Self-reported unmet care needs in daily activities among community-dwelling older adults with cancer: Analyses from the 2015-2019 National Health and Aging Trends Study.

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail. Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups. Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis. The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

Despite advancements in medical technology and early cancer detection, many colorectal cancer (CRC) survivors report unmet care needs after completion of their cancer treatment that compromise their quality of life (QoL). Previous studies on the care needs of cancer survivors have yielded inconsistent results, and few studies have been conducted on survivors of CRC in Taiwan or on predictors of their unmet care needs. The purpose of this study was to examine the unmet care needs, psychological distress, and QoL of Taiwanese CRC survivors ( n = 100) as well as to assess the mean differences by sociodemographic characteristics in their unmet care needs and other related predictors after treatment completion. This cross-sectional study using a purposive sampling method was conducted at a regional hospital in northern Taiwan between October 2019 and February 2020. The measurements used in this study included Chinese Cancer Survivors' Unmet Needs, Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-Colorectal Cancer Module 29. The independent t test and one-way analysis of variance were employed to assess sociodemographic differences in unmet care needs, and multivariate linear regression was used to identify significant predictors. More than half of the participants (63.2%) reported at least one unmet care need, with the highest categories including information needs ("signs and symptoms of cancer recurrence" 31.7% and "information related to health promotion" 31.7%), "medical care needs" ("managing health with the medical team" 13.9%), and "physical/psychological effect needs ("concerns about cancer recurrence" 23.8%). Also, 7%-57% of the participants experienced differing degrees of distress symptoms including fatigue, intestinal and urogenital dysfunctions, and anxiety or depression. The results of the univariate analyses showed unmet needs to differ significantly by age ( p = .021), employment status ( p = .007), and chronic disease status ( p = .025). The findings revealed being of older age (β = 0.23, p = .049), being employed (β = 0.26, p = .014), and having a lower functional level (β = -0.31, p = .012) to be associated with significantly higher levels of unmet care needs, collectively accounting for nearly 27.3% of the variance (adjusted R2 = .273). CRC survivors continue to experience unmet care needs and various forms of physical-psychological distress for an average of almost 2 years after their completion of CRC treatment. The findings of this study may assist healthcare providers in identifying the major risk factors that interfere with survivor care needs following treatment, thus facilitating the development of timely interventions to mitigate the impact of cancer on this vulnerable population.

The home environment is an increasingly important setting for long-term services and support. However, more information is needed about the relationship between the home environment and adverse consequences due to unmet needs (i.e., going without assistance with everyday activities such as eating or bathing) among older adults. We draw on information from N=4,898 low and moderate-income (annual income <$60,000) community-living respondents to the National Health and Aging Trends Study (NHATS). Two aspects of the home environment were directly observed by NHATS interviewers: home disorder (six items, including flooring problems, tripping hazards, pests) and home disrepair (five items, including missing siding and broken steps). NHATS asked participants who reported a disability whether they experienced one of seven adverse consequences (e.g., going without eating) due to no one being there to provide help or the activity is too difficult for them to complete on their own. About half of our sample (48.5%) reported a disability. We found home disorder and disrepair more prevalent among older adults with disabilities than those without (36.2% v. 28.1% and 18.2% v. 15.0%, respectively). Among older adults with disabilities, the presence of any home disorder and any home disrepair were associated with higher odds of experiencing an adverse consequence of an unmet care need in unadjusted analyses (home disorder: OR 1.33; 95% CI 1.11, 1.60; home disrepair: OR 1.16; 95% CI 0.90, 1.50). Findings show an association between home environment and unmet care needs and can signal the need to target housing-related risk factors in future interventions.

BackgroundDespite Canada’s universal health insurance coverage, many Canadians still report an unmet need for health care. I investigated whether not having prescription drug insurance increases the likelihood of reporting an unmet need for health care. I hypothesized that people without prescription drug insurance would be more likely than those with insurance to report an unmet health care need.MethodsI included 31 630 people in Ontario 64 years of age or younger who had participated in the Canadian Community Health Survey Cycle 3.1. Multivariate logistic regression models were used to obtain an adjusted odds ratio (OR) for the association between having prescription drug insurance and reporting an unmet need for health care in the past 12 months, adjusting for age, sex, socio-economic status, health status and having a regular medical doctor. The reasons for reporting an unmet need for care were stratified into reasons related or not related to prescription drug insurance. Three separate multivariate logistic regressions were performed to obtain an adjusted OR for the association between prescription drug insurance and unmet need based on the reasons for reporting unmet need.ResultsNot having prescription drug insurance that covers all or part of prescription medication costs increased the likelihood of reporting an unmet need for health care services (adjusted OR 1.27, 95% confidence interval [CI] 1.16–1.39). Not having such insurance significantly increased the likelihood of reporting an unmet need for health care for reasons that were related to prescription drug insurance (adjusted OR 2.21, 95% CI 1.80–2.71). This relation was not significant when the analysis was restricted to people who reported unmet need for health care for reasons that did not relate to prescription drug insurance (adjusted OR 1.12, 95% CI 1.00–1.23).ConclusionsThese results suggest an association between a lack of prescription drug coverage and reporting an unmet need for health care. This association warrants further investigation.

BackgroundAs people age, some may require help with essential day-to-day activities like washing, dressing, shopping, preparing meals and managing medication. People who do not receive the support they need to...

BackgroundIn Ireland, entitlement to healthcare is subject to a complex system of eligibility categories. Medical cards are awarded on income grounds with holders eligible for a range of healthcare services...

Methamphetamine use has increased substantially in the United States since the 1990s. Few studies have examined the healthcare service needs of women who use methamphetamine. This study describes unmet medical needs in a community-based sample of women who use methamphetamine in San Francisco, CA. Women who use methamphetamine were recruited in San Francisco and participated in a computer-assisted survey (N = 298 HIV-negative women). Multivariate analysis was performed to explore associations among sociodemographic variables, drug use, use of health and social services, and unmet healthcare need across three domains: chronic health problems, dermatologic problems, and women's preventive healthcare. Sixty-nine percent of participants reported a need for care for a chronic health condition, and 31% of them had an unmet need for care, in the last six months. Thirty-five percent of participants reported a need for dermatologic healthcare, and 66% had an unmet need for care in the last 6 months. Ninety-two percent of participants reported a need for women's preventive healthcare and 46% had an unmet need for care in the last year. Women who reported having a healthcare provider had lower odds of reporting an unmet need for a chronic health condition or women's preventive healthcare. Women who used a case manager had lower odds of having an unmet need for dermatologic care. A significant proportion of women who use methamphetamine in this sample had an unmet need for women's preventive healthcare, and overall these women had a significant unmet need for healthcare. These findings suggest that contact with a healthcare provider or a caseworker could help to expand access to healthcare for this vulnerable population.

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.

To examine caregiver factors associated with unmet needs for care of older adults. Population-based surveys of caregivers and older adult care recipients in the United States in 2011. 2011 National Health and Aging Trends Study and National Study of Caregiving. Family caregivers (n = 1,996) of community-dwelling older adults with disabilities (n = 1,366). Disabled care recipient reports of unmet needs for care in the past month with activities of daily living (ADLs; e.g., wet or soiled clothing), mobility (e.g., have to stay inside), or instrumental activities of daily living (IADLs; e.g., medication errors). Caregiver reported sociodemographic characteristics, caregiving intensity and tasks performed, health, and psychosocial effects. Of the care recipients, 44.3% reported at least one unmet need for care in the past month (38.2% ADL related, 14.6% IADL related). Younger caregivers, caregiving sons, caregivers not living with care recipients, and having supplemental paid caregivers were associated with more unmet needs. Caregivers with recipients reporting two or more unmet needs were more likely to spend more than 100 hours per month caregiving, help with skin care and wounds, report caregiving as emotionally and physically difficult, and report restricted participation in valued activities (all P < .001). Unmet ADL needs are prevalent among older adults with family caregivers. Caregivers experiencing high levels of burden, stress, and negative physical and psychosocial impacts may provide substandard or poor care to older adults, which may be a risk factor for neglect. Clinicians caring for disabled older adults should assess their unmet needs and the capacity of caregivers to address them.

Unmet need for health care is a critical indicator of access problems. Among children, unmet need for care has special significance inasmuch as the failure to obtain treatment can affect health status and functioning in the near- and long-term. The purpose of this study was to present current prevalence estimates and descriptive characteristics of children with unmet health needs using nationally representative household survey data. We analyzed 4 years of National Health Interview Survey data spanning 1993 through 1996. Our analysis included 97 206 children <18 years old. Measures of unmet need for medical care, dental care, prescription medications, and vision care were obtained from an adult household member (usually the mother) responding for the child. Bivariate and multivariate analyses were used to assess the degree to which unmet need was related to the demographic and socioeconomic characteristics of the child and family. Overall, 7.3% (4.7 million) of US children experienced at least 1 unmet health care need. Dental care was the most prevalent unmet need. After adjustment for confounding factors, near-poor and poor children were both about 3 times more likely to have an unmet need as nonpoor children (adjusted odds ratio [95% confidence interval] = 2.89 [2.52, 3.32], 3.0 [2.53, 3.56], respectively). Uninsured children were also about 3 times more likely to have an unmet need as privately insured children (adjusted odds ratio [95% confidence interval] = 2. 92 [2.58, 3.32]). Despite the nation's great wealth, unmet health needs remain prevalent among US children. A combined public policy that addresses financial and nonfinancial barriers to care is required to reduce the prevalence of unmet need for health care.

To determine the unmet need for care and barriers for consulting sexually transmitted infection (STI) services at six primary healthcare (PHC) facilities in rural South Africa. Cross-sectional study using three community-based strategies to mobilise adult individuals with STI-associated symptoms to access care. Participants were mobilised through clinic posters and referral by community healthcare workers (CHWs) and traditional leaders after training. Men with male urethritis syndrome and women with vaginal discharge syndrome were mobilised to visit participating PHC facilities on two designated days when an expert team visited the facility. Questionnaires were completed and HIV rapid tests offered. The minimal unmet need for care of individuals with STI-associated symptoms was calculated by dividing the number of cases over the adult catchment population of each PHC facility. We successfully mobilised 177 symptomatic individuals: 134 (76%) women and 43 (24%) men. The estimated minimal unmet need for STI care was 1:364 (95% CI 1:350-1:380) individuals in this region; the rate was higher in village than township facilities, and among women. Mobilisation through clinic posters (57%) and by CHWs (23%) was most successful. Three-quarters of individuals (132/177) reported symptoms that had been present for >30days; 49% (87/177) had symptoms >6months. In addition, we identified 14 individuals with untreated HIV infection amounting to a 7% HIV testing yield. Lack of awareness of symptoms (34%), and disappointment in care due to persistent (23%) or recurrent (15%) symptoms after previous treatment, or disappointment with health services in general during previous visit(s) for any reason (10%) was the most common reasons for not consulting health care. We demonstrate a high unmet need for care of individuals with STI-associated symptoms in rural South Africa that requires urgent attention. A multidisciplinary approach that creates service demand through community awareness and information provision by healthcare workers combined with strengthening the quality of STI services is required to improve reproductive health and prevent complications of untreated STIs in this population.

PTH 5: Exclusion and Discrimination, B307 (FCSH), September 4, 2025, 15:15 - 16:09AimsThis study examines the prevalence of unmet care needs among migrant elderly in India and explores how these unmet needs are associated with health outcomes, including self-rated health, mental health, and hospitalization. As migration disrupts traditional caregiving arrangements, understanding these dynamics is crucial for designing inclusive aging policies.MethodsData were drawn from Wave 1 of the Longitudinal Aging Study in India (2017–18), a nationally representative survey of over 31,000 individuals aged 60 and above. Elderly migrants were identified based on mismatch between current and place-of-origin residence. Unmet care need was defined as having at least one limitation in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) without receiving adequate assistance. Health outcomes assessed included self-rated health, depressive symptoms (CES-D scale), and hospitalization in the past year.?Descriptive statistics were used to estimate prevalence, and multivariable logistic regression models were applied to examine associations while adjusting for socio-demographic and economic factors.ResultsAbout 23% of migrant elderly reported unmet care needs. Those experiencing unmet needs were significantly more likely to report poor self-rated health (OR = 1.67, p < 0.01), higher levels of depressive symptoms (OR = 1.84, p < 0.01), and increased likelihood of hospitalization (OR = 1.41, p < 0.05). Vulnerability was higher among elderly women, those living alone, individuals from lower-income groups, and those lacking health insurance or social support.ConclusionUnmet care needs are prevalent among migrant elderly and are strongly linked to poorer health outcomes. To ensure healthy aging, public health systems must recognize and respond to the unique care challenges of this population. Targeted interventions such as mobile health services, community-based care, and portable social protection schemes are essential to reduce health inequities among aging migrants in India.

Children dependent on mechanical ventilation are a vulnerable population by virtue of their chronic disability and are therefore at increased risk for health disparities and access barriers. The present study is the first, to our knowledge, to conduct a large-scale survey of caregivers of ventilator-dependent children to develop a comprehensive socio-demographic profile. To describe the demographic and health status profile of ventilator-dependent children, to identify the types of unmet needs families caring for a child on a ventilator face, and to determine the correlates of access to care coordination. A survey was administered to 122 parents whose children attended a pediatric home ventilator clinic at a large tertiary Midwestern medical center (84% of the clinic population). Half of the patient population had severe functional limitations, and 70% had one or more comorbidities. One quarter of caregivers reported current financial struggles, and 16% screened positive for a probable depressive disorder. More than half of families reported unmet needs for care, most frequently therapeutic services and skilled nursing care. Of those reporting an unmet need for skilled nursing care, lack of adequate staffing was the main barrier (71.1%). Financial struggles and a probable caregiver depressive disorder were significantly associated with an unmet need for care coordination. This is the first large-scale quantitative study to investigate the themes of unmet need and care coordination within this vulnerable population. The results suggest these families face barriers accessing therapeutic and skilled nursing services, and caregiver mental health and financial struggles may be important points of intervention for service providers through the inclusion of multidisciplinary care teams and the strengthening of social services referral networks.

Impoverished people who inject drugs (PWID) are at the epicenter of US drug-related epidemics. Medicaid expansion is designed to reduce cost-related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. A two-way fixed-effects model was used to analyze serial cross-sectional observational data. Seventeen metro areas in 13 US states took part in the study. Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. State-level Medicaid expansion was measured using Kaiser Family Foundation data. Individual-level self-report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two-thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage-point increase in the probability of insurance coverage, and a 9.0 (95% CI = -15.0, -0.2) percentage-point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). US Medicaid expansion may curb drug-related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non-financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample.

This cross-sectional study examined factors associated with unmet need for care from primary care physicians or from psychiatrists among clients enrolled in mental health court support programs in Toronto, Ontario. The sample included adults admitted to these programs during 2009 (N=994). Both measures of unmet need were determined by mental health court workers at program intake. Predictors included client predisposing, clinical, and enabling variables. Twelve percent had unmet need for care from primary care physicians and 34% from psychiatrists. Both measures of unmet need were associated with having an unknown diagnosis, having no income source or receiving welfare, homelessness, and not having a case manager. Unmet need for care from psychiatrists was associated with symptoms of serious mental illness and current hospitalization. Obtaining care from psychiatrists appears to be a particular challenge for justice-involved persons with mental illness. Policies and practices that improve access warrant more attention.