Introduction
The increasing population of older adults and the aging of societies represents a significant global challenge [1]. Concurrently, the diverse needs of older adults, social, psychological, environmental, and health-related, are also increasing, underscoring the growing necessity for effective planning to address these needs. A substantial body of research has demonstrated that a significant proportion of the needs of older adults remain unmet [2-4]. The specific needs of older adults to promote active and successful aging are becoming increasingly complex and comprehensive [5]. Therefore, policymakers and service providers must identify these needs and plan to address them more effectively, to offer suitable services, ensure the satisfaction of older adults, and ultimately reduce the economic burden on the healthcare system. Accordingly, this study identifies the types of needs within the older adult population.

Methods & Materials 
This cross-sectional study was conducted on a random sample of individuals aged 60 years and older in Hamadan City, Iran, during the 2022-2023. To be eligible for inclusion in the study, the participants were selected according to the following criteria: being 60 years of age or older, being a citizen of Iran, not having been diagnosed with dementia or cognitive impairment, and being able to speak. The elderly participants were randomly selected from a list of individuals registered with urban health services. The sampling method employed was cluster random sampling within Hamadan City, Iran.
The data collection instruments included four standard questionnaires: 1. a demographic information questionnaire, 2. the abbreviated mental test for identifying the absence of dementia and cognitive impairment, 3. the Barthel index to measure functional independence, and 4. the Camberwell assessment of need-elderly (CANE) to assess the met and unmet needs of elderly individuals.
The demographic information included age (in years), gender, level of education (illiterate, elementary/middle school, high school and diploma, academic), marital status (married, single, widowed, divorced), living situation (with spouse, with relatives, living alone), employment status, tobacco use (yes/no), history of chronic illness (yes/no), degree of dependency (completely independent, slightly independent (moderate), relatively independent (mild), and completely dependent), and number of children.
Once the requisite data had been collected, it was subjected to statistical analysis employing techniques such as the independent t test, analysis of variance, and multiple linear regression. The backward-stepwise method was utilized for the selection of variables to be included in the model. The analyses were conducted using the Stata software, version 17, with a confidence level of 95%.

Results
The present cross-sectional study included a total of 501 elderly individuals, comprising both male and female participants aged 60 years and above. The response rate was 85%. The majority of participants were male (52.89%) and married (73.25%). The mean age of the elderly participants was 67.96±6.36 years (Table 1).


The highest proportion of unmet needs was related to vision and hearing (10.18%), while the highest proportion of met needs was in the areas of housing (92.20%) and access to information (70.06%) (Table 2).


Women reported a higher proportion of met needs in the dimensions of environmental needs (10.42 vs 9.91; P<0.001) and psychological needs (7.68 vs 7.64, P=0.694), whereas men reported a higher proportion of met needs in the dimensions of physical needs (8.83 vs 8.99, P=0.076), and social needs (15.23 vs 15.06, P=0.047) (Table 3).


The results of the multiple linear regression model, controlling for the effects of other variables, indicated that for each one-year increase in age, the scores of met needs decreased by 0.05 units (P=0.002). Furthermore, the average met needs for married elderly individuals was 0.51 units lower than that of single elderly individuals (P=0.037). Individuals aged 60 and over who had received an academic education exhibited a mean score for met needs that was 2.23 units higher than that observed in individuals with no formal education (P<0.001). The mean met needs score for elderly individuals with a history of cardiovascular disease was found to be 0.49 units lower than that of healthy elderly individuals concerning cardiovascular conditions (P<0.001). The mean met needs score for elderly individuals reporting their health status as good was found to be 23.23 units lower than that of individuals reporting their health status as bad (P<0.001) (Table 4).



Conclusion
In the present study, the lowest average of unmet needs among the elderly was observed in the physical and psychological dimensions. The results demonstrated a direct relationship between unmet needs and educational level and age. The results of various studies also indicate that new needs that emerge during the aging process often remain unmet due to financial and physical inaccessibility. This can result in a decline in health-related quality of life and ultimately lead to dissatisfaction with life among the elderly.
Therefore, it is imperative to enhance the frequency and quality of annual physical and psychological performance assessments for the elderly, integrating educational programs comprising self-care skill training packages of superior quality into integrated care programs, particularly for the elderly with a history of chronic illnesses such as cardiovascular diseases. It is further recommended that future studies assess the needs of all elderly individuals residing in the community and those in long-term care facilities.

Ethical Considerations
Compliance with ethical guidelines
Informed verbal consent was obtained from all elderly participants who volunteered to take part. The subject of this study was approved by the Ethics Committee for Research at Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1401.874).

Funding
This article is part of a master's thesis in epidemiology at the School of Health, Hamadan University of Medical Sciences (14020205559). The Vice Chancellor for Research and Technology, Hamadan University of Medical Sciences sponsored this study.

Authors' contributions
Conceptualization: Zahra Cheraghi and Parvin Cheraghi; Research and review: Fatemeh Mansouri Shad, Qhadir Nouri, and Sedighe Mafakheri-Bashmagh; Methodology: Zahra Cheraghi and Parvin Cheraghi; Drafting: Fatemeh Mansouri Shad; Editing and finalization by: All authors; Project management: Zahra Cheraghi.

Conflicts of interest
All authors declare that there are no conflicts of interest.

Acknowledgments
The authors express their gratitude to the elderly participants in this research project, whose involvement was instrumental in enabling us to execute this study.



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