An exploration of help-seeking behaviour in older people with unmet needs.
BACKGROUND
Despite decades of research showing high rates of unmet need in older people, there currently is little understanding of why these needs remain unmet. This study was performed as part of a larger feasibility study of a multidisciplinary needs assessment tool in primary care.


OBJECTIVE
The aim of the present study was to explore patients' and carers' help-seeking behaviour and perceived barriers to meeting unmet needs.


METHODS
Four general practices were selected purposefully in inner city and suburban London A random sample of 1 in 20 people aged 75 years and over registered with each practice was selected for a multidisciplinary needs assessment using the 'Camberwell Assessment of Need for the Elderly' (CANE) schedule and unmet needs identified by patients and their informal carers. For each unmet need, a further semi-structured interview was used to explore the help-seeking behaviour and perceived barriers to meeting their needs. Responses were recorded verbatim contemporaneously and a thematic analysis performed on perceived barriers following completion of all interviews.


RESULTS
A total of 55/84 (65.5%) of patients and 15/17 (88%) of carers completed the initial needs assessment. For 104 unmet needs identified by 31 patients and 11 carers, a further interview was completed on the barriers to meeting that need. Help had been sought for only 25/104 (24%) of unmet needs and it had been offered in only 19/104 (18%). In those not seeking help, withdrawal, resignation and low expectations were dominant themes. In those that had sought help, there were issues of perceived failure of service delivery and rationing, with themes of resignation and withdrawal again emerging in those declining help offered.


CONCLUSIONS
The majority of older people and their carers do not appear to seek help for their unmet needs for a range of complex reasons, often involving issues of withdrawal, resignation and low expectations. This complexity has implications for the commissioning of services for older people.
Walters
K
K
Department of Primary Care and Population Sciences, Royal Free and University College Medical School, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London N19 3UA, UK.
Iliffe
S
S
Orrell
M
M
D000203:Activities of Daily Living; D000368:Aged / Q000523:psychology* / Q000706:statistics & numerical data; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D005194:Family Practice / Q000592:standards*; D005260:Female; D015577:Geriatric Assessment; D006297:Health Services Accessibility / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008131:London; D008297:Male; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires