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Objective: To examine sociodemographic factors associated with having unmet needs in medications, mental health, and food security among older adults during the COVID-19 pandemic. Data Sources and Study Setting: Primary data and secondary data from the electronic health records (EHR) in an age-friendly academic health system in 2020 were used. Study Design: Observational study examining factors associated with having unmet needs in medications, food, and mental health. Data Collecting/Extraction Methods: Data from a computer-assisted telephone interview and EHR on community-dwelling older patients were analyzed. Principle Findings: Among 3400 eligible patients, 1921 (53.3%) (average age 76, SD 11) responded, with 857 (45%) of respondents having at least one unmet need. Unmet needs for medications were present in 595 (31.0%), for food in 196 (10.2%), and for mental health services in 292 (15.2%). Racial minorities had significantly higher probabilities of having unmet needs for medicine and food, and of being referred for services related to medications, food, and mental health. Patients living in more resource-limited neighborhoods had a higher probability of being referred for mental health services. Conclusions: Age-friendly health systems (AFHS) and their recognition should include assessing and addressing social risk factors among older adults. Proactive efforts to address unmet needs should be integral to AFHS. KEYWORDS aging, healthy place index, neighborhood resources, social determinants of health, unmet needs What is known on this topic * Both residential geographical area and person-level sociodemographic factors are associated with having unmet needs for important services. * Little is known about the association of geographical area resource limitations with unmet needs and the probability of receiving services to address unmet needs after accounting for individual factors. What this study adds * Individual sociodemographic and health risk factors are associated with having unmet needs in what matters to older adults (medications, mental health, and food security). * Geographical area resource limitations are associated with the probabilities of receiving services to address mental health needs after accounting for the individual-level factors. * Higher levels of anxiety were associated with having unmet needs for medications and the probability of being referred for services to address food insecurity after accounting for other factors., 1 | INTRODUCTION The age-friendly health systems (AFHS) framework incorporates four elements (What Matters, Medication, Mentation, and Mobility) known as the 4 M's to guide the quality care of older [...]