Differences in Expectations and Preferences for Healthcare between Baby Boomers and the Silent Generation: A Literature Review

1 Danijela Sopić

1 Alma Mater Europaea University, Maribor, Slovenia Article received: 24.11.2024.

Article accepted: 10.02.2025. https://doi.org/10.24141/2/9/1/11

Author for correspondence:

Danijela Sopić

Alma Mater Europaea University, Maribor, Slovenia E-mail: danijela.sopic@almamater.si

Keywords: healthcare for older adults, patient satisfac- tion, decision-making, healthcare communication

Abstract

Introduction. Research on differences in expecta- tions and preferences for healthcare between the Baby Boomer and Silent Generation is crucial, as these two generations represent the largest groups of healthcare service users. Their health attitudes have been shaped by specific values and socio- cultural conditions, resulting in different healthcare needs. As they enter older age, their healthcare needs become increasingly complex, requiring indi- vidualized care. Given the limited number of compar- ative studies, further research is needed to improve service quality, enhance older adults’ quality of life, and optimize resource use in healthcare systems.

Aim. The aim of this paper was to identify empiri- cal studies investigating the healthcare needs of the Baby Boomer and Silent generations.

Methods. In this paper, an analysis of ten empirical studies involving participants aged 65 and older was conducted. The data were primarily collected from the PubMed and Web of Science databases, with a focus on Research related to the healthcare needs of the Baby Boomer and Silent generations.

Results. The analysis of the selected studies reveals significant differences between the generations. Ba- by Boomers are confident, resourceful, and inclined to address their health issues independently, prefer- ring personalized communication with profession- als and technological solutions to improve access to information. In contrast, healthcare for the Silent Generation is shaped by conservative beliefs and tra-

ditional practices, leading to a more passive decision- making approach with less information.

Conclusion. Understanding generational differenc- es allows for the adaptation of healthcare services, improving care quality and patient satisfaction. A personalized approach, incorporating technology for Baby Boomers and social services for the Silent Gen- eration, ensures optimal care for both generations.

Introduction

The decline in birth rates and the increase in life ex- pectancy worldwide mark the current demographic trend of an aging population (1). Europe is facing low fertility rates, with total fertility rates varying from 1.3 to above 2.1 in different countries and re- gions (2). Additionally, the COVID-19 pandemic has significantly impacted life expectancy in Europe, with losses recorded in 391 areas, some losing more than 2-3 years (3). Outside of Europe, Japan is fac- ing a serious demographic crisis, with the country’s population decreasing by 1.5% by 2022, while the aging rate reached 29.9%, the highest among the G7 countries (4). Similarly, South Korea is experiencing rapid aging, with projections showing that by 2029, all 37 regions will achieve “super-aged society” sta- tus, with over 20% of the population aged 65 and over (5). The number of people aged 65 and over is expected to reach 1.5 billion by 2050, accounting for 16% of the global population (1, 6, 7).

These demographic trends are changing not only the numerical ratio of populations but also the fun- damental social and economic structures, present- ing new challenges in planning health and social policies. The age structure of the population is shift- ing towards an increased share of older individuals, significantly impacting the population structure (8). These changes bring challenges to health and eco- nomic systems, as well as intergenerational rela- tions. The increased prevalence of chronic diseases and the need for long-term care strain healthcare systems, requiring adjustments in the organization and financing of health services (9). The economic consequences of aging are visible in the rising costs of treating chronic diseases such as heart failure,

coronary artery disease, and diabetes (10). At the same time, reducing the younger workforce coupled with the growing number of retirees increases pres- sure on social and healthcare systems (11). Changes in the age structure also affect intergenerational solidarity. Although the need for elderly care is in- creasing, the decline in the younger population may weaken family support, leading to a greater reliance on institutional forms of care (12).

The Baby Boomer generation (born between 1946 and 1964) and the Silent Generation (born before World War II) represent the two largest groups of older individuals (13). Social values are a significant factor distinguishing these two generations. Ullrich (2017) argues that the Silent Generation values con- servative ideals and traditional customs, while Baby Boomers are more inclined to liberal attitudes on so- cial issues and are more open to differences in racial, gender, and family contexts (14).

These differences in social values are partly shaped by the historical context in which the generations grew up. The Silent Generation was raised during the Great Depression and World War II, which instilled val- ues of thriftiness, hard work, and sacrifice (13). These experiences shaped their more cautious approach to social and technological changes and, compared to younger generations, they exhibited greater resist- ance to modernization (13). At the same time, their expectations about health were often shaped by tra- ditional perceptions of aging and the limited medical advancements available during their earlier years. The study by Aguilar-Palacio et al. (2018) showed that age has a significant effect on self-rated health in older generations, suggesting that various factors shape how these generations perceive their health and access to medical care and that the influence of individual and national factors on self-rated health differs across generations (15).

In contrast, the Baby Boomer generation grew up in the post-war period, marked by economic growth, technological innovation, and expanding educational opportunities (16). The culture of the 1960s, with its emphasis on social movements and youth emancipa- tion, further shaped their attitudes and life priorities

(17). Thanks to medical advancements and improved healthcare, their health expectations were more optimistic compared to previous generations (18). There are also differences in digitalization. While the Baby Boomer generation grew up with technology, the Silent Generation’s entry into the digital world

was determined by factors such as education level and socio-economic status (13).

However, this generation was not immune to health challenges. While, on average, Baby Boomers had better cardiovascular health, with fewer heart at- tacks and lower blood pressure compared to previous generations, they simultaneously faced higher rates of chronic diseases such as hypertension, diabetes, and mental disorders (18). The increased prevalence of mental health issues in this cohort suggests that social and economic factors, including stressful life transitions and lifestyle changes, may have contrib- uted to these outcomes. Specifically, the cohort born between 1950 and 1954 showed a significantly higher prevalence of mental disorders (4.7%) com- pared to those born between 1935 and 1939 (2.5%)

(18). Despite progress in digitalization, the Baby

Boomer generation lags behind the Silent Generation in adopting a healthy lifestyle and in their percep- tion of their health (19). Davis and Roberts (2010) express concern about issues such as obesity, low vegetable consumption, physical inactivity, and the increasing prevalence of chronic diseases within this generation (20). These generational differences illus- trate how historical, economic, and social conditions have shaped not only their values and health percep- tions but also the actual health outcomes they expe- rience in older age.

Given the above, differences in expectations and preferences for healthcare between Baby Boomers and the Silent Generation have a significant impact on shaping future health policies and strategies. While both generations face aging challenges and increased healthcare needs, their distinct life cir- cumstances, social values, and approaches to health require adjustments in healthcare services. As Baby Boomers continue to enter older age, it will be nec- essary to continuously explore their changing needs and preferences, particularly in the context of the growing prevalence of chronic diseases, mental dis- orders, and an increasing reliance on technology (20). This paper lays the groundwork for understanding these specific needs, emphasizing the importance of adjusting healthcare services that consider gen- erational differences. Understanding and integrating these differences into the development of health- care services is crucial for improving the quality and effectiveness of healthcare to meet the specific de- mands of both generations.

Literature overview

Healthcare specifics of the Baby Boomer generation

According to population estimates from the U.S. Census Bureau, the number of Baby Boomers in the United States in 2019 was 71.6 million. The first Baby Boomers, born between 1946 and 1964, reached 65 in 2011, placing them in the elderly population cat- egory (21). Therefore, it is reasonable to assume that extending their lifespan will result in certain health issues. According to Badley et al. (2015), there is no proof to back up the assumption that Baby Boom- ers are healthier than previous generations (22). Re- search by Luo and Gao (2020) and Ramage-Morin and Polsky (2020) demonstrates the exact opposite, find- ing that older Baby Boomers are more prone to mental and physical health issues and have higher rates of chronic diseases and disabilities than previous gen- erations (23, 24). Chronic diseases such as diabetes, cardiovascular diseases, and obesity require constant health support (25). As a result, Baby Boomers with numerous comorbidities are probably going to use specialized medical care more than primary care (26).

Because of the impact of Baby Boomers on the healthcare system, Canizares et al. (2016) and Fio- rillo and Gorwood (2020) state that the health prob- lems of Baby Boomers necessitate adaptation to their specific needs, and healthcare providers must be aware of their comorbidities, unique expecta- tions, and preferences for healthcare services (26, 27). According to Pelok (2023), Baby Boomers are goal-oriented, confident, and resourceful, and they frequently try to solve their health problems on their own (28). They excel at searching for and critically evaluating health information on the Internet but prefer confirmation of relevant and reliable data from healthcare providers (13, 29). Kahana and Kahana (2014) state that they are smart, assertive, health- conscious, and actively involved in their healthcare

(30). However, they still want service providers’ ad-

vice before making final decisions regarding their health (31). This highlights the need for an inclusive approach to the delivery of healthcare services that respects Baby Boomers’ autonomy and fosters col- laborative decision-making.

Healthcare specifics of the Silent generation

The first members of the Silent Generation were born before World War II, and those over 85 are the fastest- growing age group in many developed countries (32). In the USA, the number of people over 80 is predicted to rise to 19.5 million by 2030 (33). Ullrich (2017) states that this generation is characterized by their ad- vanced age and quiet, adaptive nature, as well as their overall health characteristics (14). In a study on cente- narians with fragility hip fractures, Bermejo Boixareu et al. (2023) discovered that 83% of the subjects were female, 33% of the subjects had severe dementia, and 36% were living in nursing homes. This reveals that the Silent generation consists mostly of women, that degenerative changes are common, and that institu- tionalization occurs frequently (34). However, a study by Araújo and Ribeiro (2011) on adults over 80 years of age found that respondents rated their health posi- tively in comparison to other generations, despite dis- ability and age-related losses, suggesting subjective differences in health assessments (35).

According to Lee et al. (2020), the most common health problems of people over 80 include cognitive impairment, depression, anxiety, and physical health issues such as chronic diseases, musculoskeletal problems, and problems with eyes, hearing, insomnia, and teeth (36). Their diminished day-to-day func- tioning and increased cognitive impairment require additional medical attention (37). According to Bhat- tarai (2016), the aforementioned suggests that so- cial and healthcare services must be integrated and that healthcare should be provided to each patient’s unique needs and priorities. To achieve compliance, understanding the specifics of Silent generation is imperative (38). When it comes to choosing one’s healthcare, there is a preference for fewer options and less autonomy due to the conservative social characteristics and deeply ingrained traditional val- ues of the Silent Generation (39, 40).

According to Banerjee (2015), the Silent generation prefers a more passive role in the decision-making process in healthcare. As a result, they express high- er levels of satisfaction with healthcare services than younger generations and report fewer difficulties in accessing healthcare (41). This suggests providing healthcare using simple guidelines while maintain- ing a balance between expertise and adherence to traditional principles.

Aim

The aim of this paper was to identify empirical stud- ies investigating the healthcare needs of the Baby Boomer and Silent generations.

Methods

The systematic literature review was conducted in early January 2024 in two relevant bibliographic and cataloging databases: Web of Science and PubMed. The search was primarily conducted in these data- bases and covered the period from 2007 to 2023, with 2007 chosen as the starting year based on an analysis of the Web of Science database, which in- dicated that the topic began to be more intensively researched from that year. The goal of the search was to identify empirical studies investigating the healthcare needs of the Baby Boomer and Silent gen- erations. The systematic review included only empiri- cal studies to ensure the analysis of actual data and evidence directly exploring the healthcare needs of these generations. The search in the aforementioned databases was conducted by PRISMA guidelines to ensure a systematic and transparent literature analy- sis. The study selection process followed clearly de- fined inclusion and exclusion criteria (Table 1).

To ensure the comprehensiveness of the literature review, the search was extended beyond the Web of Science and PubMed databases, and relevant journals and institutional repositories were also re- viewed. This resulted in the inclusion of an additional relevant paper by Saele et al. (2019) (31), which is not indexed in these databases but was assessed as significant according to the predefined inclusion cri- teria and was thus included in the analysis of results.

The article search conducted in the Web of Science database used the following keywords: “Baby Boom- er generation” OR “Seniors” AND “Health Decision Making” OR “Patient Preferences”, which initially re- sulted in 8,571 results. After applying the inclusion and exclusion criteria and filtering by specific cate-

gories within Web of Science recognized as relevant to the research topic (Health Care Sciences Services, Gerontology, Geriatrics Gerontology, Medical Infor- matics, Nursing, Nutrition and Dietetics), the number of results was reduced to 726 articles. Further selec- tion of thematic citations at the meso level: Palliative Care, Nutrition and Dietetics, Nursing, Health Litera- cy, and Telemedicine, further reduced the results to 385 articles.

The search in the PubMed database was conducted using a combination of keywords: health care prefer- ences AND aging population AND healthcare needs of seniors OR generational differences in health care, which initially resulted in a total of 4,249 articles. After applying the inclusion and exclusion criteria (Table 1), the number of potentially relevant papers was reduced to 414. The distinction in the keywords used in Web of Science and PubMed arises from the specific characteristics of each database and their focus areas; while Web of Science offers a broader approach to multidisciplinary fields, PubMed special- izes in biomedical and health literature, so the select- ed keywords were better aligned with medical and health literature. During the merging of results from PubMed and Web of Science, 27 duplicates were identified and removed. After this process, the total number of articles was reduced to 772, which were then subjected to further analysis (Figure 1).

Results

After reviewing the titles, abstracts, and keywords, 20 articles were selected for further analysis. The selection criteria included a focus on specific popu- lations by generation or age, clarity of insights into generational differences, decision-making in health- care, relevance to the research topic, and adequacy of the data collection methods used (including both qualitative and quantitative studies). After a detailed review of the full texts of these 20 articles, 10 stud- ies were selected that met specific conditions: they analyzed aspects of decision-making in healthcare (including behaviors, expectations, and interactions of participants with healthcare providers), exam- ined factors influencing decision-making (such as socio-demographic characteristics, education, trust in healthcare providers, health behaviors, and prefer- ences), and investigated how key healthcare needs and challenges for older adults (such as trust, health literacy, and preferences regarding services) affect the delivery and utilization of healthcare services within the older population.

A total of ten articles were included in the overall analysis: nine found in the Web of Science and Pub- Med databases, and one additional article, Seale et al. (2019), which was not indexed in the mentioned databases but was deemed relevant according to the predefined inclusion criteria (Table 2).

Included

Eligability

Screening

Identification

Figure 1. PRISMA Flowchart for Search in Web of Science and PubMed Databases

Discussion

Chen et al. (2007) analyzed the differences between cohorts of women born in two distinct periods, pre- boomers (1935–1944) and Baby Boomers (1945– 1954), with a focus on their self-assessed health status (42). The findings show that Baby Boomers rate their health lower than members of the Silent Generation, with chronic diseases and depressive symptoms being key predictors of this self-assess- ment (42). These results suggest that, despite sig- nificant improvements in social and healthcare con- ditions, Baby Boomers report lower levels of health self-assessment. This can be attributed not only to the increased prevalence of chronic diseases and mental health issues such as depression but also to their greater access to medical information, which may make them more aware of their health condi- tions (18).

The findings by Chen et al. (2007) are further con- firmed by a study by Martin et al. (2009), who iden- tify a paradox between the improvement of objective health indicators and the decline in subjective health assessments among Baby Boomers (46). Although mortality rates in this generation have decreased and life expectancy has increased, their self-assess- ment of health has not necessarily improved (46). This suggests that, even though Baby Boomers live longer, it does not mean they enjoy better health. A key factor in this paradox may be the higher preva- lence of diagnosed chronic diseases, but it is impor- tant to note that this increase may be due to better diagnostic methods and advanced healthcare tech- nologies, rather than a genuine deterioration of the population’s health status (46).

In addition to objective improvements in health in- dicators, it is essential to consider the psychological and social factors that may shape Baby Boomers’ per- ception of health. This generation has had significant socio-economic and medical advantages throughout their lives, which could have raised their expecta- tions and standards regarding health (46). As a re- sult, despite objective improvements in health, their self-assessment may be lower because they com- pare themselves to the high health standards they have set for themselves over the years. Furthermore, Baby Boomers are the first generation to have had widespread access to medical information and pre-

ventive care, which may make them more critical of their health status. Increased awareness of health risks and the availability of diagnostic tools can lead to a higher perception of illness, even when objective indicators do not suggest significant deterioration in health.

Similarly, the way Baby Boomers perceive health- care plays a crucial role in their health assessment. A qualitative study conducted in Quebec showed that this generation views healthcare as a partner- ship between patients and healthcare providers, with expectations for an active role in making decisions about their health (43). This approach reflects Baby Boomers’ long exposure to modern medical advance- ments and the high level of healthcare they have become accustomed to, further reinforcing their high expectations regarding the availability and quality of healthcare services in older age. Therefore, their lower self-assessment of health may not necessar- ily reflect a genuinely worse health situation but rather a shift in how they define their well-being, influenced by higher standards, more advanced di- agnostic methods, and a redefined relationship with the healthcare system.

The historical context in which Baby Boomers grew up has also significantly shaped their relationship with health. This generation witnessed unprece- dented technological advances and the expansion of healthcare, creating the expectation that they should be the healthiest generation to date (18). However, their perception of health has not been shaped sole- ly by objective indicators but also by the standards they have developed over their lives. Research by Canizares et al. (2016) shows that even individuals with multiple comorbidities maintain high expecta- tions of healthcare, indicating the growing need for a system tailored to chronic disease management (26). This suggests that this generation, which has wit- nessed technological progress and the expansion of healthcare, has developed high expectations of the healthcare system, including an active role in deci- sion-making about their health. This further shapes their perception of health, as they still expect high- quality services despite the increased prevalence of chronic diseases.

In addition to technology, technological innovations play an important role in shaping Baby Boomers’ health, as they provide significant advantages in managing chronic diseases and promoting healthy lifestyle habits. This generation shows a high de-

gree of acceptance of new technologies, including email, video conferencing, and SMS messages, which improve communication with healthcare profession- als and facilitate daily health management (47). For example, the Healthy Lifestyle Management (HLM) model, which uses mobile health technology, allows Baby Boomers to actively participate in their care. This approach enhances collaboration with providers and encourages informed decision-making that sup- ports sustainable healthy habits (48). This model is particularly beneficial as most Baby Boomers have at least one chronic health condition, which increases healthcare costs (20).

In addition, Baby Boomers are showing increasing health literacy, which can also reduce the need for ex- pensive medical interventions. Research by Seale et al. (2019) found that Baby Boomers successfully use the Internet to search for health resources and criti- cally evaluate their relevance (31), indicating their growing engagement in the health decision-making process. While they use online sources, they simulta- neously prefer reliable information from healthcare professionals, suggesting a need for close collabora- tion between this generation and healthcare provid- ers (31). This combination of autonomy and demand for professional guidance creates a balance that ena- bles optimal health management and better quality healthcare.

Additionally, Gill and Cameron (2022) emphasize that Baby Boomers possess a high level of independence and critical judgment, which allows them to selec- tively choose the information and services they use, which is especially important in the context of the overwhelming availability of information on the in- ternet (29). These characteristics not only show their tendency for active management of their health but also highlight the importance of independence in healthcare decision-making while maintaining high standards for the quality of services and information they receive. This suggests that by using technolo- gy, Baby Boomers can optimally manage their health, making it easier to monitor chronic conditions daily while also allowing for the creation of personalized health plans, including their active engagement.

On the other hand, the Silent Generation shows a clear preference for simpler, more straightforward options when making health decisions. According to research by Reed et al. (2008), members of the Si- lent Generation prefer fewer options when making healthcare decisions (39), reflecting their tendency

to simplify the process. This behavioral pattern can be linked to cognitive changes that occur with ag- ing, when the capacity to process larger amounts of information may be reduced. This suggests that for this generation, it is more important to have struc- tured guidelines from healthcare professionals than to rely on online sources or new technologies.

The Silent Generation’s tendencies toward more tra- ditional approaches to health are confirmed by the results of research by Zachrison et al. (2021), who found that the Silent Generation is significantly less likely to adopt virtual healthcare compared to young- er generations (49). Specifically, doctors from the Silent Generation were significantly less likely (OR 0.39) to be early adopters of virtual healthcare tech- nologies compared to younger colleagues (49). This resistance to new technologies is likely due to their preference for traditional forms of communication, where personal interaction with healthcare providers plays a key role in decision-making. Similar tenden- cies toward simpler, more personal forms of commu- nication are confirmed by research by Lissitsa et al. (2022), which showed that members of the Silent Generation use search engines less frequently than Baby Boomers (13), which can be linked to lower lev- els of digital literacy.

Furthermore, research by Paige et al. (2018) also found that the Silent Generation has lower levels of trust in e-health resources and their digital skills (44). These tendencies may be a result of social norms and conditions in which they grew up when personal rela- tionships and direct communication with healthcare professionals were key to making health decisions. As a result, many members of the Silent Generation may not consider it necessary to use the internet to find health information but instead prefer direct communication and trust the expertise of healthcare professionals. Such a preference for personal con- tact suggests their need for recognition and respect within the healthcare system, which differs from the Baby Boomers’ more liberal approach (45).

However, it is interesting to note that research by Papp-Zipernovszky et al. (2021) shows that, despite initial barriers to internet access, older generations (including the Silent and Baby Boomer generations) report a greater sense of empowerment when they succeed in finding useful health information online

(50). This paradox indicates that, although the Si- lent Generation may have lower overall digital skills when they are allowed to access relevant health

information via the Internet, they feel empowered and informed, which may contribute to a better self- assessment of health.

Moreover, research by Bermejo Boixareu et al. (2023) shows high rates of the Silent Generation living in care facilities, but this generation is still more likely to live in informal housing (34). This also confirms their preference for traditional values in healthcare, which are based on interpersonal relationships, where fam- ily and community play an important role as support systems. These findings suggest that understanding the Silent Generation’s preferences for simpler, more traditional approaches to health is crucial for optimiz- ing healthcare, with an emphasis on interpersonal relationships and involving family and community as key support systems. This will allow the creation of inclusive healthcare services that take into account the specific needs of this generation while support- ing the integration of new technologies in a way that is understandable and accepted by them.

Conclusion

The Baby Boomer and Silent generations’ expecta- tions and preferences for health care are influenced by differences in their social values, technological preferences, and lifestyles. While their health sta- tus is comparable to that of other generations, Baby Boomers are notable for having a greater number of chronic diseases, requiring specialized medical care. They expect a high level of engagement from service providers, combining self-help skills with the need for reliable information. However, the Silent generation wants less autonomy over their own healthcare deci- sions, and to meet their needs, such as those related to musculoskeletal and cognitive issues, social and individual services must be integrated. Baby Boom- ers also emphasize the importance of technologically supported communication, while the Silent genera- tion prefers a more traditional approach. To provide services that are tailored to the unique needs of each generation and promote the best possible health and well-being, healthcare providers must be aware of these differences. Creating personalized health plans with a focus on technology support specific to the

needs of Baby Boomers is one of the good practice case proposals. Regarding the Silent generation, the focus should be placed on implementing social and individual services, paying particular attention to tai- loring communication to their preferences.

Author contributions

The author solely conceived the study, conducted a systematic literature review, analyzed the available sources, and wrote the manuscript.

Conflict of interest

The author declares no conflict of interest.

Acknowledgments

Not applicable.

Funding

This research received no external funding.

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