P128 Unmet care needs in later life: who is most at risk? A systematic review of quantitative and qualitative evidence

Background

As people age, some may require help with essential day-to-day activities like washing, dressing, shopping, preparing meals and managing medication. People who do not receive the support they need to remain independent are considered to have an unmet care need. Such unmet needs are detrimental to older people’s wellbeing and are linked to greater healthcare utilisation and costs. A clear understanding of who is most at risk of unmet care needs is important to support policy efforts to achieve equity in care and equality in healthy ageing. To address this, we aimed to synthesise evidence about factors associated with unmet care needs in later life.

Methods

A systematic review was conducted (PROSPERO #CRD42021250489). Seven bibliographic databases and four non-bibliographic evidence sources were searched. Eligible studies were: quantitative observational designs that estimated the association between a risk factor and the outcome unmet care need; and, qualitative systematic reviews that reported factors implicated in the experience of unmet care needs. Studies were included if they reported this evidence for populations aged 50+, in high-income countries. No limits to publication date were imposed. Studies were quality assessed and a narrative synthesis used. Forrest plots were used to visualise quantitative data.

Results

Forty-three quantitative studies and 10 qualitative systematic reviews were included. Seven groups of risk factors for unmet care needs were identified: demographic, socioeconomic, health and disability, health service use, care configurations, unpaid carer characteristics, and area level measures. Risk factors for unmet care needs included being male, the younger old, living alone, having lower levels of income, poor self-rated health, more functional limitations, and greater severity of depression. In the qualitative reviews, care eligibility criteria, the quality, adequacy and absence of care, and cultural and language barriers were implicated in the experience of unmet care needs.

Discussion

Equitable access to care in later life requires targeted support at groups whose needs are most likely to go unmet. Policy efforts to prolong older people’s independence should consider extending the social care offer to the younger old. Financial and material barriers to care must be addressed to ensure those experiencing socioeconomic disadvantage access the support they need. Further research could explore if and how risk factors for unmet care needs differ across later life.