Family Structure and Unmet Care Needs Among Older Adults With and Without Dementia in the United States

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 2 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.