Health care costs and financial security were found to be the leading concerns for older US adults. More than half of adults aged 50 years or older reported being very concerned about the costs of medical care, prescription medications, and health insurance.

In a nationally representative survey of 2,576 adults aged 50 to 101 years conducted from February to March 2024, researchers found that 56.2% were very concerned about medical care costs and 54.3% about prescription medication costs. The cost of home care, assisted living, and nursing home care topped the list at 56.3%.

Financial scams and fraud also ranked high, with 52.8% of respondents expressing significant concern. These findings suggested that economic issues related to health and aging were paramount for this key voting demographic.

The study, led by John Z. Ayanian, MD, MPP, and colleagues at the University of Michigan, used data from the National Poll on Healthy Aging, a recurring survey of adults 50 years or older conducted using the NORC AmeriSpeak panel and was published in JAMA.

Demographic Differences in Concerns

The researchers found notable differences in concern levels across demographic groups:

Age: Adults aged 50 to 64 years were more concerned about medical care costs 59.6% than those 65 years or older 53.4%.

Gender: Women reported higher concern about medical care costs (59.3%) compared with men (54.1%).

Political ideology: Liberals (68.2%) were more concerned about medical care costs than moderates 56.4%, who in turn were more concerned than conservatives (51.4%).

Geographic location: Respondents in nonmetropolitan areas expressed greater concern about medical care costs (61.7%) than those in metropolitan areas (55.9%).

For prescription medication costs, significant differences were observed by gender, Hispanic ethnicity, US Census region, and political ideology. Notably, Hispanic respondents (62.9%) were more concerned about prescription medication costs than White, non-Hispanic respondents (52.7%).

Methods and Study Design

The survey included 26 health-related policy issues identified through focus groups and pilot testing with older adults. Participants rated their level of concern (very, somewhat, or not concerned) about each issue for older adults in their community.

The study used a stratified random sample of adults aged 50 to 101 years, with data collected online and by phone. The weighted survey response rate was 71.0% (2,576 of 3,626 invited participants). The cohort included 1,385 women (53.1%) and 1,176 men (46.6%) with a mean age of 65.2 years and median of 66 years.

Researchers used logistic regression to adjust for demographic characteristics when estimating weighted percentages of adults very concerned about medical care and prescription medication costs. 

Additional Findings

While health care costs dominated the top concerns, other issues also garnered attention:

• 52.1% were very concerned about the cost of health insurance and Medicare
• 44.6% about dental care costs
• 38.1% about access to quality home care, assisted living, or nursing home care
• 33.7% about health care quality
• 33.2% about inaccurate or misleading health information
• 32.1% about access to affordable healthy foods
• 31.2% about poverty
• 29.2% about access to quality mental health care
• 28.0% about social isolation or loneliness
• 27.6% about being able to age in place
• 26.9% about unequal access to health care

Lower on the list were concerns such as:

• Marijuana or cannabis use (10.6%)
• Alcohol use (11.2%)
• Access to social and recreational activities (15.4%)
• Health risks from polluted water and air (18.3%)
• Racial and ethnic discrimination (18.0%)

Socioeconomic Factors

The study provided insights into the socioeconomic characteristics of the respondents:

• 40% had a high school education or less
• 28.5% had some college education
• 31.5% had a bachelor's degree or higher
• 49.1% reported annual household incomes below $60,000

Geographic Distribution

The survey included respondents from various US regions:

• 37.5% from the South
• 23.5% from the West
• 19.9% from the Midwest
• 19.2% from the Northeast

Political Ideology

The sample represented a range of political ideologies:

• 46.8% identified as moderate
• 35.9% identified as conservative
• 17.3% identified as liberal

Study Limitations and Implications

The authors noted limitations, including the lack of data on personal health concerns and non-health issues that may influence older voters' preferences. However, the findings aligned with another 2024 national survey where 73% of adults of all ages reported being very or somewhat concerned about health care costs.

The study's comprehensive approach, examining 26 health-related issues and providing detailed demographic breakdowns, offered valuable insights for policymakers and health care professionals as they address the concerns of older adults in the lead-up to the 2024 election. The findings highlighted the need for targeted interventions and policies to address health care affordability, access to quality care, and financial security for the aging population.

Conflict of interest disclosures can be found in the study.