The unmet activities of daily living (adl) needs of dependent elders and their related factors: An approach from both an individual- and area-level perspective

Background: The unmet activities of daily living (ADL) needs often lead to negative consequences in dependent elders. This study examines disabled elders' unmet ADL needs and the factors associated to those unmet needs. Methods: Data from a representative sample from Taiwan of 6820 elders and family caregiver dyads were analyzed, using hierarchical linear modeling to identify the individual- and area-level factors. Standardized measures were administered through face-to-face interview. Results: The highest percent of unmet ADL needs was for climbing stairs (21.0%), and the lowest pertained to eating (5.9%). The mean age of the respondents in this study was 79.25 years. The majority of respondents were female (59.3%). The mean ADL score was 55.39, showing a medium level of dependency. The mean instrumental activities of daily living (IADL) limitation number was 7.49. The results revealed the following factors as important: education level; living arrangements; number of illnesses; number of IADL limitations; caregiver's age; the caregiver-patient relationship; care burden; household size; interaction between welfare expense and service uptake; and between welfare expense and the number of IADL limitations. Conclusion: Our results show that social welfare expenditure moderates unmet needs by provision of services, which means that the positive effect of social welfare services cannot be ignored; therefore, the government should play a supervisory role. In addition, the definition and measurement of unmet needs must be further clarified to assess accurately the prevalence of such needs, and further research should be undertaken on the adverse consequences of unmet needs.