A dynamic approach to unmet needs in long-term care for older people across Europe

Studies on unmet needs in long-term care (LTC) have focused on specific time points and have not adopted a dynamic approach that considers changes over time. This study examined the trajectories of unmet needs for care and support with activities of daily living (ADLs) and instrumental ADLs (IADLs) among adults aged 50+ across European countries up to 9 years after the onset of needs.

Using the longitudinal data from the SHARE survey (2011-2022; n = 6,154), we used latent profile analysis to identify 5 trajectory types defined by time until onset of unmet needs, number of changes of state, time spent with unmet needs, ADL/IADL limitations, and age at onset of needs. These trajectories are marked by early periods of unmet needs (short-delayed met needs; long-delayed met needs; high needs and delayed), ambivalent (U-shaped met needs), or outright positive (met needs from onset).

An overwhelming majority of older adults experienced unmet needs at some point after the onset of needs. Multivariate analysis shows that having a cohabiting spouse/partner and higher income are associated with trajectories where care is available early on. Country-level public expenditure on LTC is also a strong determinant of belonging to different trajectories. We further explored the association between these trajectories and mortality and ADL/IADL limitations.

Results confirm the relevance of transition points, such as the time around the onset of needs, highlighting the potential role for case management and discharge teams at such transitions.