Family Structure and Unmet Care Needs among Older Adults with and without Dementia in the U.S.

Abstract

Background and objectives: Family members provide the bulk of assistance to older adults with care needs, but implications of family structure for unmet care needs-and differences when dementia is present-are less clear.

Research design and methods: We use samples of older adults with care needs from the 2015 National Health and Aging Trends Study (NHATS) and the 2017 Panel Study of Income Dynamics (PSID). We examine two measures that indicate whether needs are being met for self-care and mobility activities: having unassisted difficulty with at least one activity (NHATS, PSID) and experiencing any adverse consequences related to a lack of help (NHATS). In NHATS we also combine these to identify individuals with met (no unassisted difficulty; no consequences), self-met (unassisted difficulty only), under-met (any consequence only), and unmet needs (unassisted difficulty, any consequence).

Results: Adverse consequences were reported more often among those with dementia (43%) relative to those without (24%); in contrast, unassisted difficulty was reported by fewer older adults with dementia (68%, 70%) than without dementia (85%, 87%). Having more family members was positively associated (OR=1.039) and having a spouse or partner was inversely associated (OR=0.700) with experiencing adverse consequences. Having stepchildren was associated with lower odds of having unassisted difficulty (OR=0.228, 0.531), but greater odds of unmet (relative to met) needs (RRR=1.610). Most family associations were not moderated by dementia.

Discussion and implications: Adverse consequences, unassisted difficulty, and unmet need are distinct concepts, and produce different estimates and distinctive relationships with dementia and family structure.