Social inequalities in health care and long-term care for the very old: a scoping review

Abstract

Aim Despite broad discussions in the scientific literature concerning the connection between social and health inequalities, the group of the very old (people aged 80 years and older) is not sufficiently represented in the research concerning health and long-term care. Are there inequalities among the very old in home and institutional care in the so-called industrialized Western countries and Asian countries? What differences can be detected regarding social determinants, gender, and region? Are there mutual aspects of health and long-term care on an international level? Is there a kind of tipping point in the progressive aging process at which the need for long-term care becomes inevitable? Subject and methods Based on these four guiding questions, a scoping review of the literature in the last 10 years was conducted with German and English search terms. CINAHL, PubMed, ProQuest, and Scopus were searched in December 2022 and January 2023. In addition, a manual search was performed. Results The very old are still not adequately represented in the research on the issue of social and health inequalities and implications for health and long-term care. Nevertheless, evidence of inequalities in care design was found. Market-based health and long-term care systems appear to show these more frequently. Also, market-based health and long-term care systems seems to rely more heavily on family structures than supply-oriented systems like in the Scandinavian countries. System structures tend to provide for an accumulation of inequalities in health and long-term care, as is also seen for low incomes. Conclusion The scoping review showed that the group of the very old is underrepresented in health services research. At the same time, there are indications of a perpetuation of social inequality at old age. There is a need for more research on appropriate research terminologies and methods as well as research-based health care and long-term care measures and interventions.