Department of Sociology, The University of Texas at San Antonio, San Antonio, Texas, USA.
Population Research Center, The University of Texas at Austin, Austin, Texas, USA.
Gerontologist. 2024 Apr 1;64(4). doi: 10.1093/geront/gnad094.
Although disparities in disability and the unequal distribution of care resources are widely discussed in the literature, there has been less research on disparities in experiencing unmet care needs among older adults. This study aims to investigate how unmet care needs are unevenly distributed across social groups with various intersecting identities, such as race/ethnicity, nativity, and gender, although considering their care needs and care networks, drawing on the conceptual framework of the pathway to unmet needs.
The data for this study came from the National Health and Aging Trends Study (2011-2018), and the study sample consisted of 7,061 Medicare beneficiaries who needed assistance with daily activities. Questions about unmet care needs were in the form of consequences related to difficulty or lack of help with daily activities. Mixed-effects negative binomial regression models were used to predict rates of unmet needs.
Older adults of color, especially women, experienced higher rates of unmet care needs compared with their White and male counterparts. Although Black-White and gender differences in unmet needs were mostly explained by unequal exposures to care needs and differential care networks, Hispanic women and foreign-born Hispanic men were still at a disadvantage even after adjusting for these covariates.
These results emphasize the importance of adopting an intersectional approach to enhance the quality of long-term services and support for older adults facing social disadvantages.
尽管残疾和医疗资源分配不均在文献中被广泛讨论，但对于老年人未满足的护理需求存在差异的研究相对较少。本研究旨在探讨在考虑到护理需求和护理网络的情况下，尽管种族/民族、出生地和性别等各种交叉身份的社会群体之间存在差异，但如何根据未满足需求的途径这一概念框架，来研究未满足的护理需求在社会群体中是如何不均匀分布的。
本研究的数据来自国家健康老龄化趋势研究（2011-2018 年），研究样本包括 7061 名需要日常活动帮助的医疗保险受益人。关于未满足的护理需求的问题以与日常活动的困难或缺乏帮助相关的后果的形式出现。采用混合效应负二项回归模型来预测未满足需求的比率。
与白人及男性相比，有色人种老年人，尤其是女性，经历更高的未满足护理需求的比率。尽管黑人和白人之间以及男女之间的未满足需求差异主要是由对护理需求的不平等暴露和不同的护理网络解释的，但即使在调整了这些协变量后，西班牙裔女性和出生在国外的西班牙裔男性仍处于不利地位。
这些结果强调了采用交叉方法的重要性，以提高面临社会劣势的老年人的长期服务和支持的质量。
