Abstract
Background
Population aging is assumed to generate increasing demand for primary care. This assumption shapes physician workforce planning, health expenditure forecasts, and access policies. Yet longitudinal evidence on whether older adults increase physician service use over time, independently of health status and prior utilization, remains limited.
Methods
We analyzed longitudinal SHARE data from 2004–2022, following adults aged 65+ across 29 European countries. The weighted analytical sample represented 592,107,008 person-observations across survey waves. Regression models estimated within-cohort changes in annual physician office visits, adjusting for chronic conditions, functional limitations, hospitalizations, medication use, prior physician contact, sociodemographic characteristics, country fixed effects, and macro-level health system indicators.
Results
Across all age cohorts, office visits declined over time, even as cohorts aged and accumulated health limitations. This downward trend remained robust after adjustment for health, prior utilization, socioeconomic factors, and country-level differences. In fully adjusted models, later survey waves were associated with 1.2–1.5 fewer visits per year compared with earlier waves (p < 0.001). Office visits were strongly associated with chronic conditions, hospitalizations, medication use, and prior physician contact. Macro-level indicators partially attenuated, but did not eliminate, the decline.
Conclusions
Contrary to expectations, older adults in European health systems are not increasing their use of physician office visits over time. These findings challenge common assumptions that aging alone necessarily translates into higher demand for primary care. They have important implications for understanding changing patterns of service use, maintaining continuity of care, and planning the future primary care workforce as health systems face population aging, physician shortages, and growing pressure on care.
Key messages
• Older adults used fewer physician office visits over time, even as cohorts aged and accumulated health limitations.
• Declining visits challenge the assumption that population aging alone increases primary care demand and highlight workforce planning implications.