Unmet Healthcare Needs Among Older Adults Living Alone: Factors and Policy Implications for Improving Accessibility

Background and Purpose: With the rapid increase in nuclear families and population aging, the number of older adults living alone in South Korea has increased substantially. This demographic shift has raised concerns about the health and well-being of older adults, particularly in relation to their access to healthcare services. Unmet healthcare needs, defined as situations in which individuals are unable to access necessary medical services, can lead to deteriorating health conditions, heightened social inequalities, and increased public health expenditures. Despite growing attention to healthcare equity, previous research has focused on the general older population or institutionalized older adults in South Korea, with limited attention to those living alone. Existing studies often emphasize structural factors such as insurance coverage or service availability, while overlooking the interplay of psychological, socioeconomic, and individual-level health factors that uniquely affect older adults who live alone. Therefore, this study aims to examine the multifaceted factors associated with unmet healthcare needs among older adults living alone.

Methods: Data were drawn from the 2024 Community Health Survey, targeting 21,954 individuals aged 65 and older who were living alone. The dependent variables were the presence and types of unmet healthcare needs. Independent variables included demographic (age, gender, education), economic (household income, employment), and health-related characteristics (subjective health status, perceived stress, health-related quality of life [HRQoL]). Binary and multinomial logistic regression analyses were conducted to identify predictors of unmet care across different causes: economic barriers, health-related barriers, and physical access barriers.

Results: Overall, 6.2% of older adults living alone reported experiencing unmet healthcare needs. These experiences were significantly associated with gender, income, education, stress, subjective health status, and HRQoL. Specifically, perceived stress (OR = 3.576, p < .001) and poor self-rated health (OR = 3.077, p = .001) substantially increased the odds of unmet healthcare needs. Lower HRQoL was a consistent and powerful predictor across all unmet need types (e.g., OR = 4.216, p < .001 for general unmet care). Men were more likely than women to report unmet care due to financial barriers (OR = 1.518, p = .007), and the odds were especially high among those earning less than 500,000 KRW per month (OR = 4.535, p < .001). For accessibility-related unmet care, lack of formal education, stress, poor health, and low HRQoL were significant predictors.

Implications: This study highlights the urgent need for targeted interventions to reduce unmet healthcare among older adults living alone. Policy measures should include expanding medical financial assistance for low-income individuals, implementing stress reduction and HRQoL enhancement programs, and strengthening the capacity of public healthcare institutions to reach isolated seniors. In addition, developing community-based support networks and establishing integrated service delivery systems that connect health, social welfare, and medical services are critical. These findings underscore the importance of a multidimensional approach that addresses not only economic and physical barriers but also psychological vulnerabilities to improve healthcare equity for this growing and vulnerable population.