Care Network Characteristics and Unmet Needs Among Community-Dwelling Older Adults with Dementia by Living Arrangement

Objectives This study aimed to examine care network characteristics and unmet needs among persons living with dementia across living arrangements. Methods We analyzed 2023 National Health and Aging Trends Study data on 1,219 community-dwelling persons living with dementia receiving help with self-care, mobility, or household activities. Living arrangements were categorized as living alone (22.6%), living with a spouse (39.5%), or living with non-spouse others (37.8%). We compared network size, helper composition, care received, and unmet needs and estimated survey-weighted negative binomial regression models of unmet needs. Results Individuals living alone had the most diverse helper composition, including the greatest involvement of non-family (29%) and paid helpers (19%), yet received the least help across most domains. Those living with a spouse had the smallest networks (M=2.05), dominated by spousal care (60%). Persons living with non-spouse others had the largest networks (M=2.48 helpers), the highest child involvement (56%), and received the most help. In adjusted models, living alone was associated with significantly more unmet needs than living with non-spouse others; the estimate for living with a spouse was not statistically significant. Discussion Persons living alone face elevated risk for unmet needs, suggesting diverse networks may not translate into adequate care coverage. Coresidence was associated with fewer unmet needs among those living with non-spouse others but not among those living with a spouse, suggesting the protective value of coresidence may depend on the nature of the caregiving arrangement. Findings highlight heterogeneity in care networks and the need for tailored strategies across living arrangements.