# Self-medication among older adults in rural India: structural gaps in primary care and pain management

## TL;DR

Rural older adults in India often self-medicate due to limited healthcare access, especially for pain and injuries, highlighting gaps in primary care.

## Contribution

This study identifies injury and joint pain as key drivers of self-medication among rural older adults in India, independent of chronic disease or sociodemographic factors.

## Key findings

- 41.7% of rural adults aged ≥55 years reported self-medication in the past three months.
- Injury/fracture and joint pain were stronger correlates of self-medication than chronic morbidity.
- Self-medication practices were not significantly associated with gender, caste, income, or religion.

## Abstract

Older adults in rural India face persistent barriers to formal healthcare access, including financial constraints, transportation challenges, and limited geriatric-responsive services. In this context, self-medication often emerges as an informal strategy to manage symptoms and everyday health needs. Understanding the prevalence and correlates of self-medication among rural older adults is important for designing equitable, age-inclusive primary healthcare systems.

A community-based cross-sectional survey was conducted between May and August 2024 among adults aged ≥ 55 years in five rural villages of Chengalpattu district, Tamil Nadu, India. Data were collected on sociodemographic characteristics, chronic morbidity, recent injuries, joint pain, prescribed medication use, and perceived barriers to care. Self-medication was assessed as any self-medication episode in the past three months (yes/no). Associations were examined using Poisson regression with robust standard errors to estimate adjusted prevalence ratios (aPRs).

Among 520 participants, 41.7% reported self-medication in the past three months. Although chronic morbidity was common, chronic illness burden was not independently associated with self-medication. In contrast, experiential health indicators—particularly recent injury (including fractures) and current joint pain—showed the strongest associations with self-medication in adjusted models. Adults aged ≥ 60 years and those currently married had a lower prevalence of self-medication compared with adults aged 55–59 years and those not currently married. Self-medication did not differ significantly by gender, caste, religion, or household income. Nearly one-third of participants reported irregular or no use of prescribed medications despite a high burden of chronic conditions.

Self-medication is common among rural older adults in Tamil Nadu and appears more strongly associated with injury- and pain-related discomfort than with chronic disease diagnosis. This pattern is consistent with a symptom-driven pathway whereby acute discomfort, combined with barriers to timely and continuous care, is associated with unsupervised medication use. These findings highlight gaps in pain management, injury follow-up, and medication continuity within primary care and underscore the need for geriatric-responsive, equity-oriented outreach through Health and Wellness Centres/Ayushman Arogya Mandirs.

Not applicable.

The online version contains supplementary material available at 10.1186/s12913-026-14114-z.

Self-medication is common in India, but evidence among rural older adults is limited.

Older adults face access barriers; unsafe self-medication can worsen inequities.

41.7% prevalence of self-medication among rural adults aged ≥55 years.

Injury/fracture and joint pain were stronger correlates than chronic morbidity.

Minimal sociodemographic gradients; practices cut across caste/income/sex.

Suggests a symptom-driven pathway under constrained access/continuity of care.

Prioritise pain management, injury follow-up, and medication continuity in PHC.

Use HWCs/Ayushman Arogya Mandirs for geriatric-responsive outreach and safety.

The online version contains supplementary material available at 10.1186/s12913-026-14114-z.