Unmet needs of older Americans common in many living settings

Older adults who live in retirement or senior housing communities are more likely to have unmet needs for help than are older adults who live in traditional housing, according to a new study.

About 2.5 million older adults live in these settings, nearly as many as the 3 million who live in residential care settings, including nursing homes.

"Unmet needs are common among older adults with limitations across all kinds of settings," said Vicki Freedman, research professor at the University of Michigan Institute for Social Research. "But some needs, like those related to grocery shopping, laundry and making hot meals, are more likely to go unmet for those in retirement or senior housing communities.

The study, funded by the National Institute on Aging, appears in a special issue of the Journal of Gerontology: Social Sciences that highlights research findings from the National Health and Aging Trends Study, based on data from more than 8,000 Medicare beneficiaries aged 65 and older. The NHATS is designed to provide a deeper understanding of national trends in late-life functioning, and the consequences of late-life disability for individuals, families, and society.

In their article, Freedman and colleague Brenda Spillman of The Urban Institute report that among the 3 million older adults who live in residential care settings, about one third are in nursing homes, another third are in assisted living settings, and the rest are in independent living settings.

The researchers confirm that needs differ across settings, with those in traditional housing least likely to have difficulty or receive help with daily activities. Among those with needs in traditional housing, 31 percent have an unmet need; in retirement and assisted living settings, the figures are 37 percent and 42 percent, respectively.

Differences in types of needs and other characteristics account for higher rates in assisted living but not in retirement settings. Freedman and Spillman suspect differences in availability and access to services across settings may be partly responsible.

"When we probed further, we found the risks of having any unmet need were elevated for older adults in publicly subsidized but not private retirement communities," Freedman said.

As nursing homes have changed in recent decades to focus on care for the frailest and sickest residents, an increasing proportion of the older population with limitations is living in a spectrum of residential settings, the researchers say. These trends may be cost-effective for public programs and supportive of the health, functioning and well-being of the older population in terms of ability to live in preferred, less restrictive settings.