The care needs of 3 million older adults in the U.S. that require help with three or more activities of daily living are not being met and may lead to adverse consequences, according to a new report in the Millbank Quarterly. A detailed analysis finds that a disproportionate share of older people who require substantial assistance are poor, minorities or widowed. Additionally, nearly half of older adults, or about 18 million people, need help with or had trouble carrying out at least one ADL in the month prior to analysis.

Researchers examined a representative sample from the 2011 National Health and Aging Trends Study (NHATS). Of those requiring assistance in non-nursing home settings, one in five — about 6.6 million seniors — received help with the most basic self-care or mobility activities. This includes a wide range of assistance from family or paid caregivers such as bathing, dressing, eating, getting rides to medical appointments, or help with walking.

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Liz Seegert is an independent health journalist and AHCJ’s topic leader on aging. She covers older adults, baby boomers, health policy, and social determinants of health, as well as many other health issues. Her bylines include stories for PBS/NextAvenue.org. the American Journal of Nursing, TIME Health, Medscape, Consumer Reports, and Medical Economics, as well as dozens of other trade and mainstream media. Her articles have been syndicated in Forbes.com, the Los Angeles Times, the Hartford Courant, the Saturday Evening Post and other major outlets.