The Effects of Social Networks of the Older Adults with Limited Instrumental Activities of Daily Living on Unmet Medical Needs

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018

Background and Objectives

Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States.

Research Design and Methods

We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively.

Results

A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents.

Discussion and Implications

Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.

Retrospective cross-sectional study examining the association between loneliness and unmet healthcare needs among middle-aged and older adults using the Canadian Longitudinal Study of Aging (CLSA)

OBJECTIVES

Our primary objective was to estimate the association between loneliness and unmet healthcare needs and if the association changes when adjusted for demographic and health factors. Our secondary objective was to examine the associations by gender (men, women, gender diverse).

DESIGN, SETTING, PARTICIPANTS

Retrospective cross-sectional data from 44 423 community-dwelling Canadian Longitudinal Study on Aging participants aged 45 years and older were used.

PRIMARY OUTCOME MEASURE

Unmet healthcare needs are measured by asking respondents to indicate (yes, no) if there was a time when they needed healthcare in the last 12 months but did not receive it.

RESULTS

In our sample of 44 423 respondents, 8.5% (n=3755) reported having an unmet healthcare need in the previous 12 months. Lonely respondents had a higher percentage of unmet healthcare needs (14.4%, n=1474) compared with those who were not lonely (6.7%, n=2281). Gender diverse had the highest percentage reporting being lonely and having an unmet healthcare need (27.3%, n=3), followed by women (15.4%, n=887) and men (13.1%, n=583). In our logistic regression, lonely respondents had higher odds of having an unmet healthcare need in the previous 12 months than did not lonely (adjusted odd ratios (aOR) 1.80, 95% CI 1.64 to 1.97), adjusted for other covariates. In the gender-stratified analysis, loneliness was associated with a slightly greater likelihood of unmet healthcare needs in men (aOR 1.90, 95% CI 1.64 to 2.19) than in women (aOR 1.73, 95% CI 1.53 to 1.95). In the gender diverse, loneliness was also associated with increased likelihood of having an unmet healthcare need (aOR 1.38, 95% CI 0.23 to 8.29).

CONCLUSIONS

Loneliness was related to unmet healthcare needs in the previous 12 months, which may suggest that those without robust social connections experience challenges accessing health services. Gender-related differences in loneliness and unmet needs must be further examined in larger samples.

Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study

Background

Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure.

Methods

We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers’ corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness.

Results

During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19.

Conclusion

This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02799-w.

The Unmet Medical Demand among China's Urban Residents

Our work aimed to build a reasonable proxy for unmet medical demands of China's urban residents. We combined health demand modeling and stochastic frontier analysis to produce a frontier medical demand function, which allowed us to disentangle unmet medical demands from the unobservable effects. We estimated unmet medical demands by using China's provincial dataset that covered 2005-2018. Our estimates showed that unmet medical demand at the national level was 12.6% in 2018, and regions with high medical prices confronted more unmet medical demands than regions with moderate or low medical prices during 2005-2018. Furthermore, medical prices and education were the main factors that affected unmet medical demand; therefore, policy making should pay more attention to reducing medical costs and promoting health education.

ADL/ IADL dependencies and unmet healthcare needs in older persons: A nationwide survey

PURPOSE

To determine the impact of overall and component-wise activities for daily living (ADL) as well as instrumental activities of daily living (IADL) dependencies on unmet healthcare needs in older adults.

MATERIALS AND METHODS

Cross-sectional analyses were performed based on a National Survey of Older Koreans. A total of 10,082 participants aged ≥ 65 years were included. All data were collected through standardized, personal interviews with participants and their representatives. Logistic regression was used to analyse the risk of unmet healthcare needs, with or without adjustment.

RESULTS

Amongst all participants, 734 (7.2%) had ADL dependency. Participants with ADL dependency had lower income, education level, and perceived health status (p<0.001). The adjusted odds ratio (aOR) for the risk of unmet healthcare needs was 1.52 (95%, confidence interval [CI] 1.19-1.95) for ADL and 1.54 (95%, CI 1.28-1.86) for IADL. When men have ADL dependency, aOR of unmet healthcare needs was higher than that of women (aOR 1.89, 95% CI 1.15 - 3.11; aOR 1.65, 95% CI 1.15 - 2.36, respectively) and IADL showed the same trend. Any dependency on ADL or IADL was associated with higher risk of unmet healthcare needs, whether adjusted or not (p<0.001).

CONCLUSIONS

Older adults with ADL or IADL dependency had higher risks of unmet healthcare needs than their independent counterparts. In addition to mobility problems, other components were related to unmet healthcare needs. Therefore, to reduce unmet healthcare needs, integration of health and social care that supports ADL or IADL dependency should be considered.