# Socio-economic differences in receiving care by the over-80s in Germany and England: intensity of care needs as a moderator

## TL;DR

This study compares how socio-economic status affects care use among people over 80 in Germany and England, finding that care needs intensity influences these patterns.

## Contribution

The study introduces the concept of care needs intensity as a moderator of socio-economic disparities in care use among the over-80s.

## Key findings

- Higher SES individuals with few care needs are more likely to experience unmet care needs in both Germany and England.
- In Germany, higher SES is linked to less informal and more formal care use for those with high care needs.
- In England, care use for those with high care needs shows little variation by SES.

## Abstract

The growing number of people aged 80 or older living in the community has raised concerns about meeting their care needs and about socio-economic inequalities in their care use. The study examines socio-economic status (SES) patterns in informal and formal care use, as well as unmet care needs, of people aged 80 or older living in the community in Germany and England. We propose that SES patterns in care use change with the intensity of care needs. The analyses use data from the Survey of Quality of Life and Well-Being of the Very Old in North Rhine-Westphalia and the English Longitudinal Study of Ageing. Despite the differences in the long-term care systems (LTCSs) and cultural norms around filial obligations, we find a consistent pattern of association between socio-economic status (SES) and care use for older people with only few care needs in both countries. In this group, people with a higher SES have the highest likelihood of experiencing unmet care needs. For older people with many care needs, we find country-specific SES patterns that we link to cultural differences and the design of the LTCSs. In Germany, SES is negatively associated with using informal care and positively with using formal care. In England, care use shows little SES variation for older people with many care needs. The findings underscore the importance of considering the intensity of care needs when assessing inequalities in care access.

The online version contains supplementary material available at 10.1007/s10433-025-00864-y.