Do you know what Unmet Care Needs are?

Athina Vlachantoni, SCDTP Director, is a member of the UK Social Policy Association, the British Society of Gerontology, and the British Society of Population Studies. Athina is also Deputy Editor of Ageing & Society, and a member of the Editorial Board for the Journal of Social Policy.

• 55% of 65-year-olds + have a difficulty with an Activity of Daily Living like bathing
• 24% of elderly persons reported inability to do an Instrumental Activity of Daily Living such as housework
• 80% noted an unmet need related to mobility issue such as going up the stairs.

The world population is ageing, and the ageing of our population, as a result of an increase in average longevity, is not the only reason behind an expected rise in the demand for care in the future. Changing family structures, trends of urbanisation, economic migration trends more broadly, as well as changing social norms about family obligations, are all contributing to a reduced availability of individuals as informal (or unpaid) carers within the family. At the same time, the last decade or so, has seen a real-terms reduction in state-funded social care, with an equivalent increase of provision of care from the independent (or private) sector, for those who can afford it. The combination of these trends means that the experience of having unmet care needs – where an individual reports having difficulty with daily tasks but not receiving any support with such tasks- is likely to becoming more and more common.

Our team’s research on this topic, using nationally-representative data on older persons from England, has shown certain stark findings. More than half of individuals aged 65 and over, who reported a difficulty with an Activity of Daily Living such as bathing or dressing, reported unmet need with such activity (55%). This compared with about one-in-four (24%) of older individuals experiencing unmet need with an Instrumental Activity of Daily Living such as doing housework or shopping, and 80% of the participating older individuals experiencing unmet needs related to a mobility issue such as going up the stairs.

Particular characteristics

The research also found particular characteristics associated with the experience of unmet need for particular tasks, for example being male and living alone was linked to unmet need with either Activity of Daily Living or Instrumental Activity of Daily Living, but being older, having a poorer health status and a lower socio-economic status was linked with unmet need for bathing.

Further longitudinal research showed that a significant proportion of older persons experience repeated unmet need over time.

Why do these results matter?

Firstly, understanding the overall level of need and unmet need is important in the context of population ageing and changing socio-economic structures. Policymakers are tasked with ensuring that all older persons, regardless of their demographic or socio-economic characteristics, can receive the support they need into the future, and such evidence contributes to making informed decisions about the funding and provision of social care.

Secondly, results from quantitative analysis such as those described above, tell us only one side of the story in terms of the prevalence and factors associated with need and unmet need. What we need more research on, including research using qualitative and mixed methods, is older persons’ views and preferences about the care they receive. This is important because we know from national and international research that every cohort of older persons has different characteristics, values and preferences.

Finally, understanding what unmet need means and exploring what we can do about it, goes at the heart of what it means to have an inclusive and compassionate community, and an effective welfare state.

To sum up, our research findings on unmet care needs amongst our older population might, for some, be cause for concern, but they also make up for interesting metrics to aid policy makers and care providers to go by. On a larger scope, they offer an otherwise unattainable data for concerned parties such as charities working the older population to get their act together and for the general public to do their bit through volunteering some of their free time to meet these unmet needs.