Unmet home care needs among community-dwelling elderly people in Spain

Background and aims: Sociodemographic changes affecting the elderly population and the family role in providing home care call for reorganization of formal community care services. The aim of this study was to determine the prevalence of home care needs and the factors associated with unmet home care needs among community-dwelling elderly people in Spain. Methods: The data were derived from a representative sample of community-dwelling elderly people living in a town of the metropolitan area of Madrid (N=1135). Dependency for daily, weekly and monthly activities was based on disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). Insufficient help was estimated as an indicator of unmet needs. Logistic regressions were fitted to identify correlates of unmet needs for each type of activity. Results: Overall, 14, 39, and 50% of subjects reported dependency for daily, weekly and monthly activities, respectively. Of these, 40, 27, and 12% reported receiving inadequate assistance. Unmet needs were strongly associated with low monthly income, low educational level, living alone, and symptoms of depression. Families were the exclusive source of almost all assistance provided, few persons reporting the use of additional formal community care sources. Conclusions: There are considerable social and material inequalities in access to home care. In view of the poor coverage of the public system for home and personal care, these inequalities may widen in the near future. New public policy initiatives are needed to provide affordable formal family-support services.