Effect of financial strain on older adults' unmet needs : Evidence from a national longitudinal study

Objectives: The aim of the study is to assess the effects of financial strain and socioeconomic factors on the unmet needs of community-dwelling older adults with disabilities. Method: Perceived unmet need for personal assistance in activities of daily living (ADL) and instrumental ADL (IADL) and for difficulties in accessing healthcare services due to financial strain and socioeconomic factors were examined for older adults using data from an eight-year longitudinal and nationally representative sample of older adults in Taiwan. Generalized estimating equations (GEE) models were employed, adjusted for demographic factors, psychosocial factors, and health conditions at baseline. Result: A total of 1389 older adults were included for analysis. Among these older adults, their ADL unmet needs ranged from eating (4.8%) to bathing (13.2%), and IADL unmet needs ranged from managing money (16.6%) to using transportation (48.3%). Around 17.8% of respondents had at least 1 ADL unmet need, 60.3% had at least 1 IADL unmet need, and 7.5% had difficulty accessing healthcare. GEE models revealed that older adults who experienced financial strain perceived higher level of unmet need for personal assistance in both ADL and IADL, and had more difficulty accessing healthcare. However, other socioeconomic factors did not show significant associations with unmet need. Conclusion: This study suggests a negative effect of financial strain on unmet needs and accessing healthcare. Policies and interventions which aim to provide personal assistance and to improve access of care for vulnerable groups are needed to eliminate the healthcare disparity for vulnerable groups among older adults.