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

Chiara Ceolin; Maria Beatrice Zazzara; Francesco Salis; Myriam Macaluso; Elena Levati; Graziano Onder; Roberto Bernabei; Caterina Trevisan; Federica D'Ignazio; Giulia Rivasi; null null; Stefano Andreoli; Giada Arena; Giorgio Basile; Giuseppe Bellelli; Federica Bellone; Leonardo Bencivenga; Roberto Bernabei; Anna Bertocco; Davide Maria Biancone; Enrico Brunetti; Maria Modestina Bulla; Maria Lucia Bursi; Stefano Cacciatore; Marco Capacci; Cristina Cargiolli; Stefano Caruso; Ludovica Ceolin; Giuseppina Coniglio; Andrea Corbani; Antonio D'Errico; Rosa De Felice; Maria Cristina Ferrara; Elvira Filicetti; Panaiotis Finamore; Tommaso Finco; Beatrice Fumagalli; Thelma Geneletti; Alessia Ghidini; Rossella Giordano; Giulia Gorla; Claudio Guarneri; Giovanni Lazzaro; Elisa Lenotti; Leonarda Maltese; Davide Montini; Chukwuma Okoye; Ilaria Parrotta; Giulia Pasolini; Chiara Petrucci; Roberto Presta; Antonella Risoli; Giuseppe Rengo; Priscilla Romagnoli; Ottavio Scarano; Pierfederico Scaroni; Luca Soraci; Ungar Andrea; Virdis Agostino; Alberto Zucchelli

doi:10.1007/s11739-025-04171-3

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

Chiara Ceolin
, Maria Beatrice Zazzara
, Francesco Salis^*
, Myriam Macaluso
, Elena Levati
, Graziano Onder
, Roberto Bernabei
, Caterina Trevisan
, Federica D'Ignazio
, Giulia Rivasi
, null null
, Stefano Andreoli
, Giada Arena
, Giorgio Basile
, Giuseppe Bellelli
, Federica Bellone
, Leonardo Bencivenga
, Roberto Bernabei
, Anna Bertocco
, Davide Maria Biancone

Enrico Brunetti, Maria Modestina Bulla, Maria Lucia Bursi, Stefano Cacciatore, Marco Capacci, Cristina Cargiolli, Stefano Caruso, Ludovica Ceolin, Giuseppina Coniglio, Andrea Corbani, Antonio D'Errico, Rosa De Felice, Maria Cristina Ferrara, Elvira Filicetti, Panaiotis Finamore, Tommaso Finco, Beatrice Fumagalli, Thelma Geneletti, Alessia Ghidini, Rossella Giordano, Giulia Gorla, Claudio Guarneri, Giovanni Lazzaro, Elisa Lenotti, Leonarda Maltese, Davide Montini, Chukwuma Okoye, Ilaria Parrotta, Giulia Pasolini, Chiara Petrucci, Roberto Presta, Antonella Risoli, Giuseppe Rengo, Priscilla Romagnoli, Ottavio Scarano, Pierfederico Scaroni, Luca Soraci, Ungar Andrea, Virdis Agostino, Alberto Zucchelli

^*Corresponding author

Karolinska Institutet
University of Padua
University of Cagliari
University of Ferrara
University of Florence

Research output: Contribution to journal › Article

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.

Original language	English
Pages (from-to)	153-161
Number of pages	9
Journal	Internal and Emergency Medicine
Volume	21
Issue number	1
DOIs	https://doi.org/10.1007/s11739-025-04171-3
Publication status	Published - 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

All Science Journal Classification (ASJC) codes

Internal Medicine
Emergency Medicine

Keywords

Caregivers
Gender
Gender medicine
Older adults
Sex differences

Access to Document

10.1007/s11739-025-04171-3

Cite this

Ceolin, C., Zazzara, M. B., Salis, F., Macaluso, M., Levati, E., Onder, G., Bernabei, R., Trevisan, C., D'Ignazio, F., Rivasi, G., null, N., Andreoli, S., Arena, G., Basile, G., Bellelli, G., Bellone, F., Bencivenga, L., Bernabei, R., Bertocco, A., ... Zucchelli, A. (2026). Influence of sex and gender-related factors on the knowledge of generic medicines among older patients and caregivers. Internal and Emergency Medicine, 21(1), 153-161. https://doi.org/10.1007/s11739-025-04171-3

@article{24fc7b89fa1b45f1a042133b339a4fe6,

title = "Influence of sex and gender-related factors on the knowledge of generic medicines among older patients and caregivers",

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{\textendash}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{\textendash}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{\textendash}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{\textendash}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.",

keywords = "Caregivers, Gender, Gender medicine, Older adults, Sex differences, Caregivers, Gender, Gender medicine, Older adults, Sex differences",

author = "Chiara Ceolin and Zazzara, \{Maria Beatrice\} and Francesco Salis and Myriam Macaluso and Elena Levati and Graziano Onder and Roberto Bernabei and Caterina Trevisan and Federica D'Ignazio and Giulia Rivasi and null null and Stefano Andreoli and Giada Arena and Giorgio Basile and Giuseppe Bellelli and Federica Bellone and Leonardo Bencivenga and Roberto Bernabei and Anna Bertocco and Biancone, \{Davide Maria\} and Enrico Brunetti and Bulla, \{Maria Modestina\} and Bursi, \{Maria Lucia\} and Stefano Cacciatore and Marco Capacci and Cristina Cargiolli and Stefano Caruso and Ludovica Ceolin and Giuseppina Coniglio and Andrea Corbani and Antonio D'Errico and \{De Felice\}, Rosa and Ferrara, \{Maria Cristina\} and Elvira Filicetti and Panaiotis Finamore and Tommaso Finco and Beatrice Fumagalli and Thelma Geneletti and Alessia Ghidini and Rossella Giordano and Giulia Gorla and Claudio Guarneri and Giovanni Lazzaro and Elisa Lenotti and Leonarda Maltese and Davide Montini and Chukwuma Okoye and Ilaria Parrotta and Giulia Pasolini and Chiara Petrucci and Roberto Presta and Antonella Risoli and Giuseppe Rengo and Priscilla Romagnoli and Ottavio Scarano and Pierfederico Scaroni and Luca Soraci and Ungar Andrea and Virdis Agostino and Alberto Zucchelli",

year = "2026",

doi = "10.1007/s11739-025-04171-3",

language = "English",

volume = "21",

pages = "153--161",

journal = "Internal and Emergency Medicine",

issn = "1828-0447",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "1",

}

Ceolin, C, Zazzara, MB, Salis, F, Macaluso, M, Levati, E, Onder, G, Bernabei, R, Trevisan, C, D'Ignazio, F, Rivasi, G, null, N, Andreoli, S, Arena, G, Basile, G, Bellelli, G, Bellone, F, Bencivenga, L, Bernabei, R, Bertocco, A, Biancone, DM, Brunetti, E, Bulla, MM, Bursi, ML, Cacciatore, S, Capacci, M, Cargiolli, C, Caruso, S, Ceolin, L, Coniglio, G, Corbani, A, D'Errico, A, De Felice, R, Ferrara, MC, Filicetti, E, Finamore, P, Finco, T, Fumagalli, B, Geneletti, T, Ghidini, A, Giordano, R, Gorla, G, Guarneri, C, Lazzaro, G, Lenotti, E, Maltese, L, Montini, D, Okoye, C, Parrotta, I, Pasolini, G, Petrucci, C, Presta, R, Risoli, A, Rengo, G, Romagnoli, P, Scarano, O, Scaroni, P, Soraci, L, Andrea, U, Agostino, V & Zucchelli, A 2026, 'Influence of sex and gender-related factors on the knowledge of generic medicines among older patients and caregivers', Internal and Emergency Medicine, vol. 21, no. 1, pp. 153-161. https://doi.org/10.1007/s11739-025-04171-3

TY - JOUR

T1 - Influence of sex and gender-related factors on the knowledge of generic medicines among older patients and caregivers

AU - Ceolin, Chiara

AU - Zazzara, Maria Beatrice

AU - Salis, Francesco

AU - Macaluso, Myriam

AU - Levati, Elena

AU - Onder, Graziano

AU - Bernabei, Roberto

AU - Trevisan, Caterina

AU - D'Ignazio, Federica

AU - Rivasi, Giulia

AU - null, null

AU - Andreoli, Stefano

AU - Arena, Giada

AU - Basile, Giorgio

AU - Bellelli, Giuseppe

AU - Bellone, Federica

AU - Bencivenga, Leonardo

AU - Bernabei, Roberto

AU - Bertocco, Anna

AU - Biancone, Davide Maria

AU - Brunetti, Enrico

AU - Bulla, Maria Modestina

AU - Bursi, Maria Lucia

AU - Cacciatore, Stefano

AU - Capacci, Marco

AU - Cargiolli, Cristina

AU - Caruso, Stefano

AU - Ceolin, Ludovica

AU - Coniglio, Giuseppina

AU - Corbani, Andrea

AU - D'Errico, Antonio

AU - De Felice, Rosa

AU - Ferrara, Maria Cristina

AU - Filicetti, Elvira

AU - Finamore, Panaiotis

AU - Finco, Tommaso

AU - Fumagalli, Beatrice

AU - Geneletti, Thelma

AU - Ghidini, Alessia

AU - Giordano, Rossella

AU - Gorla, Giulia

AU - Guarneri, Claudio

AU - Lazzaro, Giovanni

AU - Lenotti, Elisa

AU - Maltese, Leonarda

AU - Montini, Davide

AU - Okoye, Chukwuma

AU - Parrotta, Ilaria

AU - Pasolini, Giulia

AU - Petrucci, Chiara

AU - Presta, Roberto

AU - Risoli, Antonella

AU - Rengo, Giuseppe

AU - Romagnoli, Priscilla

AU - Scarano, Ottavio

AU - Scaroni, Pierfederico

AU - Soraci, Luca

AU - Andrea, Ungar

AU - Agostino, Virdis

AU - Zucchelli, Alberto

PY - 2026

Y1 - 2026

N2 - 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.

AB - 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.

KW - Caregivers

KW - Gender

KW - Gender medicine

KW - Older adults

KW - Sex differences

KW - Caregivers

KW - Gender

KW - Gender medicine

KW - Older adults

KW - Sex differences

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U2 - 10.1007/s11739-025-04171-3

DO - 10.1007/s11739-025-04171-3

M3 - Article

SN - 1828-0447

VL - 21

SP - 153

EP - 161

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

IS - 1

ER -

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

Abstract

UN SDGs

All Science Journal Classification (ASJC) codes

Keywords

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