Quantifying unmet need for social care among older persons in the WHO Region of the Americas

The Americas region is ageing rapidly, albeit with notable cross-country differences in the pace of population ageing. This demographic transition is accompanied by rising care demand - a growing number of older people needing assistance with basic and instrumental activities of daily living. When these needs are unmet, they can severely impact health and quality of life. North American countries generally benefit from more robust social welfare systems, while many Latin American and Caribbean countries face this demographic shift with fewer resources and greater reliance on family care. These contextual factors are likely associated with different drivers and levels of unmet social care needs. Quantitative assessments are critical to guide rapidly evolving long-term care systems in the region.

To estimate the prevalence of unmet social care needs in nine countries across the Americas region and examine how these vary by older adults’ demographic and social characteristics.

This project employed quantitative methods to describe the levels and variations in unmet social care needs and care receipt using nationally representative survey data available for analysis for nine countries in the region: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Puerto Rico and the United States of America. Social care needs and care receipt related to activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed based on self-report. 

• Levels of ADL care needs varied widely across the countries, with Chile and Puerto Rico recording the highest prevalence. 
• Across the countries studied, IADL care needs were consistently more common than ADL care needs. Unmet needs were more common for ADL than for IADL.
• Disparities in social care needs were observed based on different socio-demographic characteristics. Care needs increased with age, lower education and income levels, and living alone and in rural areas. However, such differences in care receipt were less apparent.

The findings reveal significant gaps in long-term care throughout the Americas, especially in Latin American and Caribbean countries, where the rapidly increasing aging populations pose a major challenge. Although more countries are working to establish comprehensive long-term care systems, coverage remains limited, and much of the care is still provided by unpaid caregivers. Therefore, it is essential for countries in these regions to prioritize the development and expansion of national long-term care policies as well as support for informal caregivers.

Journal articles and other publications from this project are expected in (or after) 2026.