Applying a Critical Gerontology and Critical Disability Perspective to the Relationship between Unmet Need Consequences and Social Participation Among Older Adults

Background and Purpose

This study examines the relationship between social participation and consequences arising from unmet Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and mobility needs using critical gerontology and critical disability perspectives. The aging field has yet to fully incorporate theoretical perspectives from disability scholarship into our understanding of health, wellbeing, accessibility and inclusion. Both social participation and unmet need consequences among older adults have been explored in terms of their prevalence, and from biopsychosocial and socioenvironmental perspectives. However, there is a lack of scholarship linking these two concepts using a critical disability lens. By situating the experience of aging, aging with care needs, and having unmet care needs within a critical disability lens we gain insight into the ways we are called to redesign the provision of supportive services to ensure meaningful inclusion in community and social change.

Methods

To illustrate the value of incorporating critical gerontology and critical disability studies, we use Wave 5 from the National Health and Aging Trends Study (NHATS) (n=7,070), a nationally representative sample of Medicare enrollees 65 and older who reside in the community or in residential care (not nursing home) facilities living in the contiguous US. We use a series of linear regressions to examine the relationship between ADL, IADL, and mobility unmet need consequences and social participation. Additional covariates include age category, race and ethnicity, gender, Medicaid beneficiary status, cognition, number of chronic conditions, and social network size.

Results

Results from the linear regressions show a significant, negative relationship between total unmet need consequences and social participation (p < .001). When that relationship is further specified into types of unmet care need consequence (ADL, IADL, and mobility), we find that ADL and mobility unmet need consequences are driving this relationship (p < .001). There is no significant association between IADL unmet need consequence and social participation.

Conclusions and Implications

This project makes visible the impact of unmet care needs and their consequences on social participation for disabled older adults. Our findings indicate that experiencing unmet care needs may not only have detrimental effects on health, but on overall adult wellbeing and may be infringing on the ability of older adults to engage with community to the extent they wish. Traditional approaches to understanding this relationship, such as those utilizing a biomedical perspective or those focusing on active and productive aging, may use these findings to promote the need for individual intervention. By applying a critical gerontology and critical disability perspective, aging researchers are called to reexamine the ways in which we consider social participation, accessibility, and full inclusion of older adults with care needs. We use these findings to encourage gerontologists to interrogate why it is that the social participation of disabled older adults is not enabled in our society and to consider how we must reimagine the structures of aging services and community to achieve social change.