Scottish ministers have been warned the care system for pensioners is at risk of 'breaking down completely' following 'alarming' levels of unmet need.
Leading charity Age Scotland has raised concern over the "catastrophic" levels of missed support for those aged 65 and over.
It comes as statistics published this week showed a majority of elderly Scots who took part in a national survey reported unmet needs in social care, with the disabled, poor and those cared for by relatives, most at risk.
A total of 48,876 adults aged 65 and over responded to the Scottish Government's health and care experience survey for 2023-24.
More than 10,000 said they needed some kind of care, support and help with everyday living.
Analysis of the survey revealed that 22% of pensioners reported that they needed or received support over the past 12 months, while 9% of adults reported unmet needs.
Of those who said they needed or received support, 43% flagged unmet support needs.
The scale of unmet needs soared for disabled adults - 17% compared to 2% of those without a disability.
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The survey also revealed the stark issues facing disabled pensioners, with 35% warning they did not receive help that met their needs.
Meanwhile, those receiving unfunded support - family care - were more likely to report an unmet need - 42%, compared to 32% receiving state-funded support.
Older adults living in the most deprived quintile (SIMD1) were more likely to report experiencing an unmet need (16%), compared with 6% of their more affluent peers.
Adam Stachura, director of policy at Age Scotland, told The Herald: “The result of this survey go to the heart of some of the worst failings in the care system.
“An alarming number of over-65s with care requirements are unable to get any of the support they need and many more are struggling to get by with too little care.
“The effect on older people of not getting the care they need can be catastrophic. Many older respondents, and especially those with disabilities, reported being limited in what daily activities they could do.
"Lack of support can also prevent older people maintaining connections among friends, family and in their communities, fuelling the loneliness epidemic affecting older people.
“Interestingly, the survey shows that those who needed support but did not receive any includes older people in both rural and urban settings across the country, which highlights that the shortcomings are a national problem in need of urgent reform.
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“We have called before for the Scottish Government to work with local authorities to fix the social care system. Figures like these should act as a reminder that inaction, and the continued failure to invest and reform, will in effect allow the care system to break down completely, causing untold misery for hundreds of thousands of older people.”
The Scottish Government has accepted that the social care system needs "fundamental reform," but said the Care Reform (Scotland) Bill, if passed in Holyrood, would achieve this aim.
The plans to reform care services costs the Scottish Government around £1 million per month despite dropping plans to set up a national care service.
The Bill proposes a raft of changes to care services, including improving the rights of care home residents to visits.
A Scottish Government spokesman said: “The health and social care system in Scotland needs fundamental reform and this report supports that.
“We are taking key steps towards delivering that through the Care Reform (Scotland) Bill. If passed by Parliament, it will help improve people’s lives and quality of care, while ensuring those who deliver vital services feel supported.
“The UK Government must also play its part in helping us deliver sustainable change by reversing increases to Employment National Insurance Contributions (ENICs) and their plans to end international recruitment – both of which will be devastating for the care sector.”
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