The Causes and Consequences of Overuse: Older Adults' Perceptions

Introduction: The U.S. spends more on healthcare than other high-income nations, but has worse health outcomes. This suggests that healthcare is overused in the U.S., exposing patients to harm with little likelihood of... [ view full abstract ]

Introduction: The U.S. spends more on healthcare than other high-income nations, but has worse health outcomes. This suggests that healthcare is overused in the U.S., exposing patients to harm with little likelihood of benefit. Older Americans may be particularly affected by overuse. Despite initiatives to foster a national dialogue about overuse, it is unknown whether patients see overuse as a problem and appreciate its consequences. Our goal was to illuminate the experiences and perspectives of older adults with respect to overuse, to begin developing a framework for understanding and reducing overuse in older adults.

Methods: People 65 years of age and older were recruited from Baltimore senior centers to participate in one of five focus groups. Transcripts were analyzed using qualitative content analysis.

Results: Of the 38 participants, 28 were women and 29 were African-American; 31 had at least a 12th grade education. Virtually all reported experience with healthcare overuse. They perceive overuse when interventions are applied in the absence of symptoms (excluding cancer screening), do not improve symptoms, are discordant with their preferences, or are duplicative. Some defined overuse as interventions that are offered before less intensive/invasive options are offered or that are recommended too early in the course of a disease. Identified contributors to overuse were poor quality communication between patients and healthcare providers, and between different healthcare providers. Participants reported suffering from treatment effects, high costs, worry, and inconvenience from overuse. They suggested that overuse is lessened when the patient is involved in decision making and when he/she has a trusted primary care doctor.

Discussion: The experience of older adults highlights potential sites of intervention to lessen overuse in healthcare. If future studies support these findings, engaging patients in the decision process and enhancing communication and knowledge transfer should be tested as interventions to reduce overuse.