Key publications database

Longer lives are one of humanity's greatest achievements. However, we don't just want to add years to our lives. We also want to enjoy good health and well-being in later life.

This is healthy ageing.

Today, too many people around the world experience worse health than they should because of unsupportive environments that prevent them from maximising their later years.

The UN Decade of Healthy Ageing (2021–2030) aims to give everyone the opportunity to add life to years, wherever they live.

In November 2023, WHO and UN partners launched the first UN Decade of Healthy Ageing progress report. This report charts efforts to improve the lives of older people since 2020, capturing the impact of major challenges such as the COVID-19 pandemic, during which over 80% of deaths were among over 60-year-olds. The report also highlights activities in support of healthy ageing in nearly 50 countries.

The report features results from a survey of 136 countries, conducted between late 2022 and early 2023, and notes the areas of greatest progress, by comparing with a previous survey from 2020. This comparison showed an over 20% increase in the number of countries reporting: legislation against ageism, legislation to support older people’s access to assistive products; national policies on comprehensive assessments of health and social care needs of ageing populations; and national programmes for age-friendly cities and communities.

Despite this progress, further efforts are needed as the Decade continues. The report highlights that less than a third of countries reported having adequate resources to deliver on the UN Decade’s four areas of action.

One area identified where there needs to be more progress is having a national multistakeholder forum or committee on ageing and health, which saw only a 7% increase from 67% to 74%. The least progress was seen in the number of countries having a national focal point on ageing.

Concerningly, the proportion of countries with policies, legislation, programmes and services to support healthy ageing is lower in low- and middle-income countries, yet that is where 80% of older people globally will live by 2050. Challenges also remain in ensuring older people are at the centre of the action for Decade; among countries with a forum on healthy ageing, one in three do not include older people.

The Thirteenth General Programme of Work (GPW 13) defines WHO’s strategy for the five-year period, 2019-2023. It focuses on triple billion targets to achieve measurable impacts on people’s health at the country level.

The triple billion targets are to ensure by 2023:

One billion more people are benefiting from universal health coverage

One billion more people are better protected from health emergencies

One billion more people are enjoying better health and well-being

Measurable impact is at the heart of WHO’s mission to transform the future of public health. See how progress is calculated towards achieving GPW 13.

The report aims to move the debate about the most appropriate public health response to population ageing into new – and much broader – territory. The overarching message is optimistic: with the right policies and services in place, population ageing can be viewed as a rich new opportunity for both individuals and societies. The resulting framework for taking public health action offers a menu of concrete steps that can be adapted for use in countries at all levels of economic development.

The level of unmet needs for health care reported in international surveys varies across countries and surveys - sometimes greatly. This brief explains these differences in the level of unmet needs, by comparing the methods and approaches used across three international surveys. It identifies at least five methodological differences that explain these inconsistencies. Despite differences in the level of unmet needs, the broad picture arising from these surveys is consistent: unmet needs are greater among the poor.

Author: Keating, N.

Publication date: 2022/01

Abstract

The mission of UN Decade of Healthy Ageing (2020–2030) is to improve the lives of older people, their families and their communities. In this paper, we create a conceptual framework and research agenda for researchers to knowledge to address the Decade action items. The framework builds on the main components of healthy ageing: Environments (highlighting society and community) across life courses (of work and family) toward wellbeing (of individuals, family members and communities). Knowledge gaps are identified within each area as priority research actions. Within societal environments, interrogating beliefs about ageism and about familism are proposed as a way to illustrate how macro approaches to older people influence their experiences. We need to interrogate the extent to which communities are good places to grow old; and whether they have sufficient resources to be supportive to older residents. Further articulation of trajectories and turning points across the full span of work and of family life courses is proposed to better understand their diversities and the extent to which they lead to adequate financial and social resources in later life. Components of wellbeing are proposed to monitor improvement in the lives of older people, their families and communities. Researcher priorities can be informed by regional and national strategies reflecting Decade actions.

Authors: Rudnicka, E., Napierała, P., Podfigurna, A., Męczekalski, B., Smolarczyk, R., & Grymowicz, M.

Publication date: 2020/09

Abstract

The ageing of the global population is the most important medical and social demographic problem worldwide. The World Health Organization (WHO) has defined healthy ageing as a process of maintaining functional ability to enable wellbeing in older age. The WHO, Member States and Partners for Sustainable Development Goals have created a Global Strategy and Action Plan for Ageing and Health for 2016–2020 and its continuation with the WHO programme The Decade of Healthy Ageing 2020–2030. The WHO has established main priorities such as supporting country planning and action, collecting better global data and promoting research on healthy ageing, aligning health systems to the needs of older people, laying the foundations and ensuring the human resources necessary for long-term integrated care, undertaking a global campaign to combat ageism, and enhancing the global network for age-friendly cities and communities. There are several reports of coordinated preventive health and social health initiatives in well developed countries. However, there is little evidence on the application of the active ageing frameworks in developing countries. Greater national capacities and closer monitoring of the progress through age-disaggregated data is needed to effectively implement the intended programmes on healthy ageing.

The global indicator framework for Sustainable Development Goals was developed by the Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs) and agreed upon at the 48th session of the United Nations Statistical Commission held in March 2017.

Reorienting health systems to primary health care as a resilient foundation for universal health coverage and preparations for a high-level meeting of the United Nations General Assembly on universal health coverage.

Authors: Janine Charnley, Paul Kowal, Brian Beach, Nawi Ng, Paul Dugdale, Susan Harding, Jean-Frederic Levesque, Nadia Minicuci, Megumi Rosenburg & Julie Byles. (Developed with input and review from CARETRACK).

Publication date: 2023

The “Agenda to Advance Research and Global Monitoring of Unmet Health and Social Care Needs of Older People” (The Agenda) is designed to support the implementation of the UN Sustainable Development Goals (SDGs), the UN Decade of Healthy Ageing, and the WHO Global strategy on ageing and health, all of which recognize the importance of strengthening measurement and data on older persons for monitoring and evaluation of public health program, policies and interventions.

The world is off track to make significant progress towards universal health coverage (UHC) (SDG target 3.8) by 2030 as improvements to health services coverage have stagnated since 2015, and the proportion of the population that faced catastrophic levels of out-of-pocket (OOP) health spending has increased.

On page 55 & 56 this report discusses the issue of unmet health and social care needs of ageing populations.

Authors: Barbara Corso, Kanya Anindya, Nawi Ng, Nadia Minicuci, Megumi Rosenberg, Paul Kowal, Julie Byles

Publication date: 2022/12

Abstract

Providing good quality health care that meets the health needs of a population is a key objective of national and sub-national health systems, and consistent with 2030 United Nations Sustainable Development Goal 3.8 and the World Health Organization’s global impact framework1, 2.(UN 2015; WHO 2019) As populations age, health needs shift, where the predominant disease burden tends to be from chronic diseases. Many of these chronic diseases and their risks are modifiable and their outcomes can be improved through accessing quality health and social care services. But in many countries, not all health needs of older people are being met. The gap represented by unmet need raises issues of equity in service coverage and universality of health care. However, current measures of universal health coverage (UHC) do not assess unmet need.

Operationally, unmet health care need can be defined as the differences between services that are necessary to deal appropriately and optimally with a defined health problem (or need) and the services that are actually accessed and provided3. However, the measurement of unmet need is theoretically complex, as needs may be partially met, met with difficulty or delay, or met sometimes and not other times. There may also be a qualitative element in the meeting of needs, as health care may be available, accessed and provided, but not necessarily in a way that is appropriate to the health care problem, or to the satisfaction of the patient. There is no standard agreed definition or measure of unmet health need.

The 2022 Revision of World Population Prospects is the twenty-seventh edition of official United Nations population estimates and projections that have been prepared by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. It presents population estimates from 1950 to the present for 237 countries or areas, underpinned by analyses of historical demographic trends. This latest assessment considers the results of 1,758 national population censuses conducted between 1950 and 2022, as well as information from vital registration systems and from 2,890 nationally representative sample surveys The 2022 revision also presents population projections to the year 2100 that reflect a range of plausible outcomes at the global, regional and national levels.

The main results are presented in a series of Excel files displaying key demographic indicators for each UN development group, World Bank income group, geographic region, Sustainable Development Goals (SDGs) region, subregion and country or area for selected periods or dates within 1950-2100. An online database (Data Portal) provides access to a subset of key indicators and interactive data visualization, including an open API for programmatic access.

Authors: Dominika Kalánková, Minna Stolt, Evridiki Papastavrou, Riitta Suhonen, and On behalf of the RANCARE COST Action CA15208

Publication date: 2021/10

Abstract

The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O’Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals’ experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients’ expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons.

Authors: Gemma Frances Spiers, Tafadzwa Patience Kunonga, Daniel Stow, Alex Hall, Andrew Kingston, Oleta Williams, Fiona Beyer, Peter Bower, Dawn Craig, Chris Todd, Barbara Hanratty

Publication date: 2022/10

Abstract

Populations are considered to have an ‘unmet need’ when they could benefit from, but do not get, the necessary support. Policy efforts to achieve equitable access to long-term care require an understanding of patterns of unmet need. A systematic review was conducted to identify factors associated with unmet need for support to maintain independence in later life.

Seven bibliographic databases and four non-bibliographic evidence sources were searched. Quantitative observational studies and qualitative systematic reviews were included if they reported factors associated with unmet need for support to maintain independence in populations aged 50+, in high-income countries. No limits to publication date were imposed. Studies were quality assessed and a narrative synthesis used, supported by forest plots to visualise data.

Forty-three quantitative studies and 10 qualitative systematic reviews were included. Evidence across multiple studies suggests that being male, younger age, living alone, having lower levels of income, poor self-rated health, more functional limitations and greater severity of depression were linked to unmet need. Other factors that were reported in single studies were also identified. In the qualitative reviews, care eligibility criteria, the quality, adequacy and absence of care, and cultural and language barriers were implicated in unmet need.

This review identifies which groups of older people may be most at risk of not accessing the support they need to maintain independence. Ongoing monitoring of unmet need is critical to support policy efforts to achieve equal ageing and equitable access to care.

NOT OPEN ACCESS

Authors: Smith, S., & Connolly, S.

Publication date: 2020/10

Abstract

There is an increasing interest in assessing unmet need for health care services particularly in European countries. Despite this there has been relatively little analysis of unmet need in the European or wider international setting. It remains a challenge to pin down what types of unmet need can and should be addressed by health care policymakers, and how to go about identifying and quantifying those unmet needs. The objective of this paper is to propose a new way of thinking about unmet need for health care which can in turn guide analysis of unmet need in terms of potential data sources and analytic approaches. Unmet need is shown to be a complex multi-faceted concept that cannot be captured by a single indicator or measurement. To advance the literature in this field, this paper considers what happens to unmet need over time. By introducing a dynamic perspective, three alternative trajectories for health care needs are outlined: non-use of health care, delayed use of health care and sub-optimal use of health care. These trajectories are discussed with a view to improving the focus, and policy applicability, of empirical research in this field.

NOT OPEN ACCESS

Authors: Scherbov, S., & Sanderson, W. C.

Publication date: 2022/10

Abstract

Objective: Most studies of population aging focus on only one characteristic of people: their chronological age. Many important characteristics of people vary with age, but age-specific characteristics also vary over time and differ from place to place. We supplement traditional measures of aging with new ones that consider the changing characteristics of people.

Method: The characteristics approach to measuring of population aging is employed. We provide examples of new measures of population aging using characteristics, such as remaining life expectancy, health, normal public pension age, and hand-grip strength.

Results: Past and future population aging look less rapid using the characteristics approach, compared with traditional ones. For some regions, almost no aging occurred in the recent past.

Discussion: Supplementing chronological age with ages that take into account the changing characteristics of people allows us to analyze aging more comprehensively and more accurately.

Authors: Jotheeswaran Amuthavalli Thiyagarajan, Christopher Mikton, Rowan H Harwood, Muthoni Gichu, Victor Gaigbe-Togbe, Tapiwa Jhamba, Daniela Pokorna, Valentina Stoevska, Rio Hada, Grace Sanico Steffan, Ana Liena, Eileen Rocard, Theresa Diaz

Publication date: 2022/07

Abstract

Over the past 100 years, life expectancy has increased dramatically in nearly all nations. Yet, these extra years of life gained have not all been healthy, particularly for older people aged 60 years and over. In 2020, the World Health Organisation (WHO) and United Nations (UN) member states embraced a sweeping 10-year global plan of action to ensure all older people can live long and healthy lives, formally known as the UN Decade of Healthy Ageing (2021–2030). With the adoption of the UN Decade of Healthy Ageing resolution, countries are committed to implementing collaborative actions to improve the lives of older people, their families and the communities in which they reside. The Decade addresses four interconnected areas of action. Adopting the UN's resolution on the Decade of Healthy Ageing has caused excitement, but a question that has weighed on everyone's mind is how governments will be held accountable? Besides, there have been no goals or targets set for the UN Decade of Healthy Ageing from a programmatic perspective for the action areas, and guidance on measures, data collection, analysis and reporting are urgently needed to support global, regional and national monitoring of the national strategies, programmes and policies. To this end, WHO in collaboration with UN agencies and international agencies established a Technical Advisory Group for Measurement of Healthy Ageing (TAG4MHA) to provide advice on the measurement, monitoring and evaluation of the UN Decade of Healthy Ageing at the global, regional and national levels.

NOT OPEN ACCESS

Authors: Willine Carr & Samuel Wolfe

Publication date: 2019

Abstract

This paper discusses the Meharry Medical College Study of Unmet Needs designed to measure the effectiveness of alternative health care delivery systems: (a) comprehensive care with broad outreach, (b) comprehensive care with limited outreach, and (c) traditional care. Unmet needs are defined as the differences between services judged necessary to deal appropriately with health problems and services actually received. The central hypothesis is that comprehensive health programs will be more effective than traditional care in reducing unmet needs. Unmet needs are viewed as measures of program outcome and are one of several types of sociomedical indicators which use factors other than biomedical or biological states as measures of outcome. The distinction is made between unmet needs indicators and health status indicators.

Various approaches to measuring unmet needs are discussed and the relatively limited focus of these is contrasted with the more comprehensive Meharry approach. Household interviews and clinical examinations provide the data base for deriving professional judgments of unmet needs in the medical, dental, nursing, and social services areas. The Meharry work suggests several areas in which further work on unmet needs would be useful.

Authors: Md. Mizanur Rahman, Megumi Rosenberg, Gabriela Flores, Nadia Parsell, Shamima Akter, Md Ashraful Alam, Md. Mahfuzur Rahman & Tessa Edejer

Publication date: 2022/12

Abstract

The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted.

An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual.

After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3–13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9–13.1] vs female [14.4, 95% CI, 11.8–17.3]), educational level (primary or less [13.3, 95% CI, 9.6–17.6] vs higher [7.5, 95% CI, 5.9–9.3]), self-reported health (poor [23.2, 95% CI, 18.8–27.8] vs good [4.4, 95% CI, 3.4–5.5]), insurance status (insured [9.0, 95% CI, 7.5–10.6] vs uninsured [27.7, 95% CI, 24.0–31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1–44.9] vs richest [7.1, 95% CI, 3.8–11.3]). One in four (25.1, 95% CI, 17.1–34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts.

With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.

Authors: Christopher Carroll, Katie Sworn, Andrew Booth, Aki Tsuchiya, Michelle Maden, & Megumi Rosenberg

Publication date: 2022/01

Abstract

There is currently no global review of the conceptual literature on the equity of healthcare coverage (including access) for older people. It is important to understand the factors affecting access to health and social care for this group, so that policy and service actions can be taken to reduce potential inequities. A scoping review of published and grey literature was conducted with the aim of summarising how health and social care service access and coverage for older people has been conceptualised. PubMed, MEDLINE, PsycINFO, CINAHL, Web of Science, SciELO, LILACS, BIREME and Global Index Medicus were searched. Selection of sources and data charting were conducted independently by two reviewers. The database searches retrieved 10 517 citations; 32 relevant articles were identified for inclusion from a global evidence base. Data were summarised and a meta-framework and model produced listing concepts specific to equitable health and social care service coverage relating to older people. The meta-framework identified the following relevant factors: acceptability, affordability, appropriateness, availability and resources, awareness, capacity for decision-making, need, personal social and cultural circumstances, physical accessibility. This scoping review is relevant to the development and specification of policy for older people. It conceptualises those factors, such as acceptability and affordability, that affect an older person's ability and capacity to access integrated, person-centred health and social care services in a meaningful way. These factors should be taken into account when seeking to determine whether equity in service use or access is being achieved for older people.

A brief on measuring unmet health and care needs among older people using existing data.

A collection of existing research agendas with recommendations relating to the measurement and monitoring of unmet health and social care needs in factors affecting older people.

Authors: Megumi Rosenberg, Paul Kowal, Md Mizanur Rahman, Shohei Okamoto, Sarah Louise Barber, Viroj Tangcharoensathien

Publication date: 2023/09

Key messages

● Current indicators for global monitoring of universal health coverage (UHC) do not capture levels of unmet healthcare need

● A measure of unmet need for healthcare that is not bound to a single health intervention or disease and that explains access barriers would add considerable value to global UHC monitoring

● Existing survey data on self-reported unmet need for healthcare could be used to estimate the prevalence of unmet need but have technical limitations

● Standardised survey questions on unmet healthcare needs will facilitate comparability for global monitoring

Author: Vlachantoni, A.

Publication date: 2017/07

Understanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance, their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people.

The 2022 Revision of World Population Prospects is the twenty-seventh edition of official United Nations population estimates and projections that have been prepared by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. It presents population estimates from 1950 to the present for 237 countries or areas, underpinned by analyses of historical demographic trends. This latest assessment considers the results of 1,758 national population censuses conducted between 1950 and 2022, as well as information from vital registration systems and from 2,890 nationally representative sample surveys The 2022 revision also presents population projections to the year 2100 that reflect a range of plausible outcomes at the global, regional and national levels.

The main results are presented in a series of Excel files displaying key demographic indicators for each UN development group, World Bank income group, geographic region, Sustainable Development Goals (SDGs) region, subregion and country or area for selected periods or dates within 1950-2100. An online database (Data Portal) provides access to a subset of key indicators and interactive data visualization, including an open API for programmatic access.

Authors: Angela Y Chang, Vegard F Skirbekk, Stefanos Tyrovolas, Nicholas J Kassebaum, Joseph L Dieleman

Publication Date: 2019

Summary

Traditional metrics for population health ageing tend not to differentiate between extending life expectancy and adding healthy years. A population ageing metric that reflects both longevity and health status, incorporates a comprehensive range of diseases, and allows for comparisons across countries and time is required to understand the progression of ageing and to inform policies.

Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, we developed a metric that reflects age-related morbidity and mortality at the population level. First, we identified a set of age-related diseases, defined as diseases with incidence rates among the adult population increasing quadratically with age, and measured their age-related burden, defined as the sum of disability-adjusted life-years (DALYs) of these diseases among adults. Second, we estimated age-standardised age-related health burden across 195 countries between 1990 and 2017. Using global average 65-year-olds as the reference population, we calculated the equivalent age in terms of age- related disease burden for all countries. Third, we analysed how the changes in age-related burden during the study period relate to different factors with a decomposition analysis. Finally, we describe how countries with similar levels of overall age-related burden experience different onsets of ageing. We represent the uncertainty of our estimates by calculating uncertainty intervals (UI) from 1000 draw-level estimates for each disease, country, year, and age.

92 diseases were identified as age related, accounting for 51·3% (95% UI 48·5–53·9) of all global burden among adults in 2017. Across the Socio-demographic Index (SDI), the rate of age-related burden ranged from 137·8 DALYs (128·9–148·3) per 1000 adults in high SDI countries to 265·9 DALYs (251·0–280·1) in low SDI countries. The equivalent age to average 65-year-olds globally spanned from 76·1 years (75·6–76·7) in Japan to 45·6 years (42·6–48·2) in Papua New Guinea. Age-standardised age-related disease rates have decreased over time across all SDI levels and regions between 1990 and 2017, mainly due to decreases in age-related case fatality and disease severity. Even among countries with similar age-standardised death rates, large differences in the onset and patterns of accumulating age-related burden exist.

The new metric facilitates the shift from thinking not just about chronological age but the health status and disease severity of ageing populations. Our findings could provide inputs into policymaking by identifying key drivers of variation in the ageing burden and resources required for addressing the burden.

Authors: Mariana Calderón-Jaramillo & Pilar Zueras

Publication date: 2023/04

Abstract

Population care needs are dynamic. They change throughout individuals’ life courses and are related to the population structure. These needs are particularly demanding during population ageing and may vary depending on how societies cope with them. In this study, we explored the unmet social care needs of individuals in twelve European countries with different social care systems. We used data from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to conduct a cross-sectional study of individuals aged 65 and over with care needs (n = 7136). Unmet care needs were measured from an absolute approach. We fitted binomial regression models to explain the relative importance of individuals’ characteristics, health status and different social care systems on unmet needs. The absolute measure shows that 53.02% of the analytical sample faced unmet care needs as they reported limitations and did not receive help. The prevalence of unmet care needs is higher for men than women and for younger than older individuals. Furthermore, we found that individuals living in Mediterranean social care systems have the highest prevalence of these unmet needs. This analysis contributes to the ongoing debate about the challenges posed by ageing populations and their relationship with care.

Authors: Kowal P , Corso B , Anindya K , Andrade FC , Giang TL , Guitierrez MTC , Pothisiri W , Quashie NT , Reina HAR , Rosenberg M , Towers A , Vicerra PMM , Minicuci N , Ng N , & Byles J

Publication date: Preprint

Abstract

Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information.

This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60 + years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.