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 r emain 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. Method. Four general practices were selected purposively in inner city and suburban London. A random sample of 1 in 20 people aged 75 years and over r egistered with each practice was selected for a multidisciplinary needs ass essment using the 'Camberwell Assessment of Need for the Elderly' (CANE) sc hedule and unmet needs identified by patients and their informal carers. Fo r each unmet need, a further semi-structured interview was used to explore the help-seeking behaviour and perceived barriers to meeting their needs. R esponses were recorded verbatim contemporaneously and a thematic analysis p erformed on perceived barriers following completion of all interviews. Results. A total of 55/84 (65.5%) of patients and 15/17 (88%) of carers com pleted the initial needs assessment. for 104 unmet needs identified by 31 p atients 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 nee ds and it had been offered in only 19/104 (18%). In those not seeking help, withdrawal, resignation and low expectations were dominant themes. In thos e that had sought help, there were issues of perceived failure of service d elivery and rationing, with themes of resignation and withdrawal again emer ging in those declining help offered. Conclusion. 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 invol ving issues of withdrawal, resignation and low expectations. This complexit y has implications for the commissioning of services for older people.