Reasons for unmet care needs in older adults with cancer: Analyses from the 2015–2019 National Health and Aging Trends Study.

Abstract

11112 Background: Despite extensive research on unmet care needs in older adults (ages ≥65) with cancer, few studies explore the reasons for unmet care needs, knowledge of which can inform future interventions. We aimed to identity reasons for unmet care needs in older adults with cancer and associated factors. Methods: Our analyses included community-dwelling older adults with cancer from the 2015–2019 National Health and Aging Trends Study (NHATS). NHATS captures unmet care needs in 12 activities from three domains: activities of daily living (ADL), instrumental ADL (IADL), and mobility. We separately evaluated two categories of reasons for unmet care needs: “difficulty performing activities independently” (for participants without a caregiver), and “caregivers’ inability to help” (for those receiving caregiver assistance). Personal characteristics included demographic (gender, age, marital status, race, ethnicity, educational level), clinical (cancer type, years since cancer diagnosis), and health variables (physical function, nutritional status, cognition, psychological status). We built logistic models to assess characteristics associated with unmet care needs, adjusting for NHATS year and cancer type. In exploratory analyses, we further evaluated associations of years since cancer diagnosis with unmet care needs. All models were built separately for participants with and without a caregiver. Results: Our analysis included 1829 participants. In 2015, participants had a mean age of 81 years; more than half were female (55%), White (79%), non-Hispanic (96%), had impaired physical function (92%), and received caregiver assistance (51%). From 2015 to 2019, 29% to 32% participants without a caregiver reported any unmet care needs due to difficulty with performing the activity independently, with toileting (45-53%) and managing medications (27-31%) being the most prevalent. Between 18% and 20% participants with a caregiver reported any unmet care needs due to caregivers’ inability to help, with toileting (26-44%) and going around inside home (20-29%) being the most prevalent. Hispanic ethnicity, being separated/divorced, living alone or with non-spouses, and worse health status were independently associated with unmet care needs due to either reason. Compared to pre-diagnosis, being 1-2, [odds ratio (OR) 1.7], 3-4 (OR 1.8) and 5+ (OR 2.2) years from cancer diagnosis was significantly associated with higher odds of unmet care needs among those without a caregiver, but not those with a caregiver. Conclusions: Unmet care needs due to difficulty performing activities independently are common among older adults with cancer. Caregivers generally meet care recipients’ needs in IADLs, but may face challenges in toileting and mobility needs. Tailored interventions addressing specific reasons for unmet needs are needed, particularly for those at greater risk.