Introduction
The increase in the elderly population in Iran requires us to prepare ourselves to manage the aging wave in the next few decades. Meeting the special needs of the elderly to promote active and successful aging leads to the emergence of new and wider dimensions every day. On the one hand, accurate needs assessment is necessary for basic planning to provide patient-centered treatment services, determine appropriate and unique treatment goals, and allocate the health and social services. In order to identify the most important needs of the elderly, it is necessary to use tools that enable a complete, systematic and organized assessment of the various needs of the elderly. Therefore, this study aims to achieve a comprehensive understanding of the health needs of the elderly in Rafsanjan county so that these issues can be examined closely and realistically.
Methods
This cross-sectional study was conducted on 267 older people in Rafsanjan county (Mean age=61.34 years). The entry criteria were: Age≥60 years, willingness to participate in the study, the ability to communicate, and the ability to answer the questions. For sampling, using the stratified sampling method and urban map, and according to the population density in different geographical locations, 6 centers were randomly selected from among 30 comprehensive health centers. Each comprehensive health center was considered as a cluster. Then, the number of selected seniors was determined from each center according to its population (ratio distribution), and sampling was finally done randomly from each center.
Written consent was obtained for voluntary participation in the study from the participants. Then, the demographic form and Camberwell Assessment of Need for the Elderly questionnaire were completed by interview. Both types of met and unmet needs, the severity and type of needs, the help received from official and unofficial sources, the relevance of the help received and the help needed, and the level of satisfaction with this help were measured.
To describe data, mean and standard deviation were used and data were analyzed in SPSS v. 26. Chi-square test was used to compare the met and unmet needs between the old men and women, between younger, middle-aged and older adults, and between the elderly living alone and the elderly living with spouse or relatives. 
Results
The unmet needs of the elderly were mostly in terms of psychological distress (12.3%), memory (9.3%), and mobility (8.6%). Among the met needs, the needs related to the supply of medicine (67.5%), physical health (64.2%), and obtaining information (40.7%) were frequent. The highest percentage for the lack of need (99.3%) was related to receiving benefits, drinking alcohol, deliberate and accidental self-harm. In terms of environmental needs, the most unmet need was related to accommodation (5.2%) and the most met need was household skills (15.7%). In terms of physical needs, the most unmet need was related to memory (9.3%) and the most met need was related to the use of medicines (67.5%). In terms of social needs, the most unmet need related to the mobility status (8.6%).
In terms of care needs, in 0.7% of participants, both self-care and continence were among the unmet needs, while in 9.3% and 6% of participants, self-care and continence were the met needs, respectively. In terms of psychological needs, the most unmet need was psychological distress (12.3%) and the most met need was information acquisition (40.7%). Regarding the help received from unofficial sources, the most common need for which participants reported that they received a “high” help was “psychological distress” (0.4%), while the most common need for which they reported that they received “no” help was “accommodation” (2.2%). Regarding the help received from official sources, the most common needs for which participants reported that they received a “moderate” help were physical health and household skills (0.4%), while the most common need for which they reported that they received “no” help was physical health (71.3%).
In the field of psychological needs, the highest frequency of unmet needs was observed in women aged 75-89 years and in the elderly who were living with relatives, while the highest frequency of met needs was reported in women aged 60-74 years and those living with relatives. In general, the most unmet needs were seen in women than in men and in the age group of 60-74 years than in other age groups.
Discussion
The unmet needs of the elderly in Rafsanjan county are psychological needs, physical needs, and environmental needs. The highest frequency of met needs are: medication, physical needs, and the need for information, while their most unmet needs are benefits, drinking alcohol, deliberate self-harm, and accidental self-harm. The most unmet needs are seen in women than in men and in the age group of 60-74 years than in other age groups. In terms of receiving help from unofficial sources, the highest rate of received help is in the field of psychological distress while the highest rate of not-received help is in the field of accommodation. In terms of receiving help from official sources, the highest rate of received help are in the fields of household skills and physical health, while the highest percentage of not-received help is in the field of physical health.

Ethical Considerations
Compliance with ethical guidelines
Considering that this study was conducted during the outbreak of the COVID-19 virus. Therefore, to conduct the interview, all hygiene and distance protocols were carried out. In order to comply with ethical considerations in the research, the people participating in the study were assured that their information would remain confidential and if they did not wish to continue cooperation, they would be excluded from the study. Also, the study protocol was approved by the Ethics Committee of the Faculty of Health, Shahid Sadougi University of Medical Sciences, Yazd (ethics code IR.SSU.SPH.REC.1399.142).

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
All the seniors who participated in this research, as well as all managers and officials and personnel of the health centers of Rafsanjan City, who cooperated in this research, are appreciated and thanked.

References

1. Delpisheh A, Kohi Ardebili S, BaBanejad M, Mansorian M, Ghorbani M, Rezapor A, et al. [Survey of health status and health needs of the elderly in Ilam Province (Persian)]. Journal of Tolooebehdasht. 2016; 14(5):1-14. [Link]
2. Reynolds T, Thornicroft G, Abas M, Woods B, Hoe J, Leese M, et al. Camberwell Assessment of Need for the Elderly (CANE): Development, validity and reliability. British Journal of Psychiatry. 2000; 176:444-52. [DOI:10.1192/bjp.176.5.444] [PMID]
3. Sousa RM, Scazufca M, Menezes PR, Crepaldi AL, Prince MJ.  Feasibility and reliability of the elderly version of the Camberwell Assessment of Needs (CANE): Results from the Sao Paulo Ageing & Health Study. Brazilian Journal of Psychiatry. 2009; 31(1):34-8. [DOI:10.1590/S1516-44462009000100009] [PMID]
4. Wright J, Williams R, Wilkinson JR. Development and importance of health needs assessment. BMJ (Clinical Research ed.) 1998; 316(7140):1310-3. [DOI:10.1136/bmj.316.7140.1310] [PMID] [PMCID]
5. Hooper J, Longworth P. Health needs assessment: Workbook. London: Health Development Agency; 2002. [Link]
6. Stevens A, Gillam S. Needs assessment: From theory to practice. BMJ. 1998; 316(7142):1448-52. [DOI:10.1136/bmj.316.7142.1448] [PMID] [PMCID]
7. Gholizadeh S, Estaji Z, Akrami R, Ghanbari-Moghaddam A. [Health related needs of the elderly in Sabzevar city of Iran, 2019 (Persian)]. Journal of Gerontology. 2020; 4(4):68-75. [DOI:10.29252/joge.4.3.68]
8. Ghasemi S, Keshavarz Mohammadi N, Mohammadi Shahboulaghi F, Ramezankhani A. A critical review of studies on health needs assessment of elderly in the world. Elderly Health Journal. 2017; 3(1):1-9. [Link]
9. Smith F, Orrell M. Does the patient-centred approach help identify the needs of older people attending primary care? Age and Ageing. 2007; 36(6):628-31. [DOI:10.1093/ageing/afm131] [PMID]
10. van der Ploeg ES, Bax D, Boorsma M, Nijpels G, van Hout HP. A cross-sectional study to compare care needs of individuals with and without dementia in residential homes in the Netherlands. BMC Geriatrics. 2013; 13:51. [DOI:10.1186/1471-2318-13-51] [PMID] [PMCID]
11. Mosavi N, Ghasemi S. [Health guide for older persons Health care and nutrition in older persons (Persian)]. Tehran; Ketabkhaneh Sadr; 2020. [Link]
12. Ameri GF, Govari F, Nazari T, Rashidinejad M, Afsharzadeh P. [The adult age theories and definitions (Persian)]. Journal of Hayat. 2002; 8(1):4-13. [Link]
13. Howard L, Hunt K, Slade M, O’Keane V, Seneviratne T, Leese M, et al. CAN-M: Camberwell assessment of need for mothers. London: Royal College of Psychiatrists; 2008. [DOI:10.1037/t53418-000]
14. Salehi R, Davatgaran K, Heidari M, Mostafaee N, Latifi M. [The psychometric properties of the Persian version of the camberwell assessment of needs (CANE) for Iranian elderly people with mental disorders (Persian)]. Iranian Journal of Ageing. 2018; 13(2):168-81. [DOI:10.32598/sija.13.2.168]
15. Wieczorowska-Tobis K, Talarska D, Kropińska S, Jaracz K, Tobis S, Suwalska A, et al. The Camberwell Assessment of Need for the Elderly questionnaire as a tool for the assessment of needs in elderly individuals living in long-term care institutions. Archives of Gerontology and Geriatrics. 2016; 62:163-8.  [PMID]
16. Kaldi A, Akbari Kamrani AA, Foroghan M. [Physical, social & mental problems of elderly in district 13 of Tehran (Persian)]. Social Welfare Quarterly. 2005; 4(14):233-49. [Link]
17. Taheri Tanjani P, Sharifi F, Nazari N, Rahim F, Fakhrzadeh H, Arzaghi SM, et al. [Health status of elderly people in Khuzestan: A cross-sectional study (Persian)]. Iranian Journal of Diabetes and Metabolism. 2017; 16(4):191-200. [Link]
18. Mohagheghi Kamal SH, Sajadi H, Zare H, Biglarian A. [Need assessment among the elders of Social Security Organization & National Retirement Fund (Persian)]. Salmand: Iranian Journal of Ageing. 2008; 3(1):8-15. [Link]
19. Fernandes L, Gonçalves-Pereira M, Leuschner A, Martins S, Sobral M, Azevedo LF, et al. Validation study of the Camberwell Assessment of Need for the Elderly (CANE) in Portugal. International Psychogeriatrics. 2009; 21(1):94-102.  [PMID]
20. Najafi B, Taheri Tanjani P, Sharifi F, Fakhrzad H, Alizadeh M, Arzaghi M, et al. [Health status of elderly people in Sistan and Baluchistan province (Persian)]. Iranian Journal of Diabetes and Metabolism. 2017; 16(5):283-92. [Link]
21. Walters K, Iliffe S, Tai SS, Orrell M. Assessing needs from patient, carer and professional perspectives: The Camberwell Assessment of Need for Elderly people in primary care. Age and Ageing. 2000; 29(6):505-10. [PMID]
22. Stein J, Pabst A, Weyerer S, Werle J, Maier W, Heilmann K, et al. The assessment of met and unmet care needs in the oldest old with and without depression using the Camberwell Assessment of Need for the Elderly (CANE): Results of the AgeMooDe study. Journal of Affective Disorders. 2016; 193:309-17.  [PMID]
23. Mohammadi M, Karbalaee Z, Ayatnia M, Ghanbari-Moghaddam A. [Comprehensive geriatric haelth assessment in nursing homes if Sabzevarin 2016 on the pattern of CGA (Persian)]. Nursing Journal of The Vulnerable. 2017;  4 (11):1-15. [Link]