Social and Health Conditions That Drive the Need and Demand for, Use of and Expenditure on Social Care in the UK: A Systematic Review.

Background: The need for social care, in the form of practical assistance and personal care, is increasing alongside a growing older population with long-term conditions and places those with limited or no access to publicly funded care at risk of increasing levels of unmet need. Aim: This systematic review sought to understand the role of social and health conditions in the need, demand, utilization, and expenditure on social care in the United Kingdom. Methods: We searched Medline, CINAHL, EconLit, ASSIA, and the Campbell Collaboration from January 1, 2009 to April 14, 2025, and gray literature on August 21, 2024, for randomized trials, cohort studies, case control studies, and interrupted time series, cross-sectional, and modeling studies of populations aged ≥ 60 years old, in a UK setting, that examined the association of social and health conditions with the need and demand for, use of and expenditure on social care. We conducted risk of bias assessments using ROBINS-E for longitudinal studies, and intended to use Risk of Bias 2 for randomized trials. We applied GRADE to assess the certainty of evidence. Results were synthesized narratively, and presented in an Evidence Gap Map. Results: We included 10 longitudinal cohort and eight cross sectional studies, study sample size ranged from 526 to > 400,000 participants. Five of the cohort studies were assessed as high risk of bias, and the cross sectional studies as moderate concern or high risk of bias. Older age was associated with increased unmet need for care in most studies, and living alone with increased unmet need for care and use of residential care. Results for ethnicity, deprivation and sex varied across studies, with studies using different measures of deprivation that limited comparability of findings. A range of long-term health conditions were assessed, some studies indicated an association with an increased need and use of care; there were mixed findings for cost. For populations with cognitive impairment or dementia, the association with age and the use and cost of care varied, there was no clear association for sex, ethnicity and living alone; a previous hospital admission or ongoing health problems that included severity of dementia were associated with increased use of care. Conclusion: Our review of UK evidence indicates that there is insufficient evidence to accurately identify populations age > 60 years that are at increasing risk for needing care due to their social and health conditions.