title: The adverse consequences of unmet need among older persons living in the community: dual-eligible versus Medicare-only beneficiaries.
abstract: OBJECTIVE
  Our objective is to estimate and compare the prevalence of selected adverse consequences associated with unmet need for assistance among a socioeconomically and medically vulnerable subgroup of the older adult population, those who are dually eligible for Medicare and Medicaid, with those eligible for Medicare only.
  
  
  METHODS
  Using data from the National Health and Aging Trends Study (NHATS), a representative survey of the older Medicare population, we calculated the prevalence of disability-related need for assistance with self-care, household tasks, and mobility activities and the prevalence of adverse consequences of unmet need by dually eligible and Medicare only status.
  
  
  RESULTS
  Over 2 million community-dwelling older persons experienced an adverse consequence due to unmet need for assistance with self-care (e.g., soiled their clothes), over 2 million experienced adverse consequences due to unmet need for assistance with household tasks (e.g., went without groceries), and over 3 million persons experienced at least one adverse consequence of unmet need for assistance with mobility-related activities (e.g., had to stay in bed) in the month prior to the NHATS interview. Dually eligible persons experienced higher rates of 6 of the 11 adverse consequences studied and were more likely to have at least one adverse consequence in all 3 domains than others.
  
  
  CONCLUSIONS
  Several care models are emerging with the goal of integrating medical care, behavioral health, and long-term services for the dual eligible population. Indicators of adverse consequences of unmet need could be used to monitor the quality and adequacy of such care systems.
authors.affiliation: Providence VA HSR&D Center for Innovation (COIN) in Long Term Services and Supports for Vulnerable Veterans and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Allen
authors.affiliation: Institute for Quantitative Biomedical Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Piette
authors.affiliation: Providence VA HSR&D Center for Innovation (COIN) in Long Term Services and Supports for Vulnerable Veterans and Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D015995:Prevalence; D012112:Residential Facilities; D012648:Self Care / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Adverse consequences; Disability; Integrated care; Unmet need