Abstract
BACKGROUND: India’s population is ageing rapidly, with an estimate that one in every five Indians will be 60 years or older by 2050. Ageing with the ongoing epidemiological transition increases the burden on already strained healthcare systems of the country. Older adults face health related, financial and social vulnerabilities including access to healthcare facilities, especially in rural areas. The study aims to find the patterns and determinants of healthcare utilisation of older adults especially in rural areas. METHODS: This community-based cross-sectional study was conducted from two blocks in the Khordha district, Odisha, India from March 2023 to April 2024. Households containing older adults were included in the study. The study used a 30 × 15 cluster sampling design with villages as primary sampling units(clusters) selected by probability proportional to size. 15 households from each cluster were selected by simple random sampling. We also compared the healthcare utilisation of older adults with younger family members with health expenditure. RESULTS: The study collected information from 440 households and 604 older adults. More than half of the older adults (52.5%) had outpatient visits in the previous month. Though the majority (69.7%) visited doctors with MBBS degrees and specialists for consultation, more than two-fifths (22.3%) visited pharmacies for outpatient care and consulted pharmacists. Preference for private health facilities (41.6%) was seen among older adults. 8.1% of older adults were hospitalised in the previous year, predominantly (67.3%) in the private health facilities. The median distances to health facilities visited for outpatient visits and hospitalisations were 2 km and 20 km, respectively. The multivariable analysis showed that utilisation of public health facilities was higher among the poorest quintiles (AOR: 2.57; 95% CI: 1.09–6.08; p = 0.032) and poorer quintiles (AOR: 2.11; 95% CI: 1.01–4.42; p = 0.047) of monthly per capita consumption expenditure. On comparison with younger family members, the older adults had more outpatient visits with pharmacists and AYUSH practitioners. CONCLUSION: The study shows that higher healthcare utilisation among older adults, but public healthcare utilisation remains low. The public healthcare utilisation, mostly by poorer population, highlights equity concerns. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-025-06706-x.