Effect of Inter-Generational Living Arrangement and Digital Exclusion on Unmet Healthcare Needs Among Older Adults: Findings From Two National Cohort Studies.

Aim: To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.

Design: A prospective cohort study. The study reporting is conformed to the STROBE checklist.

Data sources: This longitudinal study utilised data from the 2018-2020 waves of the United States-based Health and Retirement Study and the 2013-2015 waves of the China Health and Retirement Longitudinal Study.

Methods: Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.

Results: A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.

Conclusion: Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.

Implications for the profession and/or patient care: These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.

Reporting method: This study using the STROBE CHECKLIST for reporting guideline.

Patient or public contribution: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY: By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.