Older adults' care networks and the pathways to unmet needs

Older adults differ widely both in the care they require and in who provides them care, often reporting significant unmet needs for assistance. Few studies have simultaneously considered the type of disability (self-care, mobility, and household activities) and multisource care networks (kin, extended-kin, non-kin, and paid help) to understand factors influencing unmet care needs among community-living older adults.

Using data from the National Health and Aging Trends Study (2011; N = 3,265; M _Age [SD] = 77 [7.74] years, 62% women), we conducted a latent class analysis to identify care network types based on older adults' functional limitations and caregiver sources. Multinomial logistic regression models predicted network membership based on personal and structural predictors. Zero-inflated Poisson regression examined the relationship between network type and unmet care needs 1 year later.

Seven distinct care network types emerged, characterized by combinations of caregiving sources and disability domains. Kin caregivers were involved across all network types. Older adults coresiding with kin typically received minimal paid help, which significantly increased their likelihood of unmet care needs in the subsequent year. Networks predominantly relying on non-kin caregivers tended to not use paid services and exhibited higher unmet care needs. Mismatches between disability type and the assistance received (e.g., requiring self-care assistance but primarily receiving household help) were associated with unmet care needs in the subsequent year.

The provision of adequate care was contingent upon the direct alignment of caregiving tasks with the functional limitations of aging adults and the effective coordination of informal and formal care resources. Enhancing care alignment through targeted assessments, supplementing family caregiving with formal services, and promoting coordinated caregiving arrangements could substantially reduce unmet care needs.