Considerations of older adults with multimorbidity when facing healthcare choices: A qualitative systematic review

healthcare decision-making of older adults with multimorbidity is challenging and patient preferences regarding healthcare choices have been insufficiently studied. We aimed to explore what considerations older adults with multimorbidity take into account when facing choices in a healthcare context and what meaning these choices hold for them.

systematic review of literature from four databases up until November 2024 using a thematic synthesis of qualitative research (PROSPERO CRD42023477681). Peer-reviewed, empirical studies reporting on the considerations regarding healthcare choices of older people (aged ≥ 75) with multimorbidity in English were included. The JBI Critical Appraisal Checklist for Qualitative Research was used to appraise included studies.

20 articles relating to 19 studies with a total of 225 participants were included. Studies were mainly based on interviews (n = 12) or combined observational and interview data (n = 7) and reported on multiple types of healthcare choices. The synthesis showed a variety of patient considerations regarding engagement with decision-making delineating a spectrum of engagement and a diversity of drivers for healthcare choices. Contextual factors such as complexity, power dynamics, information provision, and relationships shaped patients' considerations.

The synthesis showed that considerations of older people with multimorbidity are diverse and considerably shaped by patient and decision context. Therefore, this context should be considered in decision-making, with specific attention to vulnerability to power dynamics, and room should be provided to attune decision-making to individual patient considerations. Interventions to improve integration of patient considerations in decision-making and patient engagement should not only focus on patients, but also target healthcare professionals and systems.