The Unmet Activities of Daily Living (ADL) Needs of Dependent Elders and their Related Factors: An Approach from Both an Individual- and Area-Level Perspective

Abstract

s u m m a r yBackground: The unmet activities of daily living (ADL) needs often lead to negative consequences in dependent elders. This study examines disabled elders' unmet ADL needs and the factors associated to those unmet needs. Methods: Data from a representative sample from Taiwan of 6820 elders and family caregiver dyads were analyzed, using hierarchical linear modeling to identify the individual-and area-level factors. Standardized measures were administered through face-to-face interview. Results: The highest percent of unmet ADL needs was for climbing stairs (21.0%), and the lowest pertained to eating (5.9%). The mean age of the respondents in this study was 79.25 years. The majority of respondents were female (59.3%). The mean ADL score was 55.39, showing a medium level of dependency. The mean instrumental activities of daily living (IADL) limitation number was 7.49. The results revealed the following factors as important: education level; living arrangements; number of illnesses; number of IADL limitations; caregiver's age; the caregiverepatient relationship; care burden; household size; interaction between welfare expense and service uptake; and between welfare expense and the number of IADL limitations. Conclusion: Our results show that social welfare expenditure moderates unmet needs by provision of services, which means that the positive effect of social welfare services cannot be ignored; therefore, the government should play a supervisory role. In addition, the definition and measurement of unmet needs must be further clarified to assess accurately the prevalence of such needs, and further research should be undertaken on the adverse consequences of unmet needs.

Rural-urban disparities in unmet long-term care needs and the demand for community care services among elderly people in China

“…Moreover, some indicated that the prevalence of unmet needs among elderly people who required assistance in any of the six tasks for more than 3 months in China was even higher than that of this study, reaching 61.4% [7]. Furthermore, older adults in rural areas had a higher rate of unmet needs than their urban counterparts, which is in line with other studies [16,24]. Despite the different measures of unmet LTC needs, we can see that China, especially rural areas of China, faces great challenges in terms of unmet LTC needs among older people.…”

“…However, some studies have indicated this proportion may have been underestimated because respondents who received assistance were not asked whether that help was adequate or sufficient in the National Long-Term Care Survey in the USA [9,23]. Another study reported that the prevalence of BADL disability among elderly people aged 65 and over in Brazil was 16.0% and that 47.0% of those people with disabilities had their needs met, while only 10.3% did not [13]. In that study, unmet needs were defined as the presence of at least one unavailable need for BADLs.…”

“…Many studies have indicated that low educational attainment, low income, not being currently married, living alone, severe ADL disability, cognitive impairment, and unavailability and unaffordability of services were significantly associated with unmet LTC needs [8,13,[16][17][18]. Other studies have found differences between urban and rural residents.…”

The measurement and implication of the older people’s social function in the community: a Shanghai experience

“…Moreover, quite a few studies have shown that social function among Chinese elderly people is closely related to social networks (not only those of family and friends, but also those of formal and informal participation in community groups and organisation) and to social attachments (in terms of social trust, mutual benefit, reciprocity and solidarity, etc.) within the community (Chiu & Yu, 2001;Jiang, 2009;Lei, 2001;Liu, Chang, & Huang, 2012;Wang, 2006).…”

Community care for the Elderly: Needs and Service Use Study (CENSUS): Who receives home care packages and what are the outcomes?

“…Having an in‐home or other family carer is protective; however, carer characteristics such as older age [13], psychological morbidity [12,13], lower psychological quality of life (QOL) [11] and carer burden [14,15] also predict nursing home admission. Unmet care needs in community‐dwelling older people are associated with other adverse outcomes such as weight loss, dehydration, falls, burns and discomfort [16], greater psychological distress and elevated carer stress [17], hospital admissions [6,15], and mortality [15]. Home care delays nursing home admission [18,19]; this may be by reducing unmet care needs and carer burden [20,21].…”