Abstract
BACKGROUND: Middle-aged adults, defined as individuals between the ages of 45 and 64, represent a significant yet under researched group of healthcare service users. This scoping review aimed to provide a comprehensive overview of the patterns of healthcare utilisation and the factors contributing to them within this demographic. METHODS: Following PRISMA-ScR guidelines and the framework proposed by Arksey and O'Malley, a systematic literature search was conducted across PubMed, EMBASE, and the Cochrane Library databases from their inception until July 2023. Key search terms such as "healthcare utilisation" and "middle-aged" were used to identify relevant studies. Articles were included if they were original cohort, case-control, or cross-sectional studies published in English. The findings were then synthesised narratively, by identifying recurring concepts and grouping them into broader themes. The themes were categorised according to the Andersen healthcare utilisation model's three factors: predisposing factors, enabling factors, and need-related factors. RESULTS: After screening 4,810 records, a total of 25 articles were selected for final analysis, comprising 15 from developed countries and 10 from developing countries. Consistent factors influencing healthcare utilisation included multimorbidity, socioeconomic status, and poor health behaviours. Differences emerged across contexts: in developed countries, healthcare utilisation was influenced by lifestyle behaviours and access to private care, while in developing countries, socioeconomic inequalities and limited insurance coverage played more dominant roles. Healthcare system structures likely shaped utilisation patterns. CONCLUSION: Healthcare utilisation among middle-aged adults is driven by an interplay of medical, social, and economic factors that vary across contexts. Common contributors, such as multimorbidity and poor health behaviours, highlight the need for targeted interventions and policies focusing on primary and preventive care to address the long-term burden of healthcare utilisation. This demographic faces unique challenges in managing healthcare decisions amidst varying systemic and individual-level challenges, which should be further studied.