Preferences about healthcare—including risk aversion, openness to experimental treatments, and whether to leave treatment decisions to a doctor—vary substantially by age and sex in adults over 50, according to a study published on July 29 in PLOS One by Nicholas Steel of the University of East Anglia and colleagues.
The researchers analyzed data from wave 8 (2016/2017) of the English Longitudinal Study of Ageing (ELSA), which is a nationally representative biennial survey of people living in private households in England. The analysis included responses from 6,098 adults aged 50 and over who answered at least one of six healthcare preference questions. These questions addressed topics such as risk aversion, present versus future quality of life, quality versus length of life, body function versus appearance, openness to experimental treatments, and preference for leaving treatment decisions to doctors.
Findings showed that women were more likely than men to want to avoid risks, prioritize quality over length of life, avoid experimental treatments, and were less likely to defer treatment decisions to doctors. Adults aged 75 and older were more likely than those aged 50–64 to want to avoid risks, prioritize body function over appearance, avoid experimental treatments, and leave treatment decisions up to doctors.
The study authors noted that their research was limited because it only measured hypothetical preferences rather than real-life healthcare choices. They also cautioned that findings may not be generalizable beyond England. However, they concluded there are systematic differences in healthcare preferences by age and sex that could help clinicians better understand patient needs.
Dr. Oby Enwo said, "We found that older adults have different views about their health and that age, sex and education each shaped health preferences in different ways. The finding that stood out to me the most was around education - people who had fewer educational opportunities were more likely to leave treatment decisions to their doctors. To me this highlights the need to explore how we can ensure shared decision-making reaches everyone equally." Enwo also emphasized the importance of treating every consultation as a conversation about what matters most for each person.
Prof. James Banks said, "I thought it was interesting and important for us to show just how diverse people's health and healthcare preferences were across different dimensions and that they can't be summarized by a simple one- or two-dimensional measure. With patient-centered care being so important we need more systematic measures of these preferences on an ongoing basis... The relationship between education and peoples' preferences regarding types of treatment... seemed important... I thought it was particularly important... [to] document the strong preference... for quality of life over length of life."
