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Carvacho R, Carrasco M, Fernández MB, Miranda-Castillo C. Predictors of Unmet Needs in Chilean Older People with Dependency: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6928. [PMID: 37887666 PMCID: PMC10606872 DOI: 10.3390/ijerph20206928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
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.
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Affiliation(s)
- Raffaela Carvacho
- Millennium Institute for Care Research (MICARE), Santiago 8370146, Chile; (R.C.); (M.B.F.)
| | - Marcela Carrasco
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Center for Studies in Age and Aging (Centro de Estudios de Vejez y Envejecimiento CEVE-UC), Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - María Beatriz Fernández
- Millennium Institute for Care Research (MICARE), Santiago 8370146, Chile; (R.C.); (M.B.F.)
- Center for Studies in Age and Aging (Centro de Estudios de Vejez y Envejecimiento CEVE-UC), Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
- Institute of Sociology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - Claudia Miranda-Castillo
- Millennium Institute for Care Research (MICARE), Santiago 8370146, Chile; (R.C.); (M.B.F.)
- Faculty of Nursing, Universidad Andres Bello, Santiago 8370146, Chile
- Millennium Institute for Research in Depression and Personality, Santiago 7820436, Chile
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Yu Y, Zhang J, Song C, Petrovic M, Pei X, Zhang WH. Perceived availability of home- and community-based services and self-reported depression among Chinese older adults: A cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2827-e2837. [PMID: 35040216 DOI: 10.1111/hsc.13726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 12/23/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Yushan Yu
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jun Zhang
- The Research Center for Public Health, Tsinghua University, Beijing, China
| | - Chao Song
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mirko Petrovic
- Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Xiaomei Pei
- Department of Sociology, School of Social Sciences, Tsinghua University, Beijing, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
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Eimontas J, Gegieckaitė G, Zamalijeva O, Pakalniškienė V. Unmet Healthcare Needs Predict Depression Symptoms among Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158892. [PMID: 35897261 PMCID: PMC9330083 DOI: 10.3390/ijerph19158892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
Risk factors for depression in older adults include significant interpersonal losses, increasing social isolation, and deteriorating physical abilities and health that require healthcare. The effects of unmet healthcare needs on depression in older adults are understudied. This study aimed to analyze the association between unmet healthcare needs and symptoms of depression, sleep, and antidepressant medication while controlling for other significant factors among older adults. For this study, we used a multinational database from The Survey of Health, Ageing and Retirement in Europe (SHARE), containing data of individuals aged 50 and older. The final sample used in this research consisted of 39,484 individuals from 50 to 100 years (mean − 71.15, SD ± 9.19), 42.0 percent of whom were male. Three path models exploring relationships between symptoms of depression at an older age and unmet healthcare needs were produced and had a good model fit. We found that unmet healthcare needs were directly related to depression, activity limitations were related to depression directly and through unmet healthcare needs, whereas financial situation mostly indirectly through unmet healthcare needs. We discuss how depression itself could increase unmet healthcare needs.
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The longitudinal association between loneliness and depressive symptoms in the elderly: a systematic review. Int Psychogeriatr 2022; 34:657-669. [PMID: 33849675 DOI: 10.1017/s1041610221000399] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Loneliness and the onset of depression in old age are growing problems related to the greater life expectancy nowadays. This review investigated the longitudinal association between loneliness and depressive symptoms in the elderly. DESIGN A comprehensive search was conducted using three databases (Scopus, PsycInfo, and PubMed) combing for empirical studies published up until July 2020. A total of 4.549 abstracts and 221 full-text articles were assessed. Three authors independently reviewed titles and abstracts; disagreements were resolved by consensus. RESULTS Ten studies were included in the final review. We identified two categories of studies based on the outcome considered in each article: 1) the longitudinal effect of loneliness on depressive symptoms and 2) the clinical course of depression and its association with loneliness. All the articles reported a significant and positive association between loneliness and depressive symptoms in their longitudinal design research, ranging from an odds ratio of 0.41 to 17.76. The heterogeneity regarding the effect size in the analyses can be explained by the multifactorial design implemented by most of the studies included. CONCLUSIONS Future research should investigate the moderators' role and how it may influence the longitudinal association between loneliness and depression over the years.
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Roberts JS, Ferber RA, Funk CN, Harrington AW, Maixner SM, Porte JL, Schissler P, Votta CM, Deldin PJ, Connell CM. Mood Lifters for Seniors: Development and Evaluation of an Online, Peer-Led Mental Health Program for Older Adults. Gerontol Geriatr Med 2022; 8:23337214221117431. [PMID: 35966640 PMCID: PMC9373139 DOI: 10.1177/23337214221117431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Effective, scalable mental health programs are greatly needed for older adults. In this study, Mood Lifters-a peer-led, community-based program promoting mental well-being-was adapted to more specifically address the needs of older adults. Two groups completed the 14-week program via Zoom. A total of 24 participants enrolled (M age = 72 years), with 20 (83%) completing the program. Compared to baseline, program completers showed significant improvements in depression symptoms (p < .01), perceived stress (p = .04), sleep quality (p < .01), physical activity (p < .01), and brain health behaviors (p = .01), with improvements maintained at 1-month follow-up. No significant changes were reported in participants' anxiety, loneliness, or resilience. Participant ratings of program satisfaction were very high (M = 4.75/5). Results suggest Mood Lifters for Seniors is feasible to disseminate and acceptable to older adults, with preliminary evidence of benefits in several mental health domains. Future randomized trials with larger, more diverse samples are needed to confirm program benefits.
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Affiliation(s)
- J Scott Roberts
- University of Michigan School of Public Health, Ann Arbor, USA
| | | | | | | | | | | | | | - Cecilia M Votta
- University of Michigan, Ann Arbor, USA.,Mood Lifters LLC, Ann Arbor, MI, USA
| | - Patricia J Deldin
- University of Michigan, Ann Arbor, USA.,Mood Lifters LLC, Ann Arbor, MI, USA
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Carvacho R, Carrasco M, Lorca MBF, Miranda-Castillo C. Met and unmet needs of dependent older people according to the Camberwell Assessment of Need for the Elderly (CANE): A scoping review. Rev Esp Geriatr Gerontol 2021; 56:225-235. [PMID: 33888307 DOI: 10.1016/j.regg.2021.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Raffaela Carvacho
- Pontificia Universidad Católica de Chile, School of Psychology, Santiago, Chile; Millennium Institute for Caregiving Research, Santiago, Chile
| | - Marcela Carrasco
- Pontificia Universidad Católica de Chile, Faculty of Medicine, Santiago, Chile; UC Center for Studies in Age and Ageing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Beatriz Fernández Lorca
- Pontificia Universidad Católica de Chile, Institute of Sociology, Santiago, Chile; Millennium Institute for Caregiving Research, Santiago, Chile; UC Center for Studies in Age and Ageing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Miranda-Castillo
- Universidad Andres Bello, Faculty of Nursing, Santiago, Chile; Millennium Institute for Caregiving Research, Santiago, Chile; Millennium Institute for Research in Depression and Personality, Santiago, Chile.
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Clignet F, Houtjes W, van Straten A, Cuijpers P, van Meijel B. Unmet care needs, care provision and patient satisfaction in patients with a late life depression: a cross-sectional study. Aging Ment Health 2019; 23:491-497. [PMID: 29356572 DOI: 10.1080/13607863.2018.1426716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research has shown that some 30% of total care needs in people with late-life depression (LLD) are unmet. It is not known to what extent patients actually don't receive any care for these needs or consider the care to be insufficient and their satisfaction with the provided care. AIM The aim of this study is to obtain insight into the care provided in relation to the reported unmet care needs and satisfaction with the total care provided is examined. METHOD A cross-sectional study of 99 people with LLD in an ambulatory setting. RESULTS In 67% of patients, at least one unmet need was ascertained. In most cases (80%) care was actually provided for those needs by professionals and/or informal caregivers. Patients were satisfied with the care delivered for 81% of the reported care needs. Satisfaction was lowest for social care needs (67%). For six specific care needs it was demonstrated that dissatisfied patients were significantly more depressed than satisfied patients. CONCLUSION Even though patients might receive care for certain needs, this does not mean that their needs are met. A substantial proportion of patients with LDD feel that they need additional help for unmet needs.
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Affiliation(s)
- Frans Clignet
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands.,b Department of old age psychiatry , Altrecht specialists in Mental Health Care , Zeist , 3705 WH , Netherlands
| | - Wim Houtjes
- c GGZ-VS, Academy for Clinical Nurse Specialists in mental healthcare , Utrecht , 3511 GE , Netherlands
| | - Annemieke van Straten
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands
| | - Pim Cuijpers
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands
| | - Berno van Meijel
- d Department of Health & Self-management , Inholland University of Applied Sciences , Amsterdam , 1081 HV , Netherlands
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Tobis S, Wieczorowska-Tobis K, Talarska D, Pawlaczyk M, Suwalska A. Needs of older adults living in long-term care institutions: an observational study using Camberwell Assessment of Need for the Elderly. Clin Interv Aging 2018; 13:2389-2395. [PMID: 30538435 PMCID: PMC6254588 DOI: 10.2147/cia.s145937] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Sławomir Tobis
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland,
| | | | - Dorota Talarska
- Department of Preventive Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Mariola Pawlaczyk
- Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland,
| | - Aleksandra Suwalska
- Laboratory of Neuropsychobiology, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care. Eur J Ageing 2018; 16:215-225. [PMID: 31139035 DOI: 10.1007/s10433-018-0490-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
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.
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Alltag S, Stein J, Pabst A, Weyerer S, Werle J, Maier W, Miebach L, Scherer M, Stark A, Wiese B, Mamone S, König HH, Bock JO, Riedel-Heller SG. Unmet needs in the depressed primary care elderly and their relation to severity of depression: results from the AgeMooDe study. Aging Ment Health 2018; 22:1032-1039. [PMID: 28521552 DOI: 10.1080/13607863.2017.1328480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Sophie Alltag
- a Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig , Leipzig , Germany
| | - Janine Stein
- a Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig , Leipzig , Germany
| | - Alexander Pabst
- a Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig , Leipzig , Germany
| | - Siegfried Weyerer
- b Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University , Mannheim , Germany
| | - Jochen Werle
- b Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University , Mannheim , Germany
| | - Wolfgang Maier
- c Department of Psychiatry , University of Bonn and German Center For Neurodegenerative Diseases Within the Helmholtz Association , Bonn , Germany
| | - Lisa Miebach
- c Department of Psychiatry , University of Bonn and German Center For Neurodegenerative Diseases Within the Helmholtz Association , Bonn , Germany
| | - Martin Scherer
- d Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Anne Stark
- d Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Birgitt Wiese
- e Institute For General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School , Hannover , Germany
| | - Silke Mamone
- e Institute For General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School , Hannover , Germany
| | - Hans-Helmut König
- f Department of Health Economics and Health Services Research, Hamburg Center For Health Economics , University Medical Centre Hamburg-Eppendorf, University of Hamburg , Hamburg , Germany
| | - Jens-Oliver Bock
- f Department of Health Economics and Health Services Research, Hamburg Center For Health Economics , University Medical Centre Hamburg-Eppendorf, University of Hamburg , Hamburg , Germany
| | - Steffi G Riedel-Heller
- a Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig , Leipzig , Germany
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Hermsen LAH, Hoogendijk EO, van der Wouden JC, Smalbrugge M, Leone SS, van der Horst HE, Dekker J. Self-perceived care needs in older adults with joint pain and comorbidity. Aging Clin Exp Res 2018; 30:449-455. [PMID: 28688079 PMCID: PMC5911275 DOI: 10.1007/s40520-017-0795-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/26/2017] [Indexed: 12/03/2022]
Abstract
Background The aim of this study was to explore self-perceived care needs and determinants of identified needs in older adults with joint pain and comorbidity. Methods This is a cross-sectional study using baseline data from a cohort study of older adults in the Netherlands (≥65 years) with joint pain and comorbidity (n = 407). We used the Camberwell Assessment of Need for the Elderly (CANE) to assess self-perceived care needs. Regression analyses were conducted to examine the associations between needs and sociodemographic factors (age, gender, partner status and educational level), physical factors (pain intensity, comorbidity, frailty and physical functioning) and psychosocial factors (anxiety, depression and social support). Results Older adults with joint pain and comorbidity reported on average 4.0 care needs out of 13 CANE items, of which 0.3 were unmet. High levels of environmental and physical needs were reported, such as needs with regard to physical illness (91%), household (61%) and mobility/falls (53%). However, most of these needs were met. Only few people reported psychosocial needs, but a large proportion of these needs was unmet, especially regarding company (66.7%) and daytime activities (37%). Psychosocial needs were more often present in frail participants (OR 2.40, 95% CI 1.25–4.61), and those with less perceived social support (OR 1.05, 95% CI 1.01–1.08) and more depressive symptoms (OR 1.17, 95% CI 1.07–1.26). Discussion/Conclusions Unmet needs are mainly present in the psychosocial domain. Specific attention targeted at these unmet needs may improve psychosocial well-being of older adults with joint pain and comorbidity.
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Affiliation(s)
- Lotte A H Hermsen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Stephanie S Leone
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Public Mental Health, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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van den Brink AMA, Gerritsen DL, de Valk MMH, Mulder AT, Oude Voshaar RC, Koopmans RTCM. What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study. Int J Nurs Stud 2018. [PMID: 29524680 DOI: 10.1016/j.ijnurstu.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Anne M A van den Brink
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Debby L Gerritsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda M H de Valk
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands.
| | - Astrid T Mulder
- Gelre Hospital, Department of Geriatrics, Postbus 9014, 7300 DS, Apeldoorn, The Netherlands.
| | - Richard C Oude Voshaar
- University Medical Center Groningen, University of Groningen, University Center for Psychiatry and Interdisciplinary Center for Psychopathology of Emotion Regulation, Postbus 30.001, 9700 RB, Groningen, The Netherlands.
| | - Raymond T C M Koopmans
- De Waalboog, 'Joachim en Anna', Center for Specialized Geriatric Care, Postbus 31071, 6503 CB, Nijmegen, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
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13
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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. J Affect Disord 2016; 205:182-189. [PMID: 27449550 DOI: 10.1016/j.jad.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/06/2016] [Accepted: 07/03/2016] [Indexed: 11/23/2022]
Abstract
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.
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14
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Stein J, Pabst A, Weyerer S, Werle J, Maier W, Heilmann K, Scherer M, Stark A, Kaduszkiewicz H, Wiese B, Mamone S, König HH, Bock JO, Riedel-Heller SG. 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. J Affect Disord 2016; 193:309-17. [PMID: 26774519 DOI: 10.1016/j.jad.2015.12.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/03/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Depression belongs to the most common mental disorders in late life and will lead to a significant increase of treatment and health care needs in the future. The Camberwell Assessment of Need for the Elderly (CANE) evaluates met and unmet care needs in older individuals. Reports on needs of the elderly with depression are currently lacking. The aim of the present study was to identify met and unmet needs in older primary care patients with and without depression using the German-language version of the CANE. Furthermore, the association between unmet needs and depression ought to be explored. METHODS As part of the study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)", a sample of 1179 primary care patients aged 75 years and older was assessed. Descriptive and inferential statistics as well as logistic regression analyses were conducted. RESULTS This study, for the first time in Germany, provides data on the distribution of met and unmet needs in depressive and non-depressive older primary care patients. As a main result, unmet needs were significantly associated with depression; other risk factors identified were gender, institutionalization, care by relatives and impaired functional status. LIMITATIONS The conclusions about directions and causality of associations between the variables are limited due to the cross-sectional design. CONCLUSIONS The study results provide an important contribution to generate a solid base for an effective and good-quality health and social care as well as to an appropriate allocation of health care resources in the elderly population.
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Affiliation(s)
- Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Katharina Heilmann
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Silke Mamone
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
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15
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Houtjes W, van Meijel B, van de Ven PM, Deeg D, van Tilburg T, Beekman A. The impact of an unfavorable depression course on network size and loneliness in older people: a longitudinal study in the community. Int J Geriatr Psychiatry 2014; 29:1010-7. [PMID: 24615822 DOI: 10.1002/gps.4091] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/23/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This work aims to gain insight into the long-term impact of depression course on social network size and perceived loneliness in older people living in the community. METHODS Within a large representative sample of older people in the community (Longitudinal Aging Study Amsterdam (LASA)), participants with clinically relevant levels of depressive symptoms (scores >16 on the Center for Epidemiological Studies Depression Scale) were followed up over a period of 13 years of the LASA study (five waves). General estimating equations were used to estimate the impact of depression course on network size and loneliness and the interaction with gender and age. RESULTS An unfavorable course of depression was found to be associated with smaller network sizes and higher levels of loneliness over time, especially in men and older participants. CONCLUSIONS The findings of this study stress the importance of clinical attention to the negative consequences of chronicity in depressed older people. Clinicians should assess possible erosion of the social network over time and be aware of increased feelings of loneliness in this patient group.
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Affiliation(s)
- Wim Houtjes
- GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands; Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Inholland University of Applied Sciences, Amsterdam, The Netherlands
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16
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Meesters PD, Comijs HC, Dröes RM, de Haan L, Smit JH, Eikelenboom P, Beekman ATF, Stek ML. The care needs of elderly patients with schizophrenia spectrum disorders. Am J Geriatr Psychiatry 2013; 21:129-37. [PMID: 23343486 DOI: 10.1016/j.jagp.2012.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 07/27/2011] [Accepted: 10/20/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Elderly patients constitute the fastest growing segment of the schizophrenia population. Still, their needs for care are poorly understood. This study aimed to gain insight into the care needs of older patients with schizophrenia spectrum disorders. SETTING AND PARTICIPANTS Patients, aged 60 years and older, in contact with mental health services within a Dutch psychiatric catchment area, diagnosed with schizophrenia spectrum disorders. MEASUREMENTS Needs and the extent to which these were met were assessed from the perspective of both patients and staff members. Agreement between patients and staff on the presence of needs was evaluated. In addition, the association between patient characteristics and the number of unmet needs was examined. RESULTS On average, patients (N = 114, mean age: 69 years) reported 7.6 needs, of which 6.1 were met and 1.5 were unmet. Staff members reported slightly more needs, both met and unmet. Patients and staff showed consensus on the presence of most needs, but discrepancies existed in individual need areas. Psychological and social needs were unmet more often than environmental and physical needs. The number of unmet needs correlated with several patient variables, with the strongest association found for self-reported quality of life. CONCLUSION In elderly schizophrenia patients, similar to what has been reported in younger patients, psychological and social needs appear to be under serviced. Having more unmet needs was associated with a lower perceived quality of life.
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Affiliation(s)
- Paul D Meesters
- GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands.
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17
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Houtjes W, Van Meijel B, Deeg DJH, Beekman ATF. Late-life depression: systematic assessment of care needs as a basis for treatment. J Psychiatr Ment Health Nurs 2012; 19:274-80. [PMID: 22070502 DOI: 10.1111/j.1365-2850.2011.01823.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Research shows that most of the variance in depression severity levels in late life can be explained by the unmet psychological needs of patients, more in particular the care needs of patients related with psychological distress. This case report describes the treatment of an 84-year-old patient suffering from depression. Her complaints faded upon the use of nursing interventions that were defined on the basis of a systematic assessment of her care needs with the Camberwell Assessment of Needs for the Elderly. The methodical attention to her needs for care and the interventions carried out led to the patient feeling acknowledged and to a diminished need for care and a better quality of life. Although there is no scientific evidence to date, a systematic assessment of care needs may well be a meaningful addition to the nursing diagnostic process. Moreover, alleviating distress in patients by fulfilling unmet care needs through tailored interventions can be seen as an essential element of an effective multidisciplinary depression treatment process.
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Affiliation(s)
- W Houtjes
- EMGO Institute on Health, VU University Medical Center, Amsterdam, The Netherlands.
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Unmet needs of outpatients with late-life depression; a comparison of patient, staff and carer perceptions. J Affect Disord 2011; 134:242-8. [PMID: 21684611 DOI: 10.1016/j.jad.2011.05.052] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 05/26/2011] [Accepted: 05/27/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that late life depression is associated with high levels of unmet needs. Only a minority of the depressed patients appears to be adequately treated. METHODS Ninety-nine older patients (58-92 years), 96 informal carers and 85 health-care professionals were recruited from six outpatient facilities for old age psychiatry in the Netherlands and interviewed to identify met and unmet needs, using the Camberwell Assessment of Needs for the Elderly (CANE). The severity of depression was measured with the Montgomery Åsberg Depression Rating Scale (MADRS). RESULTS On average patients scored more unmet needs than staff and carers. On item level, patients and staff showed the highest agreement in the psychological needs category. Patient and carers showed the highest agreement on physical health needs. Logistic regression showed that severe depression is a significant predictor of low concordance between stakeholders on a substantial number of CANE items. LIMITATIONS Kappa coefficients were computed to determine agreement between parties involved. However, Kappa coefficients should be interpreted with caution, especially when obvious disparity in unmet needs scores between groups of interest can be observed. CONCLUSION Home dwelling older patients with major depressive disorder, their practitioners and their informal carers have different perceptions of the older patients unmet needs.Practitioners should be aware of the negative impact of depression severity on reaching agreement regarding unmet needs and its possible consequences for mutual goal setting and compliance.
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