Association between older adults’ socioeconomic status and their healthcare experiences, preferences, and attitudes towards deprescribing : a cross-sectional study in 14 countries

Abstract

Background

Socioeconomic status (SES) can influence health outcomes. Both SES and older age are associated with polypharmacy, health literacy, and quality of care. Understanding how SES influences healthcare experiences of older adults with polypharmacy can serve to inform future interventions aiming at optimising patient care. Therefore, we investigated the association between older patients’ SES and their i) attitudes towards deprescribing, ii) satisfaction with medications, iii) self-rated health, iv) health literacy, and v) trust in their general practitioner (GP). Methods

In this cross-sectional study, older patients with polypharmacy from 14 countries completed a survey on their attitudes towards deprescribing, healthcare experiences, and sociodemographic characteristics. We compared patients’ responses across high (reference), middle, and low SES groups (defined by education and financial status), and performed multilevel logistic regressions adjusted for clustering at the country level to assess the association between patients’ SES and the outcomes. Results

Among 1,320 older adults, compared to those with high SES, patients with low SES were more likely to want a medication deprescribed (ORlowSES 1.76, 95%CI 1.20-2.57). Those with medium SES were less likely to trust their GP (ORmediumSES 0.70, 95%CI 0.52-0.94). Both low and medium SES groups were less likely to be satisfied with their current medications (ORlowSES 0.45, 95%CI 0.29-0.71; ORmediumSES 0.63, 95%CI 0.44-0.92), less likely to report good health (ORlowSES 0.22, 95%CI 0.14-0.34; ORmediumSES 0.49, 95%CI 0.37-0.65), and had lower health literacy (ORlowSES 0.10, 95%CI 0.07-0.16; ORmediumSES 0.31, 95%CI 0.24- 0.41). Conclusion

Older adults with lower SES expressed greater interest in deprescribing, lower satisfaction with medications, lower self-rated health, and lower health literacy. Our findings suggest key aspects to consider when optimising care of older adults with low SES.