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

Prevalence of depressive disorders among the very old in the 21st century

BACKGROUND

The aim of this study is to explore the prevalence of depressive disorders in very old adults over time, in rural/urban environments, between men/women, as well as to explore other factors associated with depressive disorders.

METHODS

This study was conducted utilizing the GERDA-database data, which consists of four cohorts of 85, 90 and 95+ year olds living in Northern Sweden. Participants could reside independently or in residential care. Data collections took place between 2000 and 2017. Descriptive data and logistic regression models were utilized to explore data.

RESULTS

The prevalence of depressive disorders increased between 2000/02 and 2015/17 in all age groups, with the highest percentages observed in the 95+ age group, reaching 53.6 % in 2015/17. The prevalence varied from 20.3 % in those without dementia to 65.1 % in those with dementia. Sex or living in an urban/rural environment was not associated with an increased risk of depression in the fully adjusted models. Dementia and reduced capacity in activities of daily living were associated with depressive disorders among 85 and 90-year-olds, while living alone was associated with depressive disorders in the 95+ age group.

LIMITATIONS

Potentially limited generalizability, as this study took place in northern Sweden.

CONCLUSIONS

The prevalence of depressive disorders among very old adults increases with age and the prevalence also increases throughout cohorts and time. These alarming rates of depressive disorders among the very old require immediate measures and further investigation. Future studies are needed to explore and monitor trends and to plan and design tailored interventions.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China

BACKGROUND

The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status.

METHODS

A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses.

RESULTS

Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01).

CONCLUSIONS

The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

Profiles of met and unmet care needs in the oldest-old primary care patients with depression - results of the AgeMooDe study

BACKGROUND

Unmet care needs have been associated with an increased risk of depression in old age. Currently, the identification of profiles of met and unmet care needs associated with depressive symptoms is pending. Therefore, this exploratory study aimed to identify profiles of care needs and analyze associated factors in oldest-old patients with and without depression.

METHODS

The sample of 1092 GP patients aged 75+ years is based on the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)". Depression (i.e. clinically meaningful depressive symptoms) was determined using the Geriatric Depression Scale (GDS) (cutoff score ≥ 4). Needs of patients were assessed using the Camberwell Assessment of Need for the Elderly (CANE). Associated sociodemographic and clinical factors were examined, and latent class analysis identified the need profiles.

RESULTS

The main result of the study indicates three need profiles: 'no needs', 'met physical needs', and 'unmet social needs'. Members of the 'met physical needs' (OR = 3.5, 95 %-CI: 2.5-4.9) and 'unmet social needs' (OR = 17.4, 95 %-CI: 7.7-39.7) profiles were significantly more likely to have depression compared to members of the 'no needs' profile.

LIMITATIONS

Based on the cross-sectional design, no conclusions can be drawn about the causality or direction of the relationships between the variables.

CONCLUSIONS

The study results provide important insights for the establishment of needs-based interventions for GPs. Particular attention should be paid to the presence of unmet social needs in the oldest-old GP patients with underlying depressive symptoms.

Multistate survival modelling of multimorbidity and transitions across health needs states and death in an ageing population

BACKGROUND

Unmet health needs have the potential to capture health inequality. Nevertheless, the course of healthcare needs fulfilment, and the role of multimorbidity in this process remains unclear. This study assessed the bidirectional transitions between met and unmet health needs and the transition to death and examined the effect of multimorbidity on transitions.

METHODS

This study was based on the China Health and Retirement Longitudinal Study, a nationally representative survey in 2011-2015 among 18 075 participants aged 45 and above (average age 61.1; SD 9.9). We applied a multistate survival model to estimate the probabilities and the instantaneous risk of state transitions, and Gompertz hazard models were fitted to estimate the total, marginal and state-specific life expectancies (LEs).

RESULTS

Living with physical multimorbidity (HR=1.85, 95% CI 1.58 to 2.15) or physical-mental multimorbidity (HR=1.45, 95% CI 1.15 to 1.82) was associated with an increased risk of transitioning into unmet healthcare needs compared with no multimorbidity. Conversely, multimorbidity groups had a decreased risk of transitioning out of unmet needs. Multimorbidity was also associated with shortened total life expectancy (TLEs), and the proportion of marginal LE for having unmet needs was more than two times higher than no multimorbidity.

CONCLUSION

Multimorbidity aggravates the risk of transitioning into having unmet healthcare needs in the middle and later life, leading to a notable reduction in TLEs, with longer times spent with unmet needs. Policy inputs on developing integrated person-centred services and specifically scaling up to target the complex health needs of ageing populations need to be in place.

Sociodemographic and Clinical Characteristics of People Living with Dementia and Their Associations with Unmet Healthcare Needs: Insights from the Baseline Assessment of the InDePendent Study

Background

The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions.

Objective

To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs.

Methods

We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews.

Results

Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken.

Conclusions

PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.

Healthcare Needs Patterns and Pattern-Predicting Factors in Dementia: Results of the Comprehensive, Computerized Unmet Needs Assessment from the Randomized, Controlled Interventional Trial InDePendent

Background

Determining unmet need patterns and associated factors in primary care can potentially specify assessment batteries and tailor interventions in dementia more efficiently.

Objective

To identify latent unmet healthcare need patterns and associated sociodemographic and clinical factors.

Methods

This Latent Class Analysis (LCA) includes n = 417 community-dwelling people living with dementia. Subjects completed a comprehensive, computer-assisted face-to-face interview to identify unmet needs. One-hundred-fifteen predefined unmet medical, medication, nursing, psychosocial, and social care needs were available. LCA and multivariate logistic regressions were performed to identify unmet needs patterns and patient characteristics belonging to a specific pattern, respectively.

Results

Four profiles were identified: [1] "few needs without any psychosocial need" (n = 44 (11%); mean: 7.4 needs), [2] "some medical and nursing care needs only" (n = 135 (32%); 9.7 needs), [3] "some needs in all areas" (n = 139 (33%); 14.3 needs), and [4] "many medical and nursing needs" (n = 99 (24%); 19.1 needs). Whereas the first class with the lowest number of needs comprised younger, less cognitively impaired patients without depressive symptoms, the fourth class had the highest number of unmet needs, containing patients with lower health status, less social support and higher comorbidity and depressive symptoms. Better access to social care services and higher social support reduced unmet needs, distinguishing the second from the third class (9.7 versus 14.3 needs).

Conclusions

Access to the social care system, social support and depressive symptoms should be assessed, and the patient's health status and comorbidities monitored to more comprehensively identify unmet needs patterns and more efficiently guide tailored interventions.

Predictors of Unmet Needs in Chilean Older People with Dependency: A Cross-Sectional Study

Approximately one in five Chilean older adults has some degree of dependency. Limited evidence is available on self-perceived needs in Latin-American older people. The main aim of this study was to identify predictors of unmet needs of dependent older persons without cognitive impairment, considering personal and primary informal caregivers' factors. This cross-sectional study was conducted with a sample of 77 dyads of older people with dependency and their caregivers. A survey was administered, evaluating sociodemographic characteristics, anxious and depressive symptomatology, health-related quality of life, and social support. Older people's self-reported met and unmet needs and caregivers' burden and self-efficacy were also assessed. To determine predictors of unmet needs, a multiple regression analysis was carried out. Most participants had mild to moderate levels of dependency. The most frequent unmet needs were "daytime activities" (33.8%), "company" (23.4%), "benefits" (23.4%), and "psychological distress" (24.7%). Older people's higher level of dependency and anxious symptomatology were predictors of a higher number of unmet needs, with a model whose predictive value was 31%. The high prevalence of anxious symptomatology and its relationship with the presence of unmet needs highlight the importance of making older people's psychological and social needs visible and addressing them promptly.

Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis

Objectives

Older populations have a relatively high prevalence of unmet healthcare needs, which can result in poor health status. Moreover, in the coming century, frailty is expected to become one of the most serious global public health challenges. However, there is a lack of clear evidence proving an association between unmet healthcare needs and frailty. This study aimed to assess whether unmet healthcare needs predict the onset of frailty in China.

Methods

The association between frailty and unmet healthcare needs was explored by analyzing data from the China Health and Retirement Longitudinal Study (CHARLS) using random-effects logistic regression and Cox regression with time-varying exposure.

Results

At baseline, 7,719 respondents were included in the analysis. Random-effects logistic regression shows that unmet outpatient healthcare needs were associated with increased risk of both contemporaneous (adjusted OR [aOR], 1.17; 95% CI, 1.02-1.35) and lagged (aOR, 1.24; 95% CI, 1.05-1.45) frailty, as were unmet inpatient needs (contemporaneous: aOR, 1.28; 95% CI, 1.00-1.64; lagged: aOR, 1.55; 95% CI, 1.17-2.06). For respondents not classified as frail at baseline (n = 5,392), Cox regression with time-varying exposure shows significant associations of both unmet outpatient needs (adjusted HR, 1.23; 95% CI, 1.05-1.44) and unmet inpatient needs (adjusted HR, 1.48; 95% CI, 1.11-1.99) with increased risk of developing frailty.

Conclusions

Reducing unmet healthcare needs would be a valuable intervention to decrease frailty risk and promote healthy aging in middle-aged and older populations. It is urgent and essential that the equity and accessibility of the medical insurance and health delivery systems be strengthened.

Association of unmet long-term care needs with depression and anxiety among older adults in urban and rural China

This study examined the association of unmet long-term care (LTC) needs with depression and anxiety in older adults and explored urban-rural disparities. Cross-sectional data for 1896 respondents with a mean age of 91.58 years was from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression and anxiety were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Unmet LTC needs were self-reported by older adults with functional limitations. Research methods included regression analyses, decomposition analyses, sensitivity analyses. Results showed that unmet LTC needs, depression, anxiety were more severe in rural older adults. Unmet LTC needs were significantly and positively related to depression and anxiety, but their associations with CESD-10 scores, depressive and anxiety symptoms were stronger in urban older adults. Urban-rural disparities in unmet LTC needs explained about 20%-40% of disparities in depression and anxiety. The findings highlighted the role of meeting LTC needs in reducing depression and anxiety, and that LTC policymakers should not ignore the needs of urban older adults and focus solely on rural older adults.

The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study

BACKGROUND

The unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors.

METHODS

In this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents.

RESULTS

The effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05).

CONCLUSION

Understanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.

Perceived availability of home- and community-based services and self-reported depression among Chinese older adults: A cross-sectional study

Few studies have assessed the association between perceived availability of home- and community-based services (HCBSs) and self-reported depression among Chinese older adults, which the present study attempts to rectify. This cross-sectional study enrolled 11,941 participants aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey 2018 wave. The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depression, and perceived availability was measured for four categories of HCBSs: daily life assistance, medical care services, emotional support and social services, and other. These four categories and the number of services in each were used to represent the perceived availability of service provision. Binary logistic models were used to explore the relationship between perceived availability of HCBSs and depression in older adults. Perceived daily life assistance was found to be negatively associated with depression symptoms among Chinese older adults in both urban and rural areas [rural: OR (95%CI) = 0.66 (0.55-0.78), p < 0.001; urban: OR (95% CI) = 0.69(0.60-0.79), p < 0.001], while perceived levels of medical care services, emotional support and social services, and other were not associated with depression symptoms in rural or urban areas. Our primary finding was that providing daily life assistance at the community level may help to meet more older adults' daily needs, thus potentially decreasing the risk of depression.

Depressive Symptoms and Healthcare Utilization in Late Life. Longitudinal Evidence From the AgeMooDe Study

Objective

The aim of this study was to investigate the longitudinal impact of depressive symptoms on utilization of healthcare in terms of GP visits as well as specialist visits and hospital admission in late life among community-dwelling individuals.

Methods

Longitudinal data (baseline and follow-up) were derived from the German multicentre, prospective cohort study “Late-life depression in primary care: needs, health care utilization and costs” study (AgeMooDe). At baseline, n = 1,230 patients aged 75 years and older were recruited from primary care practices. Main outcomes of interest were use of health care services: the number of GP visits, the number of medical specialist visits, and hospital admission. We used the Geriatric Depression Scale (GDS-15) to measure depression. Outcomes were analyzed with multilevel random intercept negative binominal regression and logistic random-effects models.

Results

At baseline (n = 1,191), mean age was 80.7 (SD 4.6) years, 62.9% were female, and 196 individuals (16.5%) had depression (GDS-15 ≥6). Our longitudinal analyses indicated that older individuals with more depressive symptoms visited their GP more often (IRR=1.03; CI [1.01-1.04], p &lt; 0.001), were visiting medical specialists more frequently (IRR=1.03; CI [1.01-1.04], p &lt; 0.01), and had higher odds of being hospitalized (OR=1.08; CI [1.02-1.13], p &lt; 0.01).

Conclusions

Based on this large longitudinal study we showed that, after adjustment for important covariates, older individuals with more depressive symptoms had higher health care utilization over time. They visited their GP and specialists more frequently and they had higher odds of being hospitalized. This may suggest that higher utilization of specialist care and increased likelihood of being hospitalized may be also attributable to unspecific symptoms or symptoms that are elevated through depressive symptoms.

Socioeconomic inequality of long-term care for older people with and without dementia in England

Ensuring distributive fairness in the long-term care sector is vitally important in the context of global population ageing and rising care needs. This study, part of the DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) programme, investigates socioeconomic inequality and inequity in the utilisation of long-term care for older people with and without dementia in England. The data come from three waves of the English Longitudinal Study of Ageing (ELSA, Waves 6–8, N = 16,458). We find that older people with dementia have higher levels of care needs and a lower socioeconomic status than those without dementia. The distribution of formal and informal care is strongly pro-poor. When care needs are controlled for, there is no significant inequality of formal or informal care among people with dementia, nor of informal care among people without dementia, but there is a significant pro-rich distribution of formal care among people without dementia. Unmet care needs are significantly concentrated among poorer people, both with and without dementia. We argue that the long-term care system in England plays a constructive role in promoting socioeconomic equality of long-term care for people with dementia, but support for older people with lower financial means and substantial care needs remains insufficient. Increased government support for older people is needed to break the circle between care inequality and health inequality.

Needs and Needs Communication of Nursing Home Residents with Depressive Symptoms: A Qualitative Study

Nursing home residents are affected by depressive symptoms more often than elders living at home. There is a correlation between unmet needs and depression in nursing home residents, while met needs positively correlate with greater satisfaction and well-being. The study aims to examine the needs of nursing home residents with depressive symptoms and the communication of those needs, as no previous study has explicitly addressed the needs of this group of people and the way they are communicated. We conducted semi-structured interviews with 11 residents of three nursing homes and analyzed them using content-structuring content analysis. The residents reported diverse needs, assigned to 12 categories. In addition, barriers such as health impairments prevented the fulfillment of needs. As to the communication of needs, various interlocutors, facilitators, and barriers were identified. The findings reveal that residents can express their needs and are more likely to do so if the interlocutors are patient and take them seriously. However, lack of confidants, missing or non-functioning communication tools, impatience and perceived lack of understanding on the part of caregivers, and residents’ insecurities limit communication of needs.

People over 65 Years Old in Social Isolation: Description of an Effective Community Intervention in the City of Madrid (Spain)

Loneliness and social isolation in the elderly population can be shown to be a significant independent risk factor for several conditions, such as poor health behaviours, physical health problems and psychiatric conditions. Although, in the last 20 years, several interventions have been developed to reduce the impact of social isolation and loneliness on the health of older people. However, only a small proportion of these interventions are effective. This study aims to describe the components of the Psychological Support Service for Socially Isolated Elderly People (PSIE), in addition to analysing the effectiveness of a community intervention based on an outreach strategy to combat situations of social isolation in the elderly population. The sample consisted of 63 people over 65 years of age from the city of Madrid (Spain), detected by the socio-health services as people at risk of social isolation. Sociodemographic, mental health, health and psychosocial functioning, global functioning, disability and socio-sanitary needs were evaluated with observational scales. Descriptive statistics were calculated for sociodemographic and mental health variables. An analysis was carried out to study the possible influence of gender in the initial sample on the different variables assessed, using Chi-squared and Student's t-tests for independent samples, with measures of effect size in each case. A study of the effectiveness of PSIE was carried out with an analysis of pre- and post-treatment measures. A Student's t-test was used for related samples, as well as the effect size of Cohen's d statistic. For the assessment of the possible influence of gender on the results of the intervention, a 2 × 2 repeated-measures ANOVA (pre-/post-measures × gender) was conducted. Regarding mental health, 65.2% of the sample presented symptoms compatible with a severe mental disorder, the most frequent being psychotic disorder (22.7%), alcohol use disorder (16.7%), personality disorder (15.2%), anxiety disorders (10.4%) and mood disorders (10.4%). The gender variable does not seem to have an influence on any of the outcome measures studied. The results of the effectiveness study indicate that the PSIE is an intervention programme that serves to improve the scores of people in the sample in all variables that the programme studied. Some of the components of PSIE that could explain its effectiveness are individualized interventions, with a home-based approach by professionals, serving as a link between the older person and the normalized social-sanitary network. Further research is required to provide more robust data on the effectiveness of interventions.

Unmet healthcare needs among middle-aged and older adults in China

BACKGROUND

Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems.

OBJECTIVES

This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China.

METHODS

This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45 years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed.

RESULTS

Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3-13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were 'not enough money' and 'illness is not serious, don't need treatment', respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs.

CONCLUSION

This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified.

Assessment of Met and Unmet Care Needs in Older Adults without Mental Disorders using the Camberwell Assessment of Need for the Elderly: A Systematic Review and Meta-analysis

BACKGROUND

Physical, psychological, and social changes in the aging lead to new needs in the care of the elderly. The Camberwell Assessment of Need for the Elderly (CANE) evaluates older adults' care needs. This study aimed to assess the types of needs of the elderly using the CANE questionnaire.

STUDY DESIGN

A systematic review.

METHODS

This systematic review included all cross-sectional studies. International databases, including Web of Sciences, Medline, Scopus, and ProQuest were searched up to June 2021. Such keywords as aged OR ageing OR "older adults" OR "older people" OR "older person" OR elderly, AND need OR "needs assessment" OR "met needs" OR "unmet needs" were used to design the search strategy. A 95% CI was calculated using the exact method, and the meta-analysis of proportion (metaprob) module was used for data analysis.

RESULTS

In total, 769 studies were retrieved in this review. At the following stages, 760 articles were excluded upon checking the duplicates; moreover, the titles and abstracts did not meet the eligibility criteria. Finally, nine studies remained. The mean±SD age of 2200 participants was obtained at 78.4±5.9 years. The highest and lowest met needs were related to the physical (45%) and social (21%) dimensions, respectively. Furthermore, the highest unmet needs were observed in the physical and social dimensions (0.07%), and the lowest unmet needs were related to the psychological and environmental dimensions (0.04%).

CONCLUSIONS

The CANE is sensitive enough to identify unmet needs in different samples and settings. Therefore, a new care model and appropriate interventions for the elderly can be designed based on the CANE results.

Unmet needs of the oldest old primary care patients with common somatic and psychiatric disorders-A psychometric evaluation

OBJECTIVES

Unmet needs are common in older patients and should be assessed via suitable instruments. The adapted German version of the Camberwell Assessment of Need for the Elderly (CANE) represents an often used tool to determine the needs in older individuals. Evidence on the psychometric properties of the CANE is still pending.

METHODS

A sample of 231 patients with common somatic and psychiatric diseases were interviewed about their needs including their caring relatives and general practitioners (GPs). Frequencies of unmet needs were evaluated across the different perspectives. Interrater agreement, convergent and discriminant validity were evaluated.

RESULTS

On average, psychiatric patients reported more unmet needs than somatic patients, particularly regarding to psychological distress and behavior. The interrater agreement was higher in the somatic subgroup than in the psychiatric subgroup, and higher between patients and relatives compared to patients and GPs. Evidence for construct validity was reported.

CONCLUSIONS

Patients with common somatic and psychiatric disorders report specific unmet needs that should be considered in healthcare. Moderate to good psychometric characteristics were found for the CANE. The use of valid instruments to record needs in health and nursing care can be useful and represents an important starting point for targeted interventions and effective treatment.

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital - cross-sectional results of the intersec-CM study

BACKGROUND

Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments during hospital stays. The aim of the present research is to describe and analyze the treatment needs of people with cognitive impairments in acute hospital care.

METHODS

The analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depression, pharmacological treatment, utilization of health care services and health care related needs.

RESULTS

The sample under examination had been on average mildly cognitively impaired (MMSE M = 22.3) and had a mild to moderate functional impairment (Barthel Index M = 50.4; HABAM M = 19.1). The Edmonton Frail Scale showed a mean of 7.4 and half of the patients (52.3%) had been assigned a care level. About 46.9% had a geriatric diagnosis, 3.0% had a diagnosis of dementia. According to DSM-V 19.2% of the patients had at least one main symptom of depression. The mean number of regularly taken drugs per patient was 8.2. Utilization of health care services prior to the hospital stay was rather low. On average, the sample showed 4.38 care related needs in general, of which 0.60 needs were unaddressed at the time of assessment.

CONCLUSIONS

Descriptive analyses highlight an in-depth insight into impairments and different care needs of people with cognitive impairments. The results emphasize the need for gender-specific analyses as well as an increased attention to the heterogeneity of needs of people with cognitive impairments related to specific wards, settings and regions where they are admitted. Our results indicate also that people with cognitive impairments represent a high proportion of older patients in acute hospital care.

TRIAL REGISTRATION

The intersec-CM trial is registered at ClinicalTrials.gov ( NCT03359408 ).

The Role of Social Isolation and the Development of Depression. A Comparison of the Widowed and Married Oldest Old in Germany

Widowhood is common in old age, can be accompanied by serious health consequences and is often linked to substantial changes in social network. Little is known about the impact of social isolation on the development of depressive symptoms over time taking widowhood into account. We provide results from the follow-up 5 to follow-up 9 from the longitudinal study AgeCoDe and its follow-up study AgeQualiDe. Depression was measured with GDS-15 and social isolation was assessed using the Lubben Social Network Scale (LSNS-6). The group was aligned of married and widowed people in old age and education through entropy balancing. Linear mixed models were used to examine the frequency of occurrence of depressive symptoms for widowed and married elderly people depending on the risk of social isolation. Our study shows that widowhood alone does not lead to an increased occurrence of depressive symptoms. However, "widowed oldest old", who are also at risk of social isolation, have significantly more depressive symptoms than those without risk. In the group of "married oldest old", women have significantly more depressive symptoms than men, but isolated and non-isolated do not differ. Especially for people who have lost a spouse, the social network changes significantly and increases the risk for social isolation. This represents a risk factor for the occurrence of depressive symptoms.

Met and unmet needs of dependent older people according to the Camberwell Assessment of Need for the Elderly (CANE): A scoping review

In order to address the complexity of needs of dependent older people, multidimensional and person-centered needs assessment is required. The objective of this review is to describe met and unmet needs of dependent older people, living in the community or in institutions, and the factors associated with those needs. Selection criteria included papers about need asessment which employed the Camberwell Assesment of Need for the Elderly (CANE). A search through MEDLINE, SCOPUS, WOS and CINHAL databases was carried out. Twenty-one articles were finally included. Unmet needs were found more frequently in psychosocial areas (mainly in "company", "daytime activities" and "psychological distress") and in institutionalized population. In addition, unmet needs were often associated with depressive symptoms, dependency, and caregiver burden. Discrepancies between self-reported needs and needs perceived by formal and informal caregivers were identified. It is important that professionals and caregivers try to make visible the perspective of older people and their psychological and social needs, particularly when the person is dependent, depressed or cognitively impaired.

Perceived unmet needs for community-based long-term care services among urban older adults: A cross sectional study

The purpose of this study was to explore the perceived unmet needs for community-based long-term care services among older urban adults in China. We analyzed the cross-sectional data of 5,201 urban community respondents ≥65 years of age from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The chi-squared automatic interaction detection technique was used to examine the variables associated with older adults' unmet needs for four common types of community-based services: personal care, grocery shopping, home visits, and psychological consulting. We found that the majority of the older adults perceived that they needed the four services, but only 9%-27.4% of the respondents reported that their perceived needs were met. There was a high prevalence of unmet community-based service needs (51.3%-55.5%) among urban older adults in China. Factors associated with unmet needs included depression status, ADL (activities of daily living) limitations, self-rated health, number of surviving children, educational attainment, and marital status. The results suggest that policy makers should develop services targeting specific segments of the older population, increasing the adequacy of services provided.

Grief and loss in old age: Exploration of the association between grief and depression

BACKGROUND

The proportion of older adults is increasing due to demographic changes. Depression belongs to the most common mental disorders in late life. The loss of an emotionally significant person is a risk factor for the development of depression. The aim of this study is to analyze the association between depression and grief burden resulting from loss. Based on prior evidence, we examined loneliness as a possible mediator and social support as possible moderator of this association.

METHODS

The cross-sectional analyses are based on a sample (N = 863) of study participants aged 75+ (M = 81.4 years, SD = 4.4, 62.2% female) with loss experience deriving from the multicenter prospective German cohort study AgeMooDe. Regression analyses (moderated mediation) were performed.

RESULTS

With increasing age (β = 0.10, p = .005) and grief burden (β = 0.33, p <. 001) depression severity increased. There was an indirect mediating effect of loneliness on the correlation of grief burden and depression (b = 0.04, CI [0.03, 0.05]), but no moderating effect of social support on the correlation of grief burden and loneliness. People living alone had a significantly higher risk of depression, increased loneliness and lack of social support.

LIMITATIONS

Assessments were based on self-reporting and recorded dimensionally. The cross-sectional design limits conclusions about directions and causality of associations. Sampling bias cannot be completely excluded.

CONCLUSION

The study provides empirical evidence and a better understanding of the association between grief and depression among the very old and the mediating role of loneliness.

Unmet care needs in the oldest old with social loss experiences: results of a representative survey

Background

Loss experiences such as the loss of a spouse, a close relative or significant others become more likely in old age and may be strongly related to specific unmet health care needs. These unmet needs may often remain undetected and undertreated followed by a negative impact on well-being and social role functioning. The present study aims at exploring the relationship between loss experiences and specific unmet care needs in old age.

Methods

As part of the study „Need assessment in the oldest old: application, psychometric examination and establishment of the German version of the Camberwell Assessment of Need for the Elderly (CANE)”, the adapted German version of the CANE was used in a population-representative telephone survey in a sample of 988 individuals aged 75+ years. Loss experiences within the last 12 months were assessed within the structured telephone survey. Descriptive and interferential statistical analyses were run in order to examine the association between loss experiences and occurring unmet care needs.

Results

Overall, 29.7% of the oldest old reported at least one social loss with other relatives losses being the most frequent (12.5%), followed by non-family losses (10.7%). A significant relationship between loss experiences and a higher number of unmet care needs was observed, especially for close family losses. Other risk factors for unmet care needs were age, marital status, depression, social support and morbidity.

Conclusions

This study provides, for the first time in Germany, data on the association between loss experiences and unmet needs. These findings may substantially contribute to the development of loss-specific interventions, effective treatment and health care planning for the bereaved elderly.

A Framework of Smart-Home Service for Elderly’s Biophilic Experience

Smart-home technology and related services can reinforce a person’s experiential nature, promoting sustainable living among the elderly. It is crucial in the housing industry that support “Aging in Place”, contributing to the contact, control, and simulation of nature at home as well as the creation of a high-quality living space instead of mechanical achievement. Further, biophilic experience, the strengthening of inherent human propensity to nature for optimal health and well-being, supports the elderly’s physical, mental, and sociological health. However, despite the continuing emphasis on the benefits of residential nature experiences for the elderly, the application of smart-home technology and services is insufficient. This study presents a theoretical basis for combining biophilia and smart-home technology, providing a framework for smart-home services to ensure elderly residents can have biophilic experiences. In this study, smart-home components and related studies that can support the biophilic experience and the corresponding technology are analyzed. The results suggest the type and content of smart-home service for ensuring a biophilic experience, while also indicating the configuration of supportive input and output devices according to the service framework. Moreover, we recommend the interaction characteristics of smart-home devices from the perspective of residents, space, efficient service provision, and physical application. This paper broadens our understanding of the sustainable, residential-environment nature experience and informs the expansion of the aged-friendly smart-home industry, contributing to smart-home services trends and development.

Needs and health care costs in old age: a longitudinal perspective: results from the AgeMooDe study

Background: The current study aimed to identify whether needs are associated with health care costs in late life longitudinally.Methods: Data were gathered from two waves (at baseline, n = 1199; at follow-up, n = 958) of a multicenter prospective cohort study ('Late-life depression in primary care: needs, health care utilization and costs', AgeMooDe) in Germany. Individuals aged 75 years and above were recruited via general practitioners. The 'Camberwell Assessment of Need for the Elderly' (CANE) was used to assess needs. Based on a questionnaire, the health-related resource use was assessed retrospectively from a societal perspective. The assessment covered outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Random effects regressions were used.Results: Regressions showed that the number of 'no needs' is inversely associated with total health care costs from a societal perspective (β = -584.0, p < .001). When a health care perspective was adopted, this association was also significant (β = -298.8, p < .001). The association between needs and health care costs persisted in all health care sectors considered in this study.Limitations: It might be difficult to generalize our findings to individuals residing in institutional settings.Conclusion: Adjusting for several potential confounders (e.g. sociodemographic and health-related factors), our study showed that needs - quantified using the CANE - are important for health care costs. Interventions should be developed to reduce needs in late life. These interventions may be beneficial for the health care system.

Profiles of Met and Unmet Needs in People with Dementia According to Caregivers' Perspective: Results from a European Multicenter Study

OBJECTIVES

This exploratory study aimed at investigating profiles of care needs in people with mild to moderate dementia and examined variables associated with these profiles.

DESIGN

A longitudinal international cohort study.

SETTING AND PARTICIPANTS

The baseline data of 447 community-dwelling dyads of people with dementia and their caregivers from the Access to Timely Formal Care (Actifcare) Study were included for analysis.

METHODS

A latent class analysis was applied to identify profiles of needs, measured with the Camberwell Assessment of Need for the Elderly as rated by the caregiver. We examined sociodemographic (eg, relative stress scale) and clinical characteristics (eg, neuropsychiatric inventory) associated with these profiles.

RESULTS

Four distinct need profiles were identified through latent class analysis. These comprised a "no need" profile (41% of the sample), a "met psychological needs" profile (25%), a "met social needs" profile (19%), and an "unmet social needs" profile (15%). A larger impact of caregiving on the caregiver's life as indicated by a higher relative stress scale score was associated with the "unmet social needs" profile.

CONCLUSIONS AND IMPLICATIONS

In this large European sample, there was a subgroup of persons with dementia with high "unmet social needs" whose caregivers simultaneously perceived high stress in their caregiving tasks. Identification of these profiles may help provision of appropriate support for these people.

Are older men more vulnerable to depression than women after losing their spouse? Evidence from three German old-age cohorts (AgeDifferent.de platform)

BACKGROUND

Old age is accompanied by a higher risk of losing a spouse. This study aims to longitudinally investigate the effect of widowhood on depression severity with a special focus on sex differences. We examine depression before and after widowhood in men and women separately to investigate which sex is at greater risk after losing a spouse.

METHODS

Data came from the AgeDifferent.de platform, which includes three pooled old age cohort studies. In order to examine factors associated with depression over time, we applied a linear hybrid mixed-effects regression model for the overall sample and analysed additional separate models for men and women.

RESULTS

Of 2470 respondents (mean age at baseline 79.2 (SD 3.64) years), 1256 were men. In total, 209 men and 332 women experienced spousal bereavement after baseline. In general, both sexes showed higher depression severity after widowhood. However, there were significant sex differences. Widowed men were more prone to subsequent depression than widowed women. In terms of depression severity, widowed men differed significantly compared to non-widowed men; however, this was not the case for women.

LIMITATION

We harmonized three cohort studies which used different measurement scales for depression and different recruitment procedures.

CONCLUSION

Our study showed that although both genders suffer from losing a spouse, men are more prone to subsequently develop depressive symptoms. Raising the awareness among practitioners for sex-specific differences as well as developing tailored interventions for both widowed men and women should be considered.

Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care

Despite growing concerns for the mental health of the older generation most studies focus on mental health care for younger people and there is a lack of knowledge about helpful treatment approaches and models of care for older people. Therefore, the purpose of this review was to answer the question what health care approaches are most helpful for older people experiencing mental health problems. Databases from 2000 to July 2017 were searched with focus on outcome studies, experts' opinions and treatment descriptions. Critical interpretive synthesis was used to analyse and interpret the findings. Four main models of care were found: the medical-psychiatric model which mostly focuses on antipsychotic medication for the treatment of symptoms. Psychotherapeutic and social interventions take into consideration the psychosocial perspectives of mental health problems, but little research has been done on their lasting effect. Research indicates that psychotherapy needs to be adapted to the special needs of older people. Few old people have access to psychotherapy which limits its usefulness. Holistic or integrated models of health care have emerged in recent years. These models focus on both physical and psychosocial well-being and have shown promising outcomes. To reduce antipsychotic medication older people need to be given better access to psychotherapy and social interventions. This presupposes training health care professionals in such treatment methods. The holistic models need to be developed and studied further and given high priority in health care policy.

Unmet health care needs in old age and their association with depression - results of a population-representative survey

BACKGROUND

Due to the demographic changes, unmet health care needs are expected to increase in the elderly population. The aim of this study was to analyse the distribution of met and unmet needs and their association with depression in old age.

METHODS

Based on a population-representative telephone survey of the elderly population aged 75 + years and older, a sample of 845 individuals was assessed via structured clinical interviews. Data on unmet needs were collected via the adapted German version of the Camberwell Assessment of Need for the Elderly (CANE). Descriptive and interferential statistical analyses were run.

RESULTS

Most frequently, unmet needs were reported in the CANE sections memory, physical health and mobility. Significant differences with regard to age and gender were observed. Further, regression analyses revealed that unmet needs were significantly associated with depression.

LIMITATIONS

Data on unmet needs were only assessed from the participants' perspectives. The cross-sectional design of the study does not allow drawing conclusions on causality of results.

CONCLUSION

This study provides, for the first time in Germany, population-representative data on unmet health care needs in the oldest old and represents an important starting point in the field of health and social care as well as the development of tailored treatment and interventions in old age.

Loss experiences in old age and their impact on the social network and depression- results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)

BACKGROUND

Loss experiences and bereavement are common among the oldest old. This study aims to investigate the effects of loss experiences and the social network type on depression in old age.

METHODS

As part of the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative population-based cohort study, 783 persons aged 75+ years were assessed via standardized interviews including the Practitioner Assessment of Network Type Instrument (PANT) and the Center for Epidemiologic Studies-Depression Scale (CES-D). Effects of loss experiences and network type on depression were analysed cross-sectionally (baseline survey) using logistic regressions. Effects over time were analysed longitudinally (follow-up1 and follow-up2) using hybrid techniques.

RESULTS

More than half of the elderly (57%) continuously lived in a restricted network. Only 12.1% lived in an integrated network. Although 30.9% had a change in their network, no significant association with loss experiences was found. Nevertheless, loss experiences (OR 7.56 (1.60-35.72)) and a restricted social network (OR 4.08 (1.52-10.95)) appeared to be the significant predictors of depression.

LIMITATIONS

Our study captures only a selected time window of the individual life and loss experience was only assessed at the time of the baseline survey.

CONCLUSION

Our findings revealed that elderly individuals, who experienced social loss or lived in restricted social networks, were more likely to develop depression compared to individuals who lived in integrated social networks or without loss experiences. The social integration of elderly individuals is an urgent issue that should be addressed in order to reduce depression in old age.

Needs of older adults living in long-term care institutions: an observational study using Camberwell Assessment of Need for the Elderly

Introduction

No comprehensive needs assessment is performed routinely in Poland.

Purpose

The goal of the study was to investigate the patterns of needs in older individuals living in long-term care institutions (LTCIs) using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire, based on a previously published study protocol.

Participants and methods

The study included 306 LTCI residents (age: ≥75 years) with the a Mini-Mental State Examination (MMSE) score of at least 10 points. The dependence in basic activities of daily living was measured using the Barthel index (BI). A screening for depression was performed using the Geriatric Depression Scale (GDS) in subjects with an MMSE score of ≥15 points. Thereafter, CANE was used to analyze needs receiving adequate support (met needs) and those without appropriate interventions (unmet needs).

Results

The mean age of studied individuals was 83.2±6.0 years. They had 10.4±3.2 met needs and 0.8±1.2 unmet needs. Unmet needs were reported most commonly in the following areas: company (15.9%), psychological distress (14.0%), intimate relationship (11.4%), eyesight/hearing/communication (11.4%), and daytime activities (11.0%). The OR of having a large number of met needs (ie, above the median) was almost eight times higher in residents with a BI score of 0–49 points versus those with ≥80 points. The group between (with 50–79 points) had this parameter almost four times higher. The OR of having a large number of unmet needs depended neither on BI nor on GDS and was more than four times higher in the group of 10–19 MMSE points (ie, with symptoms of moderate dementia) versus subjects with 24–30 MMSE points (ie, without symptoms of dementia).

Conclusion

We defined the target group with high probability of unmet needs and the areas in which resources and efforts should be concentrated. We believe that the results can be used to optimize care in LTCIs.

[The Physical Examination of an 'Uncooperative' Elderly Patient]

The Physical Examination of an 'Uncooperative' Elderly Patient Abstract. The physical examination of uncooperative elderly patients regularly presents physicians in the private practice, in the hospital or nursing home with great challenges. The lack of cooperation itself can be an important indication of an underlying medical problem. Important elements to improve the patient's cooperation include ensuring basic needs, sufficient time and patience, adequate communication and good cooperation with relatives and other healthcare professionals. Targeted clinical observation as well as thinking in geriatric syndromes and unmet needs can help to raise physical findings despite limited cooperation. Pathological findings are indicators of impaired organ and functional systems and must be supplemented by a detailed examination.

Unmet needs in the depressed primary care elderly and their relation to severity of depression: results from the AgeMooDe study

OBJECTIVES

This study aims at examining the distribution of unmet environmental, physical, social and psychological care needs in a sample of the oldest old primary care patients with different levels of depression severity. Furthermore, the objective of this study was to analyze the association between specific unmet care needs and severity of depression.

METHOD

The sample of patients aged 75 years (n = 202) and more was derived from the multicenter prospective cohort study AgeMooDe ('Late-life depression in primary care: Needs, health care utilization and costs'). Patients were assessed via structured clinical interviews containing the German version of the Camberwell Assessment of Need for the Elderly (CANE) and the German Hospital Anxiety and Depression Scale (HADS-D). Descriptive statistics, Spearman correlation coefficients and binary logistic regression analyses were computed.

RESULTS

Unmet needs appeared to be substantially higher in the patient group with higher levels of depression severity according to the HADS-D score. Overall, there was weak positive linear correlation between depression and CANE total unmet needs. Except of the physical unmet needs category, all other CANE care categories showed little to moderate positive linear correlations with depression according to the HADS-D score. Depression and psychological unmet needs showed the strongest of all correlations, followed by social unmet needs. The binary logistic regression analysis revealed that patients having psychological unmet needs were 4.8 times more likely diagnosed with a probable depression.

CONCLUSION

Systematic needs assessment, especially psychological needs, may play a crucial role in the course of prevention and effective treatment of late-life depression in the primary care context.

Psychometric Validation of the Korean Version of the Camberwell Assessment of Need for the Elderly (CANE-K) in Dementia

PURPOSE

The prevalence of dementia has increased rapidly with an aging Korean population. Compared to those without dementia, individuals with dementia have more and complex needs. In this study, the Korean version of the Camberwell Assessment of Need for the Elderly (CANE-K) was evaluated to determine its suitability for individuals with dementia in Korea.

METHODS

The CANE-K was developed following linguistic validation. The reliability of the measurement was examined with Cronbach's alpha coefficient. The factor structure and construct validity were evaluated by performing exploratory factor analysis (EFA) and confirmatory factor analyses (CFA). Pearson's correlation coefficients with related measures were used to ensure concurrent validity.

RESULTS

Four factors extracted with EFA and CFA validated the model structure (X2 = 367.25, p = .000, goodness of fit index = .84, adjusted goodness of fit index = .80, root mean square error of approximation = .07, and comparative fit index = .83). Items on the CANE-K loaded on the four factors in a range between .40 and .80. The output of Pearson's correlation coefficient with cognitive impairment, behavioral problems, activities of daily living and caregiver burden showed acceptable concurrent validity.

CONCLUSION

The CANE-K showed a reasonable degree of reliability and validity. Therefore, it has good potential to appropriately measure the needs and unmet needs of those with dementia.

What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study

OBJECTIVE

Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs.

METHODS

Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents' and nursing staff's perceptions. Descriptive and multivariate regression analyses were conducted.

RESULTS

Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n = 2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n = 1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated 'no need' regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs.

CONCLUSIONS

Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable.

Categorical and dimensional perspectives on depression in elderly primary care patients - Results of the AgeMooDe study

An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)" a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.

A qualitative study on older primary care patients' perspectives on depression and its treatments - potential barriers to and opportunities for managing depression

Background

Depression is one of the most common mental disorders in old age and is associated with various negative health consequences for the affected individual. Studies suggest that patients’ views on depression have an impact on help-seeking behaviour and treatment. It is thus important to investigate the patient’s perspective in order to ascertain optimum management of depression in late life. However, studies on depression and its treatment exploring the perspectives of primary care patients 75 years or older, are rare.

Methods

Qualitative data was collected in semi-structured interviews with 12 primary care patients 75 years of age or older with symptoms of depression. Data was analysed using qualitative content analysis.

Results

The study’s results show the multifaceted views on and treatment of depression in primary care patients 75 years of age or older. Some patients seemed well informed about depression and believed in the efficacy of different treatments, such as medications or psychotherapy. However, some individuals had misconceptions about depression and its treatments. Patients mentioned that they would rather avoid talking about depression within their social network, in part of fear of negative reactions. Furthermore, participants believed that other people had little understanding for people with depression. Patients had different views on the relevance of the general practitioner’s (GP) role in treating depression; some patients believed that the GP had little importance in the treatment of depression.

Conclusions

This study identified positive views of primary care patients 75 years of age or older towards depression as well as views that might hinder optimal treatments. Exemplary implications for an improved management of depression are: educating older adults about depression via age-specific information and having professionals encourage patients in believing that depression is a recognised disorder.

Electronic supplementary material

The online version of this article (10.1186/s12875-017-0684-3) contains supplementary material, which is available to authorized users.

Treatment preferences for depression in the elderly

BACKGROUND

If patients are treated according to their personal preferences, depression treatment success is higher. It is not known which treatment options for late-life depression are preferred by patients aged 75 years and over and whether there are determinants of these preferences.

METHODS

The data were derived from the German "Late-life depression in primary care: needs, health care utilization, and costs (AgeMooDe)" study. Patients aged 75+ years (N = 1,230) were recruited from primary care practices. Depressive symptoms were determined using the Geriatric Depression Scale (GDS-15). Support for eight treatment options was determined.

RESULTS

Medication, psychotherapy, talking to friends and family, and exercise were the preferred treatment options. Having a GDS score ≥ 6 significantly lowered the endorsement of some treatment options. For each treatment option, the probability of choosing the indecisive category "I do not know" was significantly increased in participants with moderate depressive symptoms.

CONCLUSIONS

Depressive symptoms influence the preference for certain treatment options and also increase indecision in patients. The high preference for psychotherapy suggests a much higher demand for late-life psychotherapy in the future. Healthcare systems should begin to prepare to meet this anticipated need. Future studies should include previous experience with treatment methods as a confounding variable.

The Impact of Depressive Symptoms on Healthcare Costs in Late Life: Longitudinal Findings From the AgeMooDe Study

OBJECTIVE

To examine whether depressive symptoms affect healthcare costs in old age longitudinally.

DESIGN

Multicenter prospective observational cohort study (two waves with n_t1 = 1,195 and n_t2 = 951) in Germany.

SETTING

Community.

PARTICIPANTS

Participants aged 75 years and older recruited via general practitioners.

MEASUREMENTS

Depressive symptoms were assessed by the Geriatric Depression Scale (GDS). The health-related resource use was measured retrospectively from a societal perspective based on a questionnaire, covering outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Hybrid regression models were used to determine the between- and within-effect of depressive symptoms on healthcare costs, adjusting for important covariates.

RESULTS

Six-month total cost increased from €3,090 (t1) to €3,748 (t2). The hybrid random effects models showed that individuals with more depressive symptoms had higher healthcare costs compared with individuals with less depressive symptoms (between-effect). Moreover, an intra-individual increase in depressive symptoms increased healthcare costs by €539.60 (within-effect) per symptom on GDS.

CONCLUSIONS

Our findings emphasize the economic importance of depressive symptoms in old age. Appropriate interventions to treat depressive symptoms in old age might also be a promising strategy to reduce healthcare costs.

Unmet care needs of the oldest old with late-life depression: A comparison of patient, caring relative and general practitioner perceptions - Results of the AgeMooDe study

BACKGROUND

Research showed that the perception of unmet needs may differ between patients, caregivers and professionals. Lacking agreement with regard to unmet needs between raters involved may have a negative impact on treatment of late-life depression.

METHODS

As part of the multicenter German study "Late-life depression in primary care: needs, health care utilization and costs" (AgeMooDe), n=1188 primary care patients aged 75-98 with and without depression, relatives (n=366) and general practitioners (GPs, n=1152) were assessed using the German version of the Camberwell Assessment of Need for the Elderly (CANE) in order to identify patients' unmet needs from different perspectives. Kappa coefficients were computed to determine level of agreement between perspectives. Penalized likelihood logistic regression models were run in order to assess the association between depression severity and disagreement between perspectives with regard to unmet needs.

RESULTS

The prevalence of unmet needs was higher in depressive patients. Kappa coefficients were on average higher for depressive patients ranging from poor to substantial. Severity of depression was significantly associated with disagreement regarding unmet needs between perspectives.

LIMITATIONS

The cross-sectional design of the study limits the results. Only a part of caring relatives was able to participate.

CONCLUSIONS

Perceptions of unmet needs in the oldest old primary care patients suffering from depression strongly differ between raters. Severity of depression seems to exacerbate the discrepancy between involved perspectives. The negative impact that depression severity may have on the perception and assessment of unmet needs requires greater attention by GPs.

The impact of depressive symptoms on utilization of home care by the elderly: Longitudinal results from the AgeMooDe study

BACKGROUND

Depression is the most common psychiatric disease in older people, often accompanied by co-morbidities and functional limitations. In cross-sectional studies, depression is associated with an increased use of health care resources, including informal care and home care. Longitudinal data are needed to better understand the causal links between depression, functional impairments, and health care utilization.

METHODS

Data were obtained at baseline and follow-up of the multicenter, prospective cohort study "Late life depression in primary care: needs, health care utilization and costs" (AgeMooDe). A sample of 955 primary care patients aged 75 years and older was interviewed twice. The primary outcomes were the average respective amounts of time spent utilizing home care, professional nursing care, domestic help and informal care. These outcomes were analyzed with Generalized Linear Mixed Models (GLMM).

RESULTS

GLMM analysis revealed that the amount of time utilizing home care over the study period was positively associated with depression, higher age, and functional and cognitive impairments, but negatively associated with living alone. In-depth analyses revealed that these associations were particularly obvious for the utilization of informal care.

LIMITATIONS

The generalizability of our findings may be limited due to use of a dimensional instrument to determine depressive symptoms.

CONCLUSIONS

Over the study period, the average amount of time receiving home care and especially informal care increased in the group of patients with depression only. People with depressive symptoms experience a growing number of functional limitations over time, increasing their dependency on others. Functional limitations, depression and dependency appear to form a vicious cycle.

Excess health care costs of late-life depression - Results of the AgeMooDe study

INTRODUCTION

The study aimed at determining excess costs of late-life depression from a societal perspective. Moreover, the impact of recognition of depression by GPs on costs was investigated.

METHODS

Cross-sectional data were obtained from a large multicenter observational cohort study (AgeMooDe). Participants (n=1197) aged 75 years or older and were recruited via their GPs in Leipzig, Bonn, Hamburg, and Mannheim in Germany from May 2012 until December 2013. In the base case analysis, depression was assessed using the Geriatric Depression Scale (GDS; cutoff GDS≥6). Data on health care utilization and costs were based on participants' self-reports for inpatient treatment, outpatient treatment, pharmaceuticals, and formal and informal nursing care.

RESULTS

Unadjusted mean costs in a six-month period for depressed individuals (€5031) exceeded those of non-depressed (€2700) by the factor 1.86 and were higher in all health care sectors considered. Statistically significant positive excess costs persisted in all formal health care sectors after adjusting for comorbidity and socio-demographics. Recognition of depression by the GP did not moderate the relationship of depression and health care costs.

LIMITATIONS

Analyses were restricted to a cross-sectional design, not permitting any conclusions on causal interference of the variables considered.

CONCLUSION

The findings stress the enormous burden of depression in old age for all sectors of the health care system. The fact that GPs' recognition of depression does not moderate the relationship between depression and costs adds further insights into the economics of this frequent psychiatric disorder.