Medical ageism and healthcare access among older adults during COVID-19: a global scoping review

Older adults were disproportionately affected by the COVID-19 pandemic, yet their healthcare experiences cannot be explained solely by biological vulnerability. Less attention has been paid to how barriers to healthcare access intersected with age-based exclusion during health system disruption. This scoping review examined how medical ageism shaped healthcare access among older adults during the COVID-19 pandemic. Searches of Web of Science, Scopus, and SciELO, complemented by citation tracking, covered publications in English, Spanish and Portuguese from January 2019 to November 2025. A total of 121 studies were included, most using qualitative methods, with evidence concentrated in Europe and North America and fewer studies from Latin America and other regions of the Global South. Evidence was synthesised thematically using Levesque et al’s framework of healthcare access together with the concept of medical ageism. Barriers were identified across all stages of access, from recognising need to seeking, reaching, affording, receiving and engaging with care. Service disruption, digital exclusion, inadequate transport and financial insecurity were recurrent barriers. Age-based exclusion operated explicitly, particularly in triage debates, and implicitly, through communication practices, clinical routines and service models poorly adapted to later life. Healthcare access during COVID-19 was shaped not only by service capacity but also by structural inequalities, institutional values and age-based assumptions embedded in pandemic responses. Integrating healthcare access theory and medical ageism provides a more comprehensive understanding of later-life inequalities and supports more age-inclusive emergency preparedness and health system planning.