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A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people

BACKGROUND: The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of t...

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Autores principales: Rahman, Md. Mizanur, Rosenberg, Megumi, Flores, Gabriela, Parsell, Nadia, Akter, Shamima, Alam, Md Ashraful, Rahman, Md. Mahfuzur, Edejer, Tessa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733388/
https://www.ncbi.nlm.nih.gov/pubmed/36482044
http://dx.doi.org/10.1186/s13561-022-00398-4
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author Rahman, Md. Mizanur
Rosenberg, Megumi
Flores, Gabriela
Parsell, Nadia
Akter, Shamima
Alam, Md Ashraful
Rahman, Md. Mahfuzur
Edejer, Tessa
author_facet Rahman, Md. Mizanur
Rosenberg, Megumi
Flores, Gabriela
Parsell, Nadia
Akter, Shamima
Alam, Md Ashraful
Rahman, Md. Mahfuzur
Edejer, Tessa
author_sort Rahman, Md. Mizanur
collection PubMed
description BACKGROUND: The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted. METHODS: An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual. RESULTS: After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3–13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9–13.1] vs female [14.4, 95% CI, 11.8–17.3]), educational level (primary or less [13.3, 95% CI, 9.6–17.6] vs higher [7.5, 95% CI, 5.9–9.3]), self-reported health (poor [23.2, 95% CI, 18.8–27.8] vs good [4.4, 95% CI, 3.4–5.5]), insurance status (insured [9.0, 95% CI, 7.5–10.6] vs uninsured [27.7, 95% CI, 24.0–31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1–44.9] vs richest [7.1, 95% CI, 3.8–11.3]). One in four (25.1, 95% CI, 17.1–34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts. CONCLUSION: With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13561-022-00398-4.
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spelling pubmed-97333882022-12-10 A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people Rahman, Md. Mizanur Rosenberg, Megumi Flores, Gabriela Parsell, Nadia Akter, Shamima Alam, Md Ashraful Rahman, Md. Mahfuzur Edejer, Tessa Health Econ Rev Research BACKGROUND: The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted. METHODS: An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual. RESULTS: After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3–13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9–13.1] vs female [14.4, 95% CI, 11.8–17.3]), educational level (primary or less [13.3, 95% CI, 9.6–17.6] vs higher [7.5, 95% CI, 5.9–9.3]), self-reported health (poor [23.2, 95% CI, 18.8–27.8] vs good [4.4, 95% CI, 3.4–5.5]), insurance status (insured [9.0, 95% CI, 7.5–10.6] vs uninsured [27.7, 95% CI, 24.0–31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1–44.9] vs richest [7.1, 95% CI, 3.8–11.3]). One in four (25.1, 95% CI, 17.1–34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts. CONCLUSION: With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13561-022-00398-4. Springer Berlin Heidelberg 2022-12-09 /pmc/articles/PMC9733388/ /pubmed/36482044 http://dx.doi.org/10.1186/s13561-022-00398-4 Text en © World Health Organization 2022 https://creativecommons.org/licenses/by/3.0/igo/Open AccessThis article is licensed under the terms of the Creative Commons Attribution 3.0 IGO License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the World Health Organization, provide a link to the Creative Commons licence and indicate if changes were made. The use of the World Health Organization’s name, and the use of the World Health Organization’s logo, shall be subject to a separate written licence agreement between the World Health Organization and the user and is not authorized as part of this CC-IGO licence. Note that the link provided below includes additional terms and conditions of the licence. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/3.0/igo/ (https://creativecommons.org/licenses/by/3.0/igo/) .
spellingShingle Research
Rahman, Md. Mizanur
Rosenberg, Megumi
Flores, Gabriela
Parsell, Nadia
Akter, Shamima
Alam, Md Ashraful
Rahman, Md. Mahfuzur
Edejer, Tessa
A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
title A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
title_full A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
title_fullStr A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
title_full_unstemmed A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
title_short A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
title_sort systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733388/
https://www.ncbi.nlm.nih.gov/pubmed/36482044
http://dx.doi.org/10.1186/s13561-022-00398-4
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