A Burden for Older US Adults

TOPLINE:

Over 80% of US adults aged 50 years or older reported that managing their health and healthcare was challenging, with some facing great difficulty. Administrative and financial challenges were major factors contributing to this.

METHODOLOGY:

• Researchers conducted a cross-sectional study using the 2022 Health and Retirement Study Treatment Burden Questionnaire to evaluate how the perceived effort of managing health and healthcare (treatment burden) affects community-dwelling adults aged 50 years or older in the US.
• They included 1795 adults who completed the questionnaire (mean age, 68.5 years; 56% women; 75% non-Hispanic White individuals), which featured 15 items across various domains, including burden related to medications, appointments, self-monitoring, lifestyle changes, and the impact on relationships.
• Participants rated their perceived level of effort or burden on a scale from 0 (no burden) to 10 (high burden).
• The primary outcome was the total treatment burden score, calculated by summing the scores of all 15 items on the questionnaire, with scores above a threshold indicating high burden.
• Associations between treatment burden and various factors such as age, sociodemographic characteristics, physical and mental health, and functional status were also assessed.

TAKEAWAY:

• Overall, 87% of respondents reported some treatment burden, with 5.4% experiencing a high burden. The greatest treatment burden was associated with being reminded of health problems, followed by administrative tasks and financial costs.
• More adults aged 50-64 years reported administrative (58.7% vs 49.0%) and financial (55.6% vs 39.4%) burdens as well as difficulty scheduling appointments (37.1% vs 26.2%) than those aged 65 years or older (P < .05 for all). They also experienced a greater burden from treatment impacts on their relationships, whereas older adults (aged ≥ 65 years) reported more burden from reminders of their health issues.
• Lower treatment burden scores were linked to older age (≥ 65 years vs < 65 years; P < .001), female sex (P = .003), and having Medicaid vs other insurance (P = .03).
• Higher treatment burden scores were associated with more chronic conditions (P < .001), depression (P < .001), vision impairment (P = .01) and hearing impairment (P =  .006), and mobility difficulties (P < .001).

IN PRACTICE:

“Reducing treatment burden in the US may require efforts extending beyond reducing healthcare utilization alone, including reforms to reduce administrative and financial burden in healthcare delivery and financing systems, and interventions to improve patient capacity to respond to burden,” the authors of the study wrote.

SOURCE:

This study was led by Audrey D. Zhang, of the Beth Israel Deaconess Medical Center in Boston. It was published online on June 19, 2025, in the Journal of the American Geriatrics Society.

LIMITATIONS:

The need to adjust the questionnaire for assessing the burden in the US context may have resulted in lower median values compared with those reported in earlier studies. The reliance on self-reported data may not accurately reflect the severity or progression of chronic conditions. The limited sample size may not include all subgroups, which restricts the conclusions that can be made.

DISCLOSURES:

This study was supported by grants from the Health Resources and Services Administration. One author received support from the Health Resources and Services Administration and three authors from the National Institute on Aging. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.