Unmet Need For Assistance Research Articles

Unmet Needs for Support in Activities of Daily Living among Older Persons: The Effects of Family and Household Structures in a Low- and Middle-Income Context.

The unmet need for assistance in activities of daily living (ADLs) accentuates older persons' risk of falls, ill health, hospitalisation, and mortality. In Nigeria, the family arrangements through which older persons derive support are changing due to modernisation, migration, and economic challenges. How the family dynamics explain the unmet needs is poorly understood. This study investigates the influence of family and household structures on older persons' unmet needs in ADLs in southwestern Nigeria. The study analysed the data of 827 older adults aged ≥65 years selected from Oyo State, southwestern Nigeria, using a multi-stage sampling design. Associations were examined using the Poisson-logit hurdle regression model. From the results, 65% of older persons with difficulties had unmet needs in instrumental ADLs and 59% in basic ADLs. Increased unmet needs were associated with older persons living with non-family members (β = 0.19; p < 0.01; 95% C.I. = 0.05-0.32) and widows (β = 0.27; p < 0.01; 95% C.I. = 0.13-0.42). Conversely, unmet needs decreased with higher family size (β = -0.06; p < 0.001; 95% C.I. = -0.08--0.03), living in rich households (β = -0.29; p < 0.001; 95% C.I. = -0.42--0.17), not being the household head (β = -0.27; p < 0.001; 95% C.I. = -0.40--0.15), close family bonds, and proximity to children/caregivers. The study recommends alternative or complementary home-based support mechanisms for seniors with vulnerable family settings in southwestern Nigeria.

Using decision tree analysis to identify population groups at risk of subjective unmet need for assistance with activities of daily living

BackgroundIdentifying predictors of subjective unmet need for assistance with activities of daily living (ADL) is necessary to allocate resources in social care effectively to the most vulnerable populations. In this study, we aimed at identifying population groups at risk of subjective unmet need for assistance with ADL and instrumental ADL (IADL) taking complex interaction patterns between multiple predictors into account.MethodsWe included participants aged 55 or older from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Subjective unmet need for assistance was defined as needing any help or more help with ADL (analysis 1) and IADL (analysis 2). Analysis 1 was restricted to participants indicating at least one limitation in ADL (N = 1,957). Similarly, analysis 2 was restricted to participants indicating at least one limitation in IADL (N = 3,801). Conditional inference trees with a Bonferroni-corrected type 1 error rate were used to build classification models of subjective unmet need for assistance with ADL and IADL, respectively. A total of 36 variables representing sociodemographics and impairments of body function were used as covariates for both analyses. In addition, the area under the receiver operating characteristics curve (AUC) was calculated for each decision tree.ResultsDepressive symptoms according to the PHQ-8 was the most important predictor of subjective unmet need for assistance with ADL. Further classifiers that were selected from the 36 independent variables were gender identity, employment status, severity of pain, marital status, and educational level according to ISCED-11. The AUC of this decision tree was 0.66. Similarly, depressive symptoms was the most important predictor of subjective unmet need for assistance with IADL. In this analysis, further classifiers were severity of pain, social support according to the Oslo-3 scale, self-reported prevalent asthma, and gender identity (AUC = 0.63).ConclusionsReporting depressive symptoms was the most important predictor of subjective unmet need for assistance among participants with limitations in ADL or IADL. Our findings do not allow conclusions on causal relationships. Predictive performance of the decision trees should be further investigated before conclusions for practice can be drawn.

The Impact of Unmet ADL Need on the Self-Rated Health and Life Satisfaction of Chinese Older Adults

This study aims to examine the associations of change in unmet need for assistance with Activities of Daily Living (ADL) with the self-rated health and life satisfaction of community-dwelling Chinese older adults. Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of unmet ADL need with self-rated health and with life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 older adults with ADL limitation. Change in unmet ADL need was categorized into “Persistently Unmet”, “Unmet at T1 Only”, “Unmet at T2 Only”, and “Never Unmet”. Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographic factors, health conditions, and social support. The results showed that older adults whose ADL needs were persistently unmet, those unmet at T2 only, and those never unmet, experienced a significant decline in self-rated health from baseline to follow-up, but those unmet at T1 only experienced a significant rise in self-rated health. While the life satisfaction was stable from baseline to follow-up among older adults whose ADL needs were persistently unmet or never unmet, it significantly decreased among those unmet at T2 only and significantly increased among those unmet at T1 only. The effects of unmet ADL need on self-rated health and life satisfaction appeared to be short-term rather than long-term. These findings facilitate a better understanding of unmet ADL need and emphasize the importance to fully meet the ADL needs of older adults.

The Impact of Unmet ADL Need on the Self-Rated Health and Life Satisfaction of Chinese Older Adults

Racial and ethnic disparities in influenza vaccination among nursing home (NH) residents are well-documented and have persisted over time, suggesting that new strategies are necessary to reduce disparities. We conducted a retrospective cohort study to examine the degree to which observable characteristics drove influenza vaccination disparities. We linked Minimum Data Set (MDS) assessments to facility-level data for short- and long-stay NH residents aged ≥65 years. We included residents with six-month continuous enrollment in Medicare and an MDS assessment during the influenza season (October 1, 2013 through March 31, 2014). Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparities in vaccination between White versus Black and White versus Hispanic residents. We analyzed short- and long-stay residents separately. Our study included 630,373 short-stay and 1,029,593 long-stay residents. Among short-stay residents, 67.2% of Whites, 55.1% of Blacks, and 54.5% of Hispanics were vaccinated against influenza; among long-stay residents, 84.2% of Whites, 76.7% of Blacks, and 80.8% Hispanics were vaccinated against influenza. Across the four comparisons, the crude disparity in influenza vaccination ranged from 3.4-12.7 percentage points. By equalizing 27 characteristics, these disparities could be reduced by 37.7%-59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors to the disparity, although characteristics unmeasured in our data (e.g., NH staff attitudes and beliefs) contributed 40.8%-62.3% to the disparity across comparisons. Intervening on factors associated with NH quality may reduce racial/ethnic disparities in influenza vaccination. Qualitative research is essential to explore potential contributors not captured in our administrative data.

The relationship between unmet need for home and community-based services and health and community living outcomes

BackgroundFew studies have examined user-reported perspectives about the quality and sufficiency of home and community-based services (HCBS) and their relationship to key health and community living outcomes. ObjectiveTo examine the association between unmet need for HCBS and health and community living outcomes in a multi-state, multi-program sample of Medicaid HCBS users. MethodsWe used data from the 2017–2018 National Core Indicators-Aging and Disability (NCI-AD) survey, collected among older adults and adults with physical disabilities who were receiving Medicaid HCBS across 13 states (N = 10,263). We conducted descriptive analysis on the demographic, functional, and health characteristics of the sample, and examined the prevalence of unmet need for HCBS across five domains: 1) assistance with daily activities, 2) assistive technology, 3) home modifications, 4) transportation, and 5) sufficiency of services for meeting user needs and goals. We used logistic regressions to estimate adjusted odds ratios for the association between unmet need for HCBS and health care utilization (ED visits, hospital/rehab stays, preventative care) and community living outcomes (active in the community, interacting with family/friends, satisfaction, control). ResultsAcross the five domains, prevalence of unmet need ranged from 21% (unmet need for assistance with self-care or other daily activities) to 54% (unmet need for assistive technology). Individuals who experienced unmet need had consistently worse health and community living outcomes than those who reported no unmet need, after adjusting for key user demographic, functional, and social characteristics (p < 0.05). ConclusionsUnmet need for HCBS is consistently and significantly associated with poor health and community living outcomes among Medicaid users.

Help after Hardship: Trends and Disparities in Sources of Support following Experiences with Material Hardship

When faced with material hardships like missing a rent payment or having telephone service disconnected, where do people find help? Using data from the Survey of Income and Program Participation, I examine the receipt of assistance following material hardships. I find that most people do not receive assistance following a hardship, but when people do receive assistance, social ties are a more common source of support than public and private safety net institutions. I find that the likelihood of receiving assistance varies by type of hardship experienced, and there has been a notable increase over time in the likelihood of receiving assistance following telephone service disconnection or utilities payment hardship. The findings also reveal differences across social and demographic groups. Overall, the findings contribute to understandings of how families make ends meet during hard times and draw attention to high levels of unmet need for assistance among households experiencing hardship.

Gender difference in unmet need for assistance with activities of daily living among disabled seniors in China : a cross-sectional study

ObjectivesThis study explores the gender difference in unmet need for assistance with activities of daily living among older adults with disabilities in China.DesignLogistic regression analysis was employed to examine the...

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life.

To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). Cross-sectional. US - 50 states, District of Columbia, and Puerto Rico. Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers

Teenagers under 18 could legally purchase e-cigarettes until states passed minimum legal sale age laws. These laws may have curtailed teenagers' use of e-cigarettes for smoking cessation. We investigate the effect of e-cigarette minimum legal sale age laws on prenatal cigarette smoking and birth outcomes for underage rural teenagers using data on all births from 2010 to 2016 from 32 states. We find that the laws increased prenatal smoking by 0.6 percentage points (pp) overall. These effects were concentrated in prepregnancy smokers, with no effect on prepregnancy non-smokers. These results suggest that the laws reduced cigarette smoking cessation during pregnancy rather than causing new cigarette smoking initiation. Our results may indicate an unmet need for assistance with smoking cessation among pregnant teenagers.

Alcohol Consumption and Management Strategies Among Gay Bar Patrons in San Francisco and Oakland, CA

Despite significant attention on gay men’s substance use, much remains unknown about how environmental factors may contribute to gay men’s elevated drinking patterns. We undertook a qualitative study of 51 gay bar patrons in San Francisco and Oakland, CA, in an effort to better understand the context of drinking motivations and management within the gay community in San Francisco and Oakland and to identify areas for potential interventions to encourage drinking moderation. A thematic analysis framework guided the process used to identify overarching themes and organize data around the social ecological framework. A focus on drinking motivations and management strategies emerged as a recurring theme across interviews. In this article, we describe alcohol consumption and management strategies that suggest that gay bar patrons experience encouragement from the individual, interpersonal, community, and structural levels to drink and that environmental and internal motivators for drinking often override participant’s intentions and individualized strategies for moderation. Our findings suggest an unmet need for assistance in helping men to create effective harm reduction strategies around drinking, as well as an opportunity for creating interventions that address community- and structural-level motivators for drinking and management.

Unmet need for assistance with activities of daily life among older adults in Brazil.

ABSTRACTOBJECTIVE To estimate the proportion of unmet need for personal assistance for basic and instrumental activities of daily life and to evaluate socioeconomic inequalities related to the unmet need among community-dwelling Brazilian older adults.METHODS This was a cross-sectional study with data from the last National Health Survey in Brazil. Unmet need was considered as the presence of at least one unmet need for basic or instrumental activities of daily life among individuals reporting the need for assistance. Logistic regression models were used to assess the correlates and probabilities of unmet need.RESULTS The proportion of unmet need was 18% and 7.1% for basic and instrumental activities of daily life, respectively. Unmet need was significantly related to living arrangements and socioeconomic status. Individuals in the first quintile of wealth status had about 50% higher probability of having an unmet need. A family member was the most prevalent type of caregiver.CONCLUSIONS Long-term care policy is needed to reduce the proportion of unmet need, especially among socioeconomically disadvantaged groups. Future studies should address the availability, training, and remuneration of caregivers, as those are an indispensable labor force in an aging society.

Abstract P5-13-12: Symptom burden, unmet need for assistance, and psychosocial adaptation among longer term breast cancer survivors

Abstract Introduction: Advances have improved survival among breast cancer (BC) patients and 89% can expect &amp;gt;5 year survival. The price for this survival, however, may be physical and psychosocial symptoms that persist many years into the survivorship trajectory. Unmet needs for symptom management and the relationships between unmet needs, symptom burden, and psychosocial adaptation remain unclear. We examined these relationships among longer term BC survivors. Method: Eligibility included non-metastatic BC survivors diagnosed &amp;gt; 3 years prior and attendance at a survivorship-focused appointment. Nineteen common symptoms of disease and treatment were evaluated and participants reported unmet need for assistance for each symptom they experienced. Psychosocial adaptation was assessed through the Hospital Anxiety and Depression Scale (HADS). Results: 103 primarily white (72%), middle aged (M=62.7 yrs) BC survivors were recruited. Participants were, on average, 11.4 yrs from diagnosis and most (78.2%) reported Stage I or II BC. Participants reported an average of 9.2 symptoms, most commonly fatigue (67%), joint pain (66%), weight gain (60%), decreased sexual drive (55%), and insomnia (52%). Participants reported an average of 2.8 unmet needs for assistance with symptoms, most commonly joint pain (29%), fatigue (25%), weight gain (23%), and difficulty with memory (21%). Overall levels of depressive (M=2.45) and anxiety (M=4.89) symptoms were low, and elevated depressive and anxiety symptoms were reported by 3% and 18% of the sample, respectively. Number of symptoms and anxiety were unrelated to any demographic, disease or treatment variables. Depressive symptoms and unmet needs were related younger age (p &amp;lt; .05) and depressive symptoms were further related to not having received radiotherapy (p &amp;lt; .05). Number of symptoms experienced and unmet needs were moderately related to both depressive (all r &amp;gt; 0.49, p &amp;lt; .001) and anxiety symptoms (all r &amp;gt; 0.31, p &amp;lt; .01). Conclusion: Among long term BC survivors symptoms are common, while unmet need and symptoms of anxiety and depression are more modest. However, both symptoms and unmet need are associated with symptoms of depression and anxiety and represent a potentially missed opportunity for improving outcomes among BC survivors. Citation Format: Palmer SC, Blauch AN, Pucci DA, Jacobs LA. Symptom burden, unmet need for assistance, and psychosocial adaptation among longer term breast cancer survivors [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-13-12.

Association of anxiety and depressive symptoms with differing needs among recent breast cancer (BC) survivors.

244 Background: Although unmet needs are associated with general distress in long term BC survivors, it is unclear is different needs are associated with specific outcomes such as anxiety and depression among recent BC survivors. Such work may provide insight into the interventions needed to improve outcomes early in survivorship for patients. Methods: Eligibility included non-metastatic BC treated &lt; 1 year prior. Prior to an initial survivorship visit, participants completed a PRO symptom measure and reported unmet need for assistance for symptoms experienced. Overall unmet need and unmet need domains (physical, psychosocial, sexual, hormonal) were examined. Anxiety and depressive symptoms were assessed using the HADS. Results: Participants (N = 137) were primarily white (72%), middle-aged (M = 55 yr), and treated for Stage I (47%) or II (38%) BC. Anxiety (M = 5.57, SD = 4.08) and depression (M = 3.21, SD = 3.33) were in the normal range, on average. 29% and 13% met “caseness” (i.e., above criteria for significant elevation) for anxiety and depression, respectively. Caseness for anxiety and depression were not significantly related to demographic variables, time from end of treatment, disease characteristics or treatment exposures (all p &gt; 0.05). Meeting criteria for depression was associated with greater overall unmet need (M = 6.11 vs. M = 2.11, p &lt; 0.001) and need in the physical (M = 2.66 vs. M = 0.83; p &lt; 0.001) and psychosocial (M = 2.56 vs. M = 0.49; p &lt; 0.001) domains, but unrelated to unmet sexual or hormonal needs (all p &gt; 0.05). Meeting criteria for anxiety was associated with greater unmet need in the hormonal (M = .47 vs. M = 0.17; p &lt; 0.05) and psychosocial (M = 1.33 vs. M = 0.55; p &lt; 0.002) domains, but unrelated to unmet overall, physical or sexual needs (all p &gt; 0.05). Conclusions: Unmet needs relate differentially to anxiety and depression in recent BC survivors. In particular, depression is associated with more than 3 times the number of unmet physical needs, while anxiety is associated with more than 2.5 times the number of unmet hormonal needs. Assessing psychosocial outcomes in the absence of unmet needs may represent a missed opportunity for intervention to improve outcomes for specific groups of survivors.

Patient-reported outcomes (PROs), unmet need, and psychosocial adaptation among recent breast cancer (BC) survivors.

212 Background: BC survivors have physical and psychosocial symptoms which, if unaddressed, result in unmet need. Unmet need has been examined primarily in long term survivors, and understanding the characteristics associated with unmet need is under-studied among recent patients. Methods: Eligibility included non-metastatic BC treated &lt; 1 year prior. Participants completed a PRO symptom measure and reported unmet need for assistance for symptoms. Concerns about recurrence risk, late effects, health maintenance, family needs, and hereditary risks were assessed. Anxiety and depressive symptoms were assessed using the HADS; quality of life (QoL),using the SF-12. Results: Participants (N = 137) were primarily white (72%), middle-aged (M = 55 yrs), and treated for Stage I (47%) or II (38%) BC. Participants reported an average of 10.7 symptoms (R = 0-18), while unmet need was less common (M = 2.6, R = 0-15). Physical and mental health QoL were similar to norm values (M = 48.0; M = 53.5). 13% and 29% met “caseness” (i.e., criteria for significant elevation) for depression or anxiety on the HADS, respectively. Unmet need was trichotomized into no (0), low (1-3), and elevated (4-15) groups. Level of unmet need was not predicted by demographic variables, time from end of treatment, treatment exposure, staging, or physical QoL. Groups differed significantly with respect to level of patient concern, mental health QoL, anxiety and depression, and meeting caseness for depression on the HADS (all p &lt; 0.03) with elevated needs being associated with worse outcomes. In multivariate analysis, overall unmet need was independently predicted by depression and level of survivorship concerns (R2 = .28, p &lt; .001). Conclusions: In the year after treatment, patient reported symptoms are common, but unmet need is less common. QoL is similar to national norms. Higher unmet need is associated with worse psychosocial adaptation, including QoL, patient concerns, anxiety, and depression. In particular, depression and survivorship concerns independently predict unmet need. Addressing unmet needs among recent BC survivors may be one means of improving the psychological functioning of these survivors.

Unmet Need for ADL Assistance Is Associated With Mortality Among Older Adults With Mild Disability.

Unmet need for assistance with activities of daily living (ADLs) disability is associated with increased risk for future hospitalization. To further explore the association between unmet ADL need and future health outcomes, we examined the association between unmet need for ADL assistance and 1-year mortality. A prospective study of 6,730 community-living Medicare recipients was conducted among respondents to the 1994, 1999, and/or 2004 National Long Term Care Survey. Only those who reported having one or more ADL disabilities were included. Time to death within 1 year after the community survey was determined from Centers for Medicare and Medicaid Services vital statistics records. The community interviews provided demographic, health, and ADL information. Unadjusted 1-year death rates were 8.7%, 10.6%, 11.4%, 19.2%, and 27.3%, respectively, for respondents with disabilities in 1, 2, 3, 4, and 5 ADLs. Overall, 21.3% reported unmet need for assistance for one or more ADL disabilities. After controlling for demographic and health characteristics, we found a significant interaction between unmet ADL need and level of ADL disability (p = .018). Post hoc analyses revealed that unmet ADL need was associated with increased risk for mortality only for those with one (hazard ratio = 1.96; 95% CI = 1.29-2.87) or two ADL disabilities (hazard ratio = 1.37; 95% CI = 1.07-1.75), but not for those with three or more ADL disabilities. Future studies are needed to determine whether these findings are replicable and, if so, whether physiologic or process of care variables explain why ADL is associated with mortality only for those with mild disability.

Met and unmet need for personal assistance among community-dwelling New Zealanders 75 years and over

Ageing in place initiatives that aim to keep older people out of hospitals and rest homes and in their own homes for longer have been at the forefront of aged care policy since the early 1990s. The success of these policies depends largely on the availability of a suitable home environment, a supportive social network and regular assessment to detect changes in the older person's health status and needs for support. The BRIGHT Trial was a randomised control trial investigating the effectiveness of introducing case finding in primary care settings to detect unmet need and risk of disability among older people. We used baseline questionnaire data collected in 2008-2009 from 3753 community-dwelling older people to estimate and describe use and need for additional personal assistance. Logistic regression was used to identify the most important predictors of reporting some need for support and unmet need. Eighty-one per cent of participants required support with at least one instrumental activity of daily living. Sixty-six per cent were meeting their needs with the support they were currently receiving. Unmet need was most frequently reported for heavy housework (65%) and light housework (53%). While spouses, family members and friends were the main providers of support for light housework, meal preparation, shopping, finances and transportation, paid staff most frequently provided personal care and heavy housework assistance. Reporting mobility difficulty (OR = 3.5), identifying as a care provider (OR = 1.7) and being female (OR = 1.9) were all significant predictors of some need for assistance as well as unmet need for assistance (OR = 2.5, 1.7 and 1.7 respectively). The findings highlight the importance of regular needs assessment for older people living in the community particularly, given the reliance on spousal support for the majority of activities.

(In)Formal Support and Unmet Needs in The National Long-Term Care Survey

We linked individual-level data from the 2004 wave of the National Long-Term Care Survey with state-level data from the National Aging Program Information Systems (NAPIS) State Program Reports to predict care mix and unmet need for assistance. Our sample consisted of 2422 community-dwelling individuals aged 65 and older (69% women, 8% nonwhite) who reported at least one limitation in an instrumental or basic activity of daily living. We used the data to predict the mix of formal and informal support received, and the probability of having at least one unmet need from individual (predisposing, enabling, and need) characteristics with statelevel home help coverage rates, intensity of home help services, and proportion of population aged 60+ residing in institutional settings. Consistent with past research, a majority (52.6%) of the disabled sample reported unmet need. At the individual level, enabling (availability of kin support) and need (number of basic and instrumental activity of daily living impairments, BADLs and IADLs) were most strongly associated with care mix and unmet need. Statelevel services were not associated with receipt of informal supports. In states providing home help services to a higher proportion of elders, women were more likely to receive formal help. In states providing more intensive services, women were less likely and individuals living alone more likely to receive formal supports. In states where a higher proportion of elders lived in nursing homes, individuals living alone were more likely to receive formal assistance, less likely overall to report unmet needs, but the oldest-old were more likely to report unmet need.

Unmet Need for Assistance to Perform Activities of Daily Living and Psychological Distress in Community-Dwelling Elderly Women

Community-dwelling seniors increasingly require physical assistance to perform the activities of daily living (ADL). To examine the possible association of this need with psychological distress, we conducted a prospective cohort study of community-dwelling people age 75 and older in Montreal, Canada. We report the results for women only (n = 530). Multivariable linear regression was used to examine the association between met and unmet need in instrumental ADL (IADL) and personal ADL (PADL) with concomitant psychological distress. Unmet IADL need was associated with elevated psychological distress [β = 0.42 (95% CI: 0.26, 0.60)], as was met IADL need [β = 0.19 (95% CI: 0.06, 0.33)], but not met and unmet PADL need. The full model explained 32.8 per cent of the total variance in psychological distress. Receiving assistance to meet IADL needs is associated with elevated psychological distress. Not receiving assistance, however, is associated with even greater distress.

Use of Eye Care Services and Need for Assistance in the Visually Impaired

To assess the use of eye care services and unmet need for assistance in visually impaired people. Cross-sectional population-based survey on a sample representing the Finnish population aged 30 years and older. Of the 7979 eligible people, 6645 (83.3%) were both interviewed and had their distance visual acuity (VA) assessed. One hundred forty-seven people were classified as visually impaired (VA < or = 0.25). A home interview included an assessment of the use of eye care services, need for assistance, sociodemographic variables, cognitive functioning, and mobility. Binocular VA for distance was measured with the participants' current spectacles, if any, as a part of a comprehensive health examination. One-half (58%) of visually impaired people had had a recent vision examination and 79% had received some vision rehabilitation services, mainly in form of spectacles (70%). Only one third (31%) had received formal low vision rehabilitation. People with moderate visual impairment (VA 0.1 to 0.25) were less likely to have received low vision rehabilitation, magnifying glasses, or other low vision aids compared with people with severe low vision (VA < 0.1). Furthermore, low cognitive capacity and living in an institution were associated with limited use of vision rehabilitation services. Of the visually impaired people living in the community, 71% reported need for assistance and 24% of them had unmet need for assistance in everyday activities. Although need for assistance was more common in people with severe low vision (83% vs. 67%, p = 0.09), unmet need for assistance seemed to be more common in people with moderate low vision (20% vs. 9%, p = 0.23). Many visually impaired people, older persons in particular, have not had a recent vision examination and lack adequate low vision rehabilitation. This highlights the need for regular evaluation of vision function in elderly people and for actively supplying information about rehabilitation services.

The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability.

This article investigates the prevalence, determinants, and consequences of unmet need for assistance with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and transportation in a randomly selected sample of adults with disability residing in Springfield, Massachusetts. Respondents were contacted through random digit dialing, and eligibility was determined through a disability screen. Eligible individuals were stratified by age; 632 people were interviewed (78% of contacted eligibles). The prevalence of need and unmet need for ADLs, IADLs, and transportation assistance was calculated separately by age strata, as was the prevalence of selected negative consequences attributed to inadequate help with specific activities. The determinants of unmet need were modeled using logistic regression. The prevalence of unmet need for assistance with individual ADLs ranged from 4.1% (eating) to 22.6% (transferring) of the full sample. Unmet need for IADLs assistance was higher, ranging from 15.9% (cooking) to 34.6% (heavy housekeeping). Respondents younger than age 65 reported higher levels of unmet need for IADLs and transportation help than respondents age 65 or older; members of the younger group also were more likely to report five of the seven negative consequences attributed to inadequate help with IADLs and transportation (eg, missing medical appointments). Regression results revealed inability to meet expenses, having few or no reliable helpers, and impairment severity to be key determinants of unmet need. Financial problems, and not age per se, placed working age adults at elevated risk of unmet need in this study. The consequences of inadequate help can impede management of chronic health conditions, and may compromise individuals' ability to maintain a safe and reasonable quality of community living.