Trends in informal and formal care utilisation and unmet care needs among older adults in Korea: evidence from repeated national surveys.

The increasing number of older adults with functional limitations has significant implications for care policy in rapidly ageing societies. This study examined trends in informal care, formal care, and unmet care needs among older Koreans, considering both individual characteristics and broader societal change. Using four waves of the National Survey of Older Koreans from 2014, 2017, 2020, and 2023, we analysed community-residing adults aged 65 and older with functional limitations and estimated survey-weighted multinomial regression models. Adjusted results showed a substantial rise in unmet care needs, from 20.4% in 2014 to 52.4% in 2023. Informal care from family and friends declined sharply, while the increase in formal care use was insufficient to compensate for this loss. Sensitivity analyses restricted to those with severe impairment also showed that unmet care needs still increased over time, but the magnitude of the increase was attenuated. However, among those with severe impairment, predicted probabilities of receiving formal care were relatively stable and even showed a decreasing trend. Older age, cognitive impairment, and a greater number of limitations were consistently associated with formal care utilisation relative to no care. These factors also predicted receipt of informal care relative to no care, although their statistical significance was less evident in recent years. These findings suggest that Korea's care system has not fully adapted to declining family-based care, accompanied by relatively unchanged formal care receipt rates and rising unmet care needs. Expanding formal care services and supporting informal caregivers remain priorities for improving elder care.