Preferences about healthcare—including risk aversion, openness to experimental treatments, and whether to leave treatment decisions to a doctor—vary substantially by age and sex in adults over 50. That's the conclusion of a new study published July 29, 2026 in the open access journal PLOS One by Nicholas Steel of the University of East Anglia, UK, and colleagues.
Despite agreement among clinicians about the importance of integrating patient preferences into routine healthcare decision-making, progress in this area has been slow. Few decision-making aids—such as educational materials to help patients understand complex medical information and consider treatment options—have been developed specifically for older adults. More evidence is needed about general healthcare preferences, especially among this population.
In the new study, researchers used data from wave 8 (2016/2017) of the English Longitudinal Study of Ageing (ELSA), a nationally representative biennial survey of people living in private households in England. 6,098 adults aged 50 and over answered at least one of the six healthcare preference questions and were included in the new analysis. The questions covered risk aversion, weighing present versus future quality of life, quality versus length of life, body function versus appearance, openness to experimental treatments, and preference to leave treatment decisions to a doctor.
Healthcare preferences varied substantially across individuals. Women were more likely than men to want to avoid risks, prioritize quality of life over length of life, and avoid experimental treatments, and were less likely to want to defer treatment decisions to doctors. Adults aged 75 and over were more likely than those aged 50–64 to want to avoid risks, prioritize body function over appearance, avoid experimental treatments, and leave treatment decisions to doctors.
The study was limited to hypothetical preferences that have not been tested against real healthcare decisions, and findings may not generalize beyond England. However, the researchers conclude that there are systematic differences in healthcare preferences by age and sex, which may offer a useful starting point for clinicians seeking to elicit patient preferences.
Prof. Nicholas Steel adds: "Women were significantly more likely to prioritize quality of life over length of life and less likely to want doctors to make healthcare decisions on their behalf. They were also more cautious about risks and less willing to try experimental treatments. Men, meanwhile, were more likely to hand decision-making power to medical professionals and were less likely to put quality of life ahead of simply living longer."
"People aged 75 and over were more likely to avoid risks, reject experimental treatments and leave healthcare decisions to their doctor than those in their 50s and early 60s. We also found that older participants were more likely to prioritize how well their body functions rather than how it looks.
"But perhaps the most surprising finding was just how varied people's views were. While age, sex and education can offer useful clues about healthcare preferences, every patient's wishes remain unique. Understanding those preferences more quickly could improve both patient satisfaction and health outcomes. This work provides a valuable starting point for more personalized care as Britain's population continues to age and healthcare decisions become increasingly complex."
Dr. Oby Enwo adds: "We found that older adults have different views about their health and that age, sex and education each shaped health preferences in different ways. The finding that stood out to me the most was around education - people who had fewer educational opportunities were more likely to leave treatment decisions to their doctors. To me, this highlights the need to explore how we can ensure shared decision-making reaches everyone equally."
"Working with ELSA data has been a privilege because thousands of older adults have given up their time to make research like this possible. I hope our findings emphasize the importance of treating every consultation as a conversation on what matters most to each person."
Prof. James Banks adds: "I thought it was interesting and important for us to show just how diverse people's health and healthcare preferences were across different dimensions and that they can't be summarized by a simple one- or two-dimensional measure. With patient-centered care being so important, we need more systematic measures of these preferences on an ongoing basis, not just for other populations, but importantly over time so we can see how these preferences change as people get older and as various life-events occur."
"The relationship between education and peoples' preferences regarding types of treatment and also how involved they wanted to be in treatment decisions seemed important and interesting to me."
"I thought it was particularly important to see and document the strong preference, on average, for quality of life over length of life."
In your coverage, please use this URL to provide access to the freely available article in PLOS One: https://plos.io/4wP2DaM
Citation: Steel N, Zaninotto P, Enwo OO, Banks J (2026) General healthcare preferences for people aged 50 and over in England: English longitudinal study of ageing. PLoS One 21(7): e0341994. https://doi.org/10.1371/journal.pone.0341994
Author countries: UK.
Funding: Research reported in this publication was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG017644. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. ELSA is funded by the NIHR Policy Research Programme (HEI) 198_1074_03. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
