# Influence of sex and gender-related factors on the knowledge of generic medicines among older patients and caregivers

## TL;DR

This study explores how sex and gender influence older patients' and caregivers' knowledge and attitudes toward generic medicines in Italy.

## Contribution

The study introduces a composite gender score to assess how gender-related factors affect perceptions of generic medicines in older adults.

## Key findings

- Patients with male gender characteristics were less likely to believe generic medicines use lower-quality substances.
- Female caregivers were more likely to believe generic medicines are made with lower-quality substances.
- Male patients were more likely to think generic medicines take longer to work.

## Abstract

Generic medicines (GMs) are bioequivalent to brand-name medicines and more cost-effective, yet their use is limited. Gender-related factors may influence attitudes toward GMs, but data on older adults are scarce. This study aimed to explore sex and gender differences in knowledge and opinions about GMs among older patients and their caregivers. SurFE is a cross-sectional multicenter survey conducted in Italy (April–May 2023) that enrolled non-institutionalized individuals aged ≥ 65 years and their caregivers. Participants completed a questionnaire assessing knowledge, attitudes, and perceptions of GMs, and sociodemographic and health-related information. We collected data on gender-specific factors and, using a validated methodology, developed a composite gender score. Among the 471 participants (312 patients and 159 caregivers), no differences related to biological sex were observed. According to the gender score, patients with male gender characteristics were less likely to believe that generic medicines are made with lower-quality substances. Additionally, both female patients and male caregivers were more likely to consider GMs equivalent to brand-name medications. As for biological sex, ordinal regression analysis adjusted for sociodemographic and educational factors showed that female caregivers were significantly more likely to believe that GMs are produced with lower-quality substances (OR 2.06, 95% CI 1.01–4.21, p = 0.047). Also, focusing on gender, male patients were more likely to believe that GMs require more time to be effective (OR 1.89, 95% CI 1.06–3.35, p = 0.030), as well as female caregivers about the belief that GMs are produced with lower-quality substances (OR 2.25, 95% CI 0.33–1.60, p = 0.037), even if not confirmed in the adjusted model. No other significant associations emerged. Attitudes toward GMs may vary by gender, but not biological sex. However, this association was not independent of socio-cultural factors and should be explored in future longitudinal research to understand and address barriers to the use of GMs.

The online version contains supplementary material available at 10.1007/s11739-025-04171-3.