Levels of unmet need reported by population sub-groups

This section of the report outlines how older adults’ reported levels of need and unmet need varies with a range of different factors, such as demographic factors, geographic factors, and the type of support they received.

Disability and unmet need

Those older adults with disabilities, and particularly those who said they were “limited a lot”, were more likely to report that they needed or received support.

39% of older adults who had a disability said they needed or received support. This compares to 4% of older adults who said they had “no” disability or limitations. Disabled older adults were also more likely to report having unmet support needs (17%) than those without a disability (2%) (These data are not visualised but can be found in the supplementary tables).

Those with higher levels of self-reported limitations from disability were more likely to report that they received or needed support. 68% of those who said they were “limited a lot” by disability said they needed or received support, compared to 23% of those who said they were “limited a little”. (Figure 3).

Figure 3: 68% of those who were disabled and said they were “limited a lot” in their daily activities said they needed or received support.

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 by their stated need for support and level of self-reported limitations to daily activities resulting from a long term health problem or disability.

Those with higher levels of self-reported limitations from disability were also more likely to report an unmet need for support. 31% of those who said they were “limited a lot” by a disability indicated some kind of unmet need for support, compared to 10% of those who said they were “limited a little”. And 2% of those who reported no disability reported an unmet need for support.

Figure 4: Of the older adults who said they needed or received support, those who reported “no limitation” (18%), or “a little” limitation from disability (14%) were more likely to say that they didn’t receive any support despite needing it than those who reported “a lot” of limitation from disability (11%).

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 who said they needed or received support, by their self-reported unmet need status and level of limitations to daily activities resulting from a long term health problem or disability.

However, those who said they needed or received support and were “limited a lot” were more likely to report having had support that did not fully meet their needs (35%) than those with “little” (27%) or “no limitations” (19%) resulting from a disability.

The reason for this is not fully clear from the survey responses, but this might suggest that people with the most complex needs are more likely to receive some support, but that their needs may be more challenging to fully meet.

Our categorisation of limiting long term health problems is based on responses to a question asking whether their day-to-day activities are “limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months”. Respondents were prompted to “include problems that relate to old age” and could select “yes, limited a lot”, “yes, limited a little” or “no”. Due to question wording, respondents who selected “no” cannot be interpreted as not having any sort of health problem or disability. They could have either a limiting health problem that is not expected to last at least 12 months, or a long-term health problem or disability that they do not consider to be limiting to their day-to-day activities.

Sex and unmet need

Figure 5: Older women (25%) were more likely than older men (18%) to report that they needed or received support.

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 by their stated need for support, and their sex.

In total, 10% of older women and 8% of older men reported an unmet need. (Please note that due to the rounding we have used, the total of two or more categories can be different to what would be calculated by adding together the rounded values presented in these charts. Please see the Rounding part of the Data and Methodoogy section for more information on rounding).

Figure 6: Amongst only those who said they needed or received support, older men (16%) were more likely than older women (11%) to say that they had no help but needed it.

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 who say they needed or received support, by their self-reported unmet need status and their sex.

Amongst older adults who said they needed or received support, men (31%) and women (30%) received help but still indicated an unmet need at similar rates.

Unmet need and relative area deprivation

The Scottish Index of Multiple Deprivation (SIMD) is a relative measure of deprivation between areas that compares income as well as access to resources and opportunities.

Figure 7: Older adults living in the most deprived quintile of areas were more likely to report that they needed or received support (SIMD1: 34%) than older adults living in the least deprived quintile of areas (SIMD5: 15%).

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 by their stated need for support and the Scottish Index of Multiple Deprivation (SIMD) quintile.

Older adults living in the most deprived quintile of areas were also much more likely to report experiencing an unmet need, with 16% of those living in the most deprived quintile (SIMD 1) reporting some kind of unmet support needs, compared to just 6% of those in the least deprived quintile (SIMD5).

Figure 8: Amongst older people who said they needed or received support, people in areas of higher deprivation were more likely to report unmet needs (SIMD1: 48%) than their counterparts living in the least deprived areas (SIMD5: 40%).

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 who said they needed or received support, by their self-reported unmet need status and the Scottish index of Multiple Deprivation (SIMD) classification of their area of residence.

Older adults who said they needed or received support and who lived in the most deprived quintile (SIMD1) were more likely to report that they did not receive any support despite needing it (15%) than those living in the least deprived quintile (SIMD5: 11%). The rates of people reporting they did not receive any help despite needing it were similar across all other comparisons of SIMD quintiles.

Further analysis suggests the higher rates of reporting an unmet need for those living in SIMD1 than in SIMD5 is not only due to differences in underlying health or disability. Among older adults who were disabled and said they were limited “a lot” by a long-term health problem, those living in the most deprived quintile of areas (SIMD1) were still more likely to report some kind of unmet need (36%) than those liniving in the least deprived quintile (SIMD5: 28%) (data not visualised, but available in the supplementary tables).

Unmet need across urban areas, towns and rural areas

Older people living in urban areas (23%) and towns (21%) reported needing or receiving support at similar rates, and were slightly more likely to report that they needed or received support than those living in rural areas (19%).

Older adults who lived in towns and urban areas reported receiving support but still experiencing an unmet need at similar rates (6-7%), but those living in rural areas reported lower rates of this (5%).

Older adults who lived in rural areas were less likely to report that they did not receive any support despite needing it (2%) than those living in urban areas (3%). A similar proportion of older adults reported these across towns and urban areas (3%).

When we looked at just the older adult population who needed or received support we found that across all geographical areas (e.g. rural areas, towns and urban areas) between 12-13% of older adults who needed or received support did not receive any.

Older adults who needed or received support and lived in urban areas were slightly more likely to report that they received support and still experienced an unmet need (31%) than their counterparts living in rural areas (28%).

Source of funding and unmet need amongst those who received support

In the 2023-24 survey, people who told us that they received support for everyday living were asked who funded this support. Two response options indicated external sources of funding, i.e. receiving state-funded support or charity-funded support. We are referring to this as “funded support”. The other two response options reported receiving unfunded forms of support, i.e self/family funded support or unpaid care. We are referring to this as “unfunded support”.

Figure 9: Of the older adults who reported receiving support, those who told us they were receiving only unfunded forms of support were more likely to report an unmet need (42%) than those who reported receiving funded support as part or all of their care (34%).

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 who reported receiving support, by their self-reported unmet need status and whether or not this support includes funded support.

42% of those who reported receiving only unfunded support reported an unmet need, which was higher than the average level of unmet need reported amongst all older adults who told us that they had received support (35%).

34% of those who received funded support as part or all of their care reported an unmet need. This was similar to the average level of unmet need reported amongst all older adults who had received support.

It is important to note that, amongst those who had received funded support, only 4% specifically selected the response option "My current care service is not enough" as a reason for reporting unmet need. The remaining 29% indicated other reasons for reporting unmet need. (Our previous publication provides more information and statistics on reasons for reporting unmet need, amongst adults of all ages).

Figure 10: Amongst just those older adults who reported receiving support and who also told us that they were limited “a lot” by a long-term health problem or disability, the reported level of unmet need rose to 50% for those who were receiving only unfunded forms of support.

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 who reported receiving support and said they are limited “a lot” in their daily activities by a long term health problem or disability, by their self-reported unmet need status and whether or not this support included funded support.

For those who had received funded support, the level of unmet need reported remained similar at 35% even for those who were also limited “a lot” by a long term health problem.

This suggests that those who received only unfunded forms of care may be more likely to experience unmet needs than those who received some funded support, and that this risk grows as the level of limitation from long term health problems increases.

We have excluded those who did not respond on the source of their funding from this part of our analysis, as we found they were also more likely to not respond when asked about unmet need and so their inclusion could produce misleading results. We have included them in our breakdown on the source of funding for just the population with unmet need (see Annex A) as this group did answer when asked about unmet need so there is no non-response risk for them.

Unmet need for those who had received help with personal tasks

Adults aged 65 or over who are assessed by their local authority as needing personal care are entitled to receive this without charge. The Community Care and Health (Scotland) Act 2002 sets out a list of personal care tasks that may not be charged for by a local authority. Examples are given on this Scottish Government webpage about personal care, and can include support with personal hygiene, at mealtimes, immobility problems, medication and general wellbeing. 

In HACE 2023-24 we asked respondents whether they received “help with personal tasks”. Whilst respondent understanding of what “help with personal tasks” may not align entirely with official definitions of “personal care”, we expect there to be substantial overlap.

Figure 11: 35% of older adults who reported receiving “help for personal tasks” (including those with funded and unfunded support) reported an unmet need, which was similar to the proportion of older adults reporting unmet need who received forms of support that did not include “help for personal tasks” (35%).

Bar chart showing the percentage of adults aged 65+ living in Scotland in 2023-24 who had received support by their self-reported unmet need status and whether or not this support included “help with personal tasks”.

It is important to note that these results are not direct indicators of the level of unmet need for personal care (or other forms of support). This is because HACE 2023-24 respondents could indicate receiving multiple types of support (e.g., help for personal tasks, help for household tasks) but were not asked which of these they needed, or needed more of.

The results show that a substantial proportion of adults who received support for personal tasks, and other forms of support, reported an unmet need.

It is important to note that of those who said that they received support that included help with personal tasks, only 4% specifically selected the response option "My current care service is not enough" as a reason for reporting unmet need. The remaining 31% of people who received support that included help with personal tasks and reported an unmet need indicated other reasons for that unmet need. (Our previous publication provides more information and statistics on reasons for reporting unmet need, amongst adults of all ages.)