Unmet needs and fall risk among older adults: evidence from Europe using SHARE data

Falls are a significant cause of disability, hospitalization, and loss of autonomy in older adults. Although unmet care needs are known to worsen health outcomes (e.g. reduced quality of life, disability), their association with fall risk among frail community-dwelling older adults remains unclear. This study examines this relationship. We used panel data from waves 6-9 (2015-22) of the Survey of Health, Ageing and Retirement in Europe for adults aged 50+. The analytic sample included 872 non-frail individuals (3001 observations) and 1061 frail individuals (3552 observations). We examined the association between unmet needs for assistance with activities of daily living and falls among frail and non-frail individuals. Two-way fixed effects models with lagged exposures were estimated to account for time-invariant individual heterogeneity and reduce reverse causality. Analyses distinguished between unmet formal and informal care needs. Among frail individuals, unmet needs (compared to met needs) for formal care were associated to 18.8 percentage point increase in fall risk (95% CI, 0.1-37.6; P = .049), while unmet needs for informal care raised the risk by 22 percentage points (95% CI, 0.1-45.1; P = .049). No significant associations were found among non-frail individuals. Effects were particularly pronounced among women, those living alone, and adults aged 70+. Unmet care needs significantly increase the risk of falls among frail older adults. Targeted public health strategies are essential to prevent falls, preserve autonomy, and limit long-term care burdens in the frail population.