Regenstrief Institute and Weill Cornell Medicine researchers outline how health systems can identify unmet needs more accurately and connect patients with services.
The U.S. population age 80 and older is projected to double over the next two decades, yet few of the tools health systems use to screen for food insecurity, transportation barriers and other social needs have been validated in older adults.
In a perspective published in The New England Journal of Medicine, Regenstrief Institute Research Scientist Joshua R. Vest, PhD, MPH, and co-author Mark A. Unruh, PhD, of Weill Cornell Medicine, argue that screening should reflect how older adults live and receive care. The authors outline changes that could help care teams identify patients’ needs more accurately and match them with appropriate services.
One widely used brief food insecurity screen, for example, was initially validated in families with young children. A question about affording groceries may be informative for someone who shops for their own food and less relevant for a nursing home resident whose meals are provided.
What happens when needs go unaddressed
The authors cite research linking food insecurity with malnutrition, falls, cognitive decline and forgoing medications. They also note that social isolation is associated with frailty, poorer mental health and higher medical spending. Older adults with multiple social needs tend to have less access to preventive care and are more likely to visit an emergency department or be hospitalized.
Unmet needs can make chronic conditions harder to manage and reduce an older adult’s ability to remain at home. Unpaid caregivers may take on more responsibility for transportation, meals or daily care.
What health systems can do
Vest and Unruh suggest adapting questions from validated screening tools or developing new ones that account for patients’ age, physical and cognitive function, and where they live and receive care. They also note that evidence is limited on how accurately family members and other caregivers report social needs on a patient’s behalf.
The authors recommend assessing financial circumstances and insurance coverage during screening because both can affect which services patients can access.
Care teams can use screening results to connect patients with services such as transportation to medical appointments, home modifications or caregiver assistance. Following up after a referral can help teams determine whether a patient received support or still faces a barrier. The Perspective cites more than 800,000 people on waiting lists for Medicaid home- and community-based services, with an average wait of more than three years.
Across their patient populations, health systems can use screening results and referral follow-up to identify needs that repeatedly go unmet. That information can help them determine where referral processes are difficult to navigate, where demand exceeds available services and where to direct limited resources.
“Health-Related Social Needs among Older Adults — Addressing Mismeasurement” was published online October 10, 2026, in The New England Journal of Medicine.
Joshua R. Vest, PhD, MPH
In addition to being a research scientist with the Clem McDonald Center for Biomedical Informatics at Regenstrief Institute, Joshua R. Vest, PhD, MPH, is a professor of health policy and management at the Indiana University Richard M. Fairbanks School of Public Health.
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