff (OR: 3.13). These results suggest that age influences satisfaction levels among people with disabilities, potentially due to varying expectations, experiences, or interactions with health facility personnel. Understanding the underlying reasons for these age-related differences is essential to inform policies and practices that ensure equitable, person-centred care for people with disabilities across the life course. Full article
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