Unmet social care needs among older people in England: determinants, costs and outcomes

Background. Unmet social care needs are an important problem for England’s ageing
population. This PhD study aimed to address research gaps relating to the determinants,
consequences and costs of unmet need among older people living in private households in
England.

Methods. A literature review was carried out to identify the determinants of unmet need, care
receipt and source of care. Data from the English Longitudinal Study of Ageing (ELSA) was
analysed to assess the determinants of unmet need and the association between unmet need and
the progression of frailty over the following two years. Economic modelling was done using a
decision tree connected to a Markov cohort model to assess the potential costs and benefits of
shortening waiting lists for home care.

Results. The review included ten studies, which all used ELSA data. The data analysis found
that living alone was a risk factor for unmet need, except in the wealthiest quartile. Local
authority deprivation was positively associated with unmet need. Unmet need had a borderline
significant association with lower odds of worsening frailty over the following two years. The
economic model showed that shortening waiting lists for home care by six months would lead
to an increase in life years, social care-related quality of life and informal carers’ earnings, as
well as to a reduction in NHS and private costs. However, it would also lead to increased
personal social services costs and public sector costs.

Conclusion. This PhD study calls for more research on the consequences of unmet need.
Further research would require data with detailed information on older people’s difficulties
with activities of daily living and information on whether those without help think they would
need or want help.