Assessing needs from patient, carer and professional perspectives: the Camberwell Assessment of need for Elderly people in primary care

Do people with dementia and carers get what they need? Barriers in social care and carers needs assessments

BACKGROUND

People with dementia and unpaid carers need to go through a social care or carers needs assessment to access and receive subsidised or fully-funded social care. With no previous evidence, this qualitative study aimed to provide insights into the access to, experiences of receiving and conducting social care or carers needs assessments, and access to social care.

METHODS

Unpaid carers of people with dementia and professionals conducting social care or carers needs assessment living or working in England were interviewed remotely about their experiences between April and August 2023. Topic guides were co-produced with two unpaid carers, and both were supported to code anonymised transcripts. Thematic analysis was used to analyse the data.

FINDINGS

Twenty-seven unpaid carers (n = 21) and professionals (n = 6) participated. Four themes were generated: (1) Issues with accessing needs assessments, not the process; (2) Knowledge of needs assessments and the health and social care system; (3) Expectations of unpaid carers; and (4) Post-assessment unmet needs. The most prominent barriers unpaid carers and their relatives with dementia encountered were awareness of and access to needs assessment. Unpaid carers were mostly unaware of the existence and entitlement to a needs assessment, and sometimes realised they had participated in one without their knowledge. Professionals described the pressures on their time and the lack of financial resources within services.

CONCLUSIONS

To facilitate improved access to dementia care and support for carers, the pathway to accessing needs assessments needs to be clearer, with better integration and communication between health and social care.

Transition of care from post-acute services for the older adults in Quebec: a pilot impact evaluation

BACKGROUND

Early discharge of frail older adults from post-acute care service may result in individuals' reduced functional ability to carry out activities of daily living, and social, emotional, and psychological distress. To address these shortcomings, the Montreal West Island Integrated University Health and Social Services Centre in Quebec, Canada piloted a post-acute home physiotherapy program (PAHP) to facilitate the transition of older adults from the hospital to their home. This study aimed to evaluate: (1) the implementation fidelity of the PAHP program; (2) its impact on the functional independence, physical and mental health outcomes and quality of life of older adults who underwent this program (3) its potential adverse events, and (4) to identify the physical, psychological, and mental health care needs of older adults following their discharge at home.

METHODS

A quasi-experimental uncontrolled design with repeated measures was conducted between April 1st, 2021 and December 31st, 2021. Implementation fidelity was assessed using three process indicators: delay between referral to and receipt of the PAHP program, frequency of PAHP interventions per week and program duration in weeks. A battery of functional outcome measures, including the Functional Independence Measure (FIM) and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scale, as well as fall incidence, emergency visits, and hospitalizations were used to assess program impact and adverse events. The Patient's Global Impression of Change (PGICS) was used to determine changes in participants' perceptions of their level of improvement/deterioration. In addition, the Camberwell Assessment of Need for the Elderly (CANE) questionnaire was administered to determine the met and unmet needs of older adults.

RESULTS

Twenty-four individuals (aged 60.8 to 94 years) participated in the PAHP program. Implementation fidelity was low in regards with delay between referral and receipt of the program, intensity of interventions, and total program duration. Repeated measures ANOVA revealed significant improvement in FIM scores between admission and discharge from the PAHP program and between admission and the 3-month follow-up. Participants also reported meaningful improvements in PGICS scores. However, no significant differences were observed on the physical or mental health T-scores of the PROMIS Global-10 scale, in adverse events related to the PAHP program, or in the overall unmet needs.

CONCLUSION

Findings from an initial sample undergoing a PAHP program suggest that despite a low implementation fidelity of the program, functional independence outcomes and patients' global impression of change have improved. Results will help develop a stakeholder-driven action plan to improve this program. A future study with a larger sample size is currently being planned to evaluate the overall impact of this program.

CLINICAL TRIAL REGISTRATION

Retrospectively registered NCT05915156 (22/06/2023).

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.

Evaluating the Accuracy of Self-Ratings of Language in Adults with Aphasia and Non-Brain Injured Adults: A Pilot Study

Rating scales are frequently used in research and clinical practice with people with aphasia (PWA) to characterize communication in the home environment. However, it remains unclear whether responses provided on rating scales accurately reflect the communication that occurs. We aim to evaluate the accuracy of PWA's self-perceptions of verbal language use as measured by a rating scale and determine whether this accuracy is different from that of non-brain-injured (NBI) participants. Four PWA and four NBI participants completed a rating scale estimating their amount of verbal language production as compared with their communication partner. Audio recordings from participants' home environments were analyzed for proportion of words and conversational turns contributed by the participant, which were compared with rating scale estimates. Perceptions of verbal language output among both PWA and NBI participants showed variable accuracy, with discrepancies between estimates and objective data across both groups. The reliability of rating scales in quantifying language output appears questionable, suggesting they may not accurately represent naturalistic language environments of PWA. Additional research with larger sample sizes is warranted to investigate whether this trend is consistent across a larger population of individuals with aphasia.

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.

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.

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.

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.

Unmet Care Needs in the Oldest Old Primary Care Patients with Cognitive Disorders: Results of the AgeCoDe and AgeQualiDe Study

BACKGROUND

In the future, an increase in health care needs in the elderly is expected. Reports on unmet care needs of the oldest old with cognitive disorders are pending. This study aims at exploring unmet needs in the oldest old primary care patients with mild cognitive impairment (MCI) and dementia. Furthermore, the association between sociodemographic and clinical factors and unmet needs ought to be analyzed.

METHODS

Based on the study "Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)" (AgeQualiDe), 749 patients (unimpaired, MCI, and dementia) aged 85 years and older, their relatives (n = 421), and general practitioners (GPs) (n = 607) were assessed. Descriptive, inferential, and regression analyses were run.

RESULTS

Most unmet needs were observed in dementia patients, although needs were less frequently rated as unmet by dementia patients themselves as compared to relatives and GPs. Unmet needs were associated with MCI and dementia; other risk factors were age, education, and marital status.

CONCLUSION

This study provides first data on unmet needs according to different perceptions in the elderly with MCI and dementia in Germany. Need assessments should be part of medical examinations to ensure a high-quality health care in the elderly.

Self-perceived care needs in older adults with joint pain and comorbidity

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.

Unmet service needs evaluated by case managers among disabled patients on hemodialysis in Japan

Background

This study aimed to investigate the levels of unmet needs for home and community-based services (HCBS) evaluated by case managers (CMs) among disabled patients on hemodialysis (DPHD) and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors.

Methods

Self-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay.

Results

The prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay.

Conclusion

CMs need to monitor unmet needs after coordinating HCBS for DPHD and need to encourage HBCS use among patients with impaired cognitive function and caregivers with heavier caregiving burdens.

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.

A brief assessment unravels unmet needs of older people in primary care: a mixed-methods evaluation of the SPICE tool in Portugal

Assessments of need may contribute to identifying health problems associated with functional deterioration in older people. A shorter version of the Camberwell Assessment of Need for the Elderly was developed for routine use in primary care, focusing on five domains: Senses, Physical ability, Incontinence, Cognition, and Emotional distress (SPICE). We aimed to explore its usefulness and feasibility in primary care.We selected a consecutive sample of 51 community-dwelling older adults. The SPICE interview was completed by GPs and patients, with perceptions about its use in primary care being explored.Needs were identified in 38 patients. Unmet needs corresponded to 7% of needs overall. 'Emotional distress' was the most frequent unmet need. SPICE helped to identify undisclosed needs, was well accepted and its importance in clinical evaluation recognised by GPs and patients, despite concerns about time constraints. Facilitating strategies are needed to improve the feasibility of these assessments in primary care.

Multidimensional measures validated for home health needs of older persons: A systematic review

OBJECTIVE

To conduct a systematic review of the literature on valid and reliable multidimensional instruments to assess home health needs of older persons.

DESIGN

Systematic review.

DATA SOURCE

Electronic databases, PubMed/Medline, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online and the Latin American and Caribbean Health Sciences Information.

REVIEW METHODS

All English, Portuguese and Spanish literature which included studies of reliability and validity of instruments that assessed at least two dimensions: physical, psychological, social support and functional independence, self-rated health behaviors and contextual environment and if such instruments proposed interventions after evaluation and/or monitoring changes over a period of time.

PARTICIPANTS

Older persons aged 60 years or older.

RESULTS

Of the 2397 studies identified, 32 were considered eligible. Two-thirds of the instruments proposed the physical, psychological, social support and functional independence dimensions. Inter-observer and intra-observer reliability and internal consistency values were 0.7 or above. More than two-thirds of the studies included validity (n=26) and more than one validity was tested in 15% (n=4) of these. Only 7% (n=2) proposed interventions after evaluation and/or monitoring changes over a period of time.

CONCLUSION

Although the multidimensional assessment was performed, and the reliability values of the reviewed studies were satisfactory, different validity tests were not present in several studies. A gap at the instrument conception was observed related to interventions after evaluation and/or monitoring changes over a period of time. Further studies with this purpose are necessary for home health needs of the older persons.

The needs of older people with mental health problems in a Portuguese psychiatric setting

BACKGROUND

This study aims to identify met and unmet needs, according to the patient, the carer and the staff, and their relationship with socio-demographic and clinical characteristics in elderly people with mental health problems.

METHODS

A sample of 306 elderly patients ≥65 years, of both sexes, diagnosed with mental illness (ICD-10 criteria), was recruited from inpatient/outpatient settings in a Department of Psychiatry and Mental Health, in northern Portugal. Patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE.

RESULTS

The majority of diagnoses were depression (33.7%), dementia (24.5%), and schizophrenia (12.7%). The patients' main unmet needs found were psychological distress (15.0%), daytime activities (10.5%), and benefits (6.5%). Patients reported significantly lower unmet and global needs than carers and staff (Z = -8.58, p < 0.001; Z = -11.07, p < 0.001, respectively). A larger number of global needs (met and unmet) were associated with the diagnosis of dementia, followed by schizophrenia, bipolar, and depressive disorder (p < 0.001), with inpatients reporting more needs than outpatients.

CONCLUSIONS

Mental disorders were associated with a greater number of needs in elderly patients, which makes this assessment important as it includes the patients' perspective, when they are the focus of intervention, in order to decrease distress and make more beneficial use of services, especially in inpatient settings. These different perspectives are crucial when assessing and planning psychiatric and mental health services.

Perceptions of unmet needs for community social care services in England. A comparison of working carers and the people they care for

Previous UK research has found expressed unmet need for services by unpaid working carers and among disabled and older people. There are, however, suggestions from research that views on unmet needs for services differ between carers and care-recipients. Working carers in the UK say that the care-recipient is sometimes reluctant to accept services and the few international comparative dyad studies that have been carried out find that carers perceive higher unmet need than care-recipients. Recent policy discussions in England have also recognised that there may be differences of opinion. We collected data in 2013 from working carer/care-recipient dyads in England about perceived need for services for the care-recipient, disability, unpaid care hour provision and individual and socio-demographic characteristics. We find that care-recipients as well as their carers perceive high unmet need for services, although carers perceive higher unmet need. For carers, unmet need is associated with the disability of the carer-recipient and being the daughter or son of the care-recipient; for care-recipients it is associated with unpaid care hours, carers' employment status and carers' health. The majority of dyads agree on need for services, and agreement is higher when the working carer provides care for 10 hours or more hours a week. Services for care-recipients may enable working carers to remain in employment so agreement on needs for services supports the implementation of legislation, policy and practice that has a duty to, or aims to, support carer's employment.

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 care needs of older patients with bipolar disorder

OBJECTIVES

With aging, bipolar disorder evolves into a more complex illness, with increasing cognitive impairment, somatic comorbidity, and polypharmacy. To tailor treatment of these patients, it is important to study their needs, as having more unmet needs is a strong predictor of a lower quality of life.

METHOD

Seventy-eight Dutch patients with bipolar I or II disorder aged 60 years and older in contact with mental health services were interviewed using the Camberwell Assessment of Need in the Elderly (CANE) to assess met and unmet needs, both from a patient and a staff perspective.

RESULTS

Patients (mean age 68 years, range 61-98) reported a mean of 4.3 needs compared to 4.4 reported by staff, of which 0.8 were unmet according to patients and 0.5 according to staff. Patients frequently rated company and daytime activities as unmet needs. More current mood symptoms were associated with a higher total number of needs. Less social participation was associated with a higher total number of needs and more unmet needs.

CONCLUSION

Older bipolar patients report fewer needs and unmet needs compared to older patients with depression, schizophrenia, and dementia. A plausible explanation is that older bipolar patients had higher Global Assessment of Functioning scores, were better socially integrated, and had fewer actual mood symptoms, all of which correlated with the number of needs in this study. The results emphasize the necessity to assess the needs of bipolar patients with special attention to social functioning, as it is suggested that staff fail to recognize or anticipate these needs.

Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms

Unmet needs are becoming acknowledged as better predictors of the worst prognostic outcomes than common measures of functional or cognitive decline. Their accurate assessment is a pivotal component of effective care delivery, particularly in institutionalized care where little is known about the needs of its residents, many of whom suffer from dementia and show complex needs. The aims of this study were to describe the needs of an institutionalized sample and to analyze its relationship with demographic and clinical characteristics. A cross-sectional study was conducted with a sample from three nursing homes. All residents were assessed with a comprehensive protocol that included Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Neuropsychiatric Inventory (NPI) and Adults and Older Adults Functional Inventory (IAFAI). To identify needs, the Camberwell Assessment of Need for the Elderly (CANE) was used. The final sample included 175 residents with a mean age of 81 standard deviation (SD = 10) years. From these, 58.7% presented cognitive deficit (MMSE) and 45.2% depressive symptoms (GDS). Statistically significant negative correlations were found between MMSE score and met (r s = -0.425), unmet (r s = -0.369) and global needs (r s = -0.565). Data also showed significant correlations between depressive symptoms and unmet (r s = 0.683) and global needs (r s = 0.407), and between behavioral and psychological symptoms (BPSD) and unmet (r s = 0.181) and global needs (r s = 0.254). Finally, significant correlations between functional impairment and met (r s = 0.642), unmet (r s = 0.505) and global needs (r s = 0.796) were also found. These results suggest that in this sample, more unmet needs are associated with the worst outcomes measured. This is consistent with previous findings and seems to demonstrate that the needs of those institutionalized elderly remain under-diagnosed and untreated.

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

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.

Determinants of Unmet Needs among Slovenian Old Population

BACKGROUND

Population ageing has significant effects on societies. The organization of care for dependent old people is one of the key issues for ageing societies. The majority of care for homebound dependent old people in Slovenia is still performed by informal carers, even though the use of formal services has been increasing over the last 20 years. The proportion and characteristics of people with unmet needs are important for the development of long term care social policy.

METHOD

The SHARE (Survey of Health, Ageing and Retirement in Europe) survey was used to assess the determinants of care arrangements and of unmet needs of the aging population in Slovenia. Multinomial regression analysis was used to evaluate individual and contextual determinants of care arrangements and unmet needs.

RESULTS

The proportion of older people with unmet needs is 4%. As expected, "needs" (Functional impairment OR=4.89, P=0.000, Depression OR=2.59, P=0.001) were the most important determinant, followed by the predisposing factor "age" (age OR 1.15, P=0.000) and two enabling factors, namely:"community setting and "availability of informal care within household" (Urban areas OR=.47, P=0.021; Household size 3+ OR=2.11, P=0.030).

CONCLUSION

This study showed that there are a proportion of older people in Slovenia with severe needs for care, which are being unmet. As shown by the importance of enabling factors, social policy should encourage the development of formal services in rural areas and elaborate policy measures for informal carers.

Gaps between the subjective needs of older facility residents and how care workers understand them: a pairwise cross-sectional study

BACKGROUND

To promote active daily living and improve the quality of life of older facility residents, it is important that care staff understand their day-to-day activities and needs. However, only a few studies have examined the needs of older residents and how care workers understand them. This study aimed to examine the subjective needs of older residents at aged care facilities, care workers' understanding of these needs, and the gaps that exist between them.

METHODS

Structured interviews with older residents with no severe cognitive impairment in ten Japanese aged care facilities and a questionnaire survey of care workers were conducted in 2008 regarding resident subjective needs. The questionnaire, which had satisfactory factorial validity, internal consistency, and reproducibility, consisted of seven items on basic activities of daily living (BADL), five items on instrumental ADL (IADL), eight items on environment and lifestyle (EL), and five items on emotion (EM). Pair-wise analyses were performed to compare responses.

RESULTS

Responses of 115 pairs were analyzed (residents ≥75 years, 85 %; 21 men, 94 women). Median proportions of residents with IADL (66 %) and EL (69 %) needs were lower compared with those with BADL (83 %) and EM (91 %) needs. Median proportions of care workers understanding IADL (55 %) and EL (60 %) needs were lower compared with those understanding BADL (87 %) and EM (87 %) needs. Less than half of the care workers understood IADL needs for household chores (30 %) and money management (43 %), and an EL need for playing a role (41 %).

CONCLUSIONS

Gaps were found between resident subjective needs and how care workers understood them. Specifically, care workers underestimated older residents' IADL and EL needs, especially with regard to playing a role. These results highlight the need for care workers to set goals based on each resident's subjective needs and plan strategies for care provision accordingly.

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial

OBJECTIVE

To test the hypotheses that (1) clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in reducing depressive symptoms of depressed, disabled, impoverished patients and that (2) development of problem-solving skills mediates improvement of depression.

METHODS

This randomized clinical trial with a parallel design allocated participants to CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Two hundred seventy-one individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST. Participants were at least 60 years old with major depression measured with the 24-item Hamilton Depression Rating Scale (HAM-D), had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median.

RESULTS

CM and CM-PST led to similar declines in HAM-D over 12 weeks (t = 0.37, df = 547, p = 0.71); CM was noninferior to CM-PST. The entire study group (CM plus CM-PST) had a 9.6-point decline in HAM-D (t = 18.7, df = 547, p <0.0001). The response (42.5% versus 33.3%) and remission (37.9% versus 31.0%) rates were similar (χ(2) = 1.5, df = 1, p = 0.22 and χ(2) = 0.9, df = 1, p = 0.34, respectively). Development of problem-solving skills did not mediate treatment outcomes. There was no significant increase in depression between the end of interventions and 12 weeks later (0.7 HAM-D point increase) (t = 1.36, df = 719, p = 0.17).

CONCLUSION

Organizations offering CM are available across the nation. With training in CM, their social workers can serve the many depressed, disabled, low-income patients, most of whom have poor response to antidepressants even when combined with psychotherapy.

Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults

OBJECTIVE

To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability.

METHODS

Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used.

RESULTS

Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12.

CONCLUSION

CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865).

The German version of the Camberwell Assessment of Need for the Elderly (CANE): evaluation of content validity and adaptation to the German-speaking context

BACKGROUND

The Camberwell Assessment of Need for the Elderly (CANE) was developed for the assessment of physical-, psychological-, and environment-related needs in the elderly. The aim of this study was to revise and adapt the German version of the CANE with regard to the content validity of the instrument.

METHODS

Following a multistage approach, face-to-face interviews using the CANE, an expert survey and a multidisciplinary consensus conference were conducted in order to evaluate the frequency and relevance of met and unmet needs in the German elderly population, and to modify the content of the CANE for the German-speaking countries.

RESULTS

In Germany, unmet physical needs including physical health, medication, eyesight/hearing/communication, mobility/falls, self-care, and continence were found to have top priority closely followed by social needs (company, intimate relationships, daytime activities, information, and abuse/neglect). Psychological needs were the lowest ranked care category. Experts' proposals for the improvement of the German version of the CANE were collected. All findings were discussed and integrated in the multidisciplinary consensus conference with the result of a revised and adapted CANE that is applicable in the German-speaking context.

CONCLUSIONS

The provision of an adapted and improved German version of the CANE may substantially contribute to a comprehensive and valid assessment of needs in the elderly population. The results of this study represent an important basis for comprehensive needs assessment in the elderly in the theoretical and practical field of healthcare and health services research.

Functional assessment of the elderly with the use of EASY-Care Standard 2010 and Comprehensive Geriatric Assessment

BACKGROUND

The wide variation in performance among the elderly leads to the search for a suitable instrument to identify the necessary support. The aim of this study was to examine the scope of independent functioning of the elderly and to indicate the necessary support using basic instruments, Comprehensive Geriatric Assessment (CGA) and EASY-Care Standard 2010.

METHODS

For statistical analysis were qualified 101 questionnaires of patients from oncological surgery clinic.

RESULTS

The study group was dominated by women (79.2%). The average age for the entire group was 74.7 ± 7.5 years. In terms of basic life activities (Barthel Index), 75.2% of the elderly performed most of their activities independently. The Lawton IADL (Instrumental Activity of Daily Living Scale) median was 25 points. Moderate depression (Geriatric Depression Scale) reported 37.6% of the group. The influence of age, education, mode of movement and efficiency in basic and instrumental life activities and depression (Geriatric Depression Scale) was demonstrated in the results in three scales of the EASY-Care Standard 2010 questionnaire: Independence score, Risk of break down in care and Risk of falls. There was no difference in terms of gender and the nature of the residence.

CONCLUSION

The study group of the elderly was characterised by a good level of efficiency in basic and instrumental activities of daily living. Questionnaire EASY-Care Standard 2010 enables to identify functional limitations of the elderly that may form the basis for planning individual support.

"It's MAGIC"--development of a manageable geriatric assessment for general practice use

Background

Geriatric assessments are established tools in institutional care since they enable standardized detection of relevant age-related disorders. Geriatric assessments could also be helpful in general practice. However, they are infrequently used in this setting, mainly due to their lengthy administration. The aim of the study was the development of a “manageable geriatric assessment – MAGIC”, specially tailored to the requirements of daily primary care.

Methods

MAGIC was developed based on the comprehensive Standardized Assessment for Elderly People in Primary Care (STEP), using four different methodological approaches: We relied on A) the results of the PRISCUS study by assessing the prevalence of health problems uncovered by STEP, the importance of the respective problems rated by patients and general practitioners, as well as the treatment procedures initiated subsequently to the assessment. Moreover, we included findings of B) a literature analysis C) a review of the STEP assessment by experienced general practitioners and D) focus groups with general practitioners.

Results

The newly created MAGIC assessment consists of 9 items and covers typical geriatric health problems and syndromes: function, falls, incontinence, cognitive impairment, impaired ears and eyes, vaccine coverage, emotional instability and isolation.

Conclusions

MAGIC promises to be a helpful screening instrument in primary care consultations involving elderly multimorbid patients. Applicable within a minimum of time it still covers health problems highly relevant with regard to a potential loss of autonomy. Feasibility will be tested in the context of a large, still ongoing randomized controlled trial on “reduction of potentially inadequate medication in elderly patients” (RIME study; DRKS-ID: DRKS00003610) in general practice.

Assessing met and unmet needs in the oldest-old and psychometric properties of the German version of the Camberwell assessment of need for the elderly (CANE)--a pilot study

BACKGROUND

The current demographic and social developments in our society will lead to a significant increase in treatment and healthcare needs in the future, particularly in the elderly population. The Camberwell Assessment of Need for the Elderly (CANE) was developed in the United Kingdom to measure physical-, psychological-, and environment-related treatment as well as healthcare needs of older people in order to identify their unmet needs. So far, the German version of the CANE has not been established in health services research. Major reasons for this are a lack of publications of CANE's German version and the missing validation of the instrument.

METHODS

The aims of the present study were to evaluate the currently available German version of the CANE in a sample of older primary care patients. Descriptive statistics and inference-statistical analyses were calculated.

RESULTS

Patients reported unmet needs mostly in CANE's following sections: mobility/falls, physical health, continence, company, and intimate relationships. Agreement level between patients' and relatives' ratings in CANE was moderate to low. Evidence for the construct validity of CANE was found in terms of significant associations between CANE and other instruments or scores.

CONCLUSIONS

The study results provide an important basis for studies aiming at the assessment of met and unmet needs in the elderly population. Using the German version of the CANE may substantially contribute to an effective and good-quality health and social care as well as an appropriate allocation of healthcare resources in the elderly population.

A cross-sectional study to compare care needs of individuals with and without dementia in residential homes in the Netherlands

Background

Little is known about met and unmet needs of individuals in residential care, many of whom suffer from dementia. Unmet needs are associated with a decreased quality of life, worse mental health, dissatisfaction with services, and increased costs of care. The aim of this study was to compare the number and type of (unmet) needs of people with and without dementia in residential care in the Netherlands.

Methods

187 individuals in residents care or their relatives were interviewed to identify their care needs on 24 topics using the Camberwell Assessment of Needs for the Elderly (CANE) interview.

Results

Individuals diagnosed with probable dementia reported more needs in total and more unmet needs in comparison with individuals without this diagnosis. More specifically, differences were found for the topics “accommodation”, “money”, “benefits”, “medication management”, “incontinence”, “memory problems”, “inadvertent self-harm”, “company” and “daytime activities”.

Conclusions

It seems that the differences in care needs between individuals with and without dementia can be attributed to actual differences in physical and cognitive functioning. Residents with dementia reported more often unmet needs which might imply that care for people with dementia can still be better attuned to their needs.

The care needs of elderly patients with schizophrenia spectrum disorders

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.

Usability of a new electronic assistive device for community-dwelling persons with mild dementia

OBJECTIVE

To evaluate a newly developed integrated digital prosthetic, the COGKNOW Day Navigator (CDN), to support persons with mild dementia in their daily lives, with memory, social contacts, daily activities and safety.

METHODS

A user participatory method was applied in the development process, which consisted of three iterative 1-year cycles with field tests in Amsterdam, Belfast and Luleå. In the successive cycles 16, 14 and 12 persons with dementia and their carers participated. Data on usability were collected by means of interviews, observations, questionnaires, logging and diaries. The CDN prototype consists of a touch screen, a mobile device, sensors and actuators.

RESULTS

The evaluation showed that persons with dementia and carers valued the CDN overall as user-friendly and useful. Conclusions regarding the effectiveness of the system in daily life were limited due to insufficient duration of the testing period caused by delays in development and some instability of the final prototype.

CONCLUSION

With the suggested adaptations, the CDN is expected to be a useful tool for supporting community-dwelling persons with mild dementia and their carers.

Health problems in elderly patients during the first post-stroke year

BACKGROUND

A wide range of health problems has been reported in elderly post-stroke patients.

AIM

The aim of this study was to analyse the prevalence and timing of health problems identified by patient interviews and scrutiny of primary health care and municipality elderly health care records during the first post-stroke year.

METHODS

A total of 390 consecutive patients, ≥65 years, discharged alive from hospital after a stroke event, were followed for 1 year post-admission. Information on the health care situation during the first post-stroke year was obtained from primary health care and municipal elderly health care records and through interviews with the stroke survivors, at 1 week after discharge, and 3 and 12 months after hospital admission.

RESULTS

More than 90% had some health problem at some time during the year, while based on patient record data only 4-8% had problems during a given week. The prevalence of interview-based health problems was generally higher than record-based prevalence, and the ranking order was moderately different. The most frequently interview-reported problems were associated with perception, activity, and tiredness, while the most common record-based findings indicated pain, bladder and bowel function, and breathing and circulation problems. There was co-occurrence between some problems, such as those relating to cognition, activity, and tiredness.

CONCLUSIONS

Almost all patients had a health problem during the year, but few occurred in a given week. Cognitive and communication problems were more common in interview data than record data. Co-occurrence may be used to identify subtle health problems.

An examination of the needs of older patients with chronic mental illness in public mental health services

OBJECTIVES

To describe the needs of patients aged 50 years and over with chronic mental illness being case managed within a public mental health service, and to determine factors that influence these needs.

METHOD

Patients were recruited from community-based Adult Mental Health (AMH) teams and Specialist Mental Health Services for Older People (SMHSOP) teams. Eligibility criteria included a diagnosis of schizophrenia or mood disorder. Patient, carer and key worker interviews were carried out using the Camberwell Assessment of Need for the Elderly (CANE).

RESULTS

Of 183 eligible patients, 97 (mean age of 66.4 years) participated, of whom 63 were managed by AMH teams and 34 by SMHSOP teams. The majority (52%) had a diagnosis of schizophrenia, particularly those managed by AMH (71%). Patients self-rated fewer needs overall on the CANE than their key workers or the researcher, and also rated a higher proportion of their needs being met (83%) than the key worker (77%) or researcher (76%). From each perspective, over 80% of psychiatric and around 95% of identified medical needs were being met. The majority of social needs were unmet, with patients reporting only 42%, and key workers only 33%, met needs. The key unmet social needs were company, daily activities and having a close confidant. Key workers, patients and researchers rated SMHSOP service delivery to have significantly less unmet needs.

CONCLUSIONS

The social needs of older patients with chronic mental illness require greater attention by public mental health services.

Multiple perspectives on mental health outcome: needs for care and service satisfaction assessed by staff, patients and family members

PURPOSE

Community-based mental health care requires the involvement of staff, patients, and their family members when both planning intervention programmes and evaluating mental health outcomes. The present study aimed to compare the perceptions of these three groups on two important subjective mental health outcome measures--needs for care and service satisfaction--to identify potential areas of discrepancy.

METHODS

The sample consisted of patients with a DSM diagnosis of psychosis and attending either outpatient or day centres operating in a community-based care system. Staff, patients and family members were assessed by using the CAN and the VSSS to evaluate, respectively, needs for care and service satisfaction. Kappa statistics were computed to assess agreement in the three groups.

RESULTS

Patients identified significantly fewer basic (e.g. daytime activities, food, accommodation) and functioning needs (e.g. self-care, looking after home, etc.) than staff or family members. Only fair levels of agreement were found in the three groups (average kappa was 0.48 for staff and patients, 0.54 for staff and family members, and 0.45 for patients and relatives), with patients and family members showing more areas of discrepancies in both needs and service satisfaction.

CONCLUSIONS

These findings provide further support for the idea that mental health services should routinely involve patients and their relatives when planning and evaluating psychiatric intervention and that this policy is a premise for developing a partnership care model.

Comparison of the needs of the elderly patients in care-rehabilitation centers in Wroclaw and in Hamburg

Introduction: The central issue of geriatrics amounts to determining the hierarchy of problems (whether health related or other) of people at old age. The healthcare offered to elderly people should be oriented at the possibly broadest approach to their needs

Aim: The main goal of the research is developing knowledge about the areas of elderly people’s needs on the basis of a sample consisted of patients from two rehabilitation centers, situated in Poland (PL:Wroclaw) and in Germany (DE:Hamburg) respectively.

Material and methods: The sample consists of 80 patients of the age 60+, divided into two groups, 40 patients in each. For the research method/technique the interview is chosen and the questionnaire CANE serves as the main research tool. Other tools used are: GDS, MMSE, Barthel Index and Socio-demographical and Clinical questionnaires.

Results: Before the patients’ admission to the center the average estimate for their overall needs was: PL 4.33 (SD=3.52), DE 5.12 (SD=3.26), out of which met needs were estimated as: PL 3.35 (SD=1.03), DE 4.47 (SD=2.99), whereas unmet as: PL 0.97 (SD=1.33), DE 0.65 (SD=1.03) respectively. After the patients’ admission to the center the average estimate for overall needs increased both for PL: 8.93 (SD=2.08) and for DE: 6.53 (SD=2.54), out of which met needs amounted to: PL, 7.55 (SD=1.50) and DE, 5.95 (SD=2.37) respectively, whereas not unmet ones to: PL, 1.38 (SD=1.44) and DE, 0.57 (SD=0.96).

Conclusions: The patterns of needs /met and unmet/ of the elderly patients from two researched centers were similar before the patients’ admission to the clinics, but after the admission differences were observed between the two groups. Much from the needs both met (e.g. looking after the home, physical health) and unmet (e.g. psychological distress), mentioned before the admission to the clinic remained in the area of needs also after the admission. That observation is valid both for PL group as for DE one.

Psychological distress as a key component of psychosocial functioning in community-dwelling older people

OBJECTIVES

To explore the key components representative of measures of psychosocial functioning with a focus on identifying the constituents of psychological distress in an Irish sample of community-dwelling older adults and to examine the relationship between these components and health outcomes such as frailty.

METHOD

Cross-sectional observational study at the Technology Research for Independent Living (TRIL) Clinic, a comprehensive geriatric assessment facility in St. James's Hospital, Dublin. In this study, 579 participants were given eight primary assessments (Centre for Epidemiological Studies of Depression, Geriatric Adverse Life Events Scale, Pittsburgh Sleep Quality Index, De Jong-Gierveld Scale, Practitioner Assessment of Network Type, Eysenck Personality Inventory, Hospital Anxiety and Depression Scale, Lubben Social Network Scale) and a broad range of health and demographic secondary assessments. Principal factor analysis identified the core components relating to psychosocial functioning. Following this, the regression factors of these components were correlated with health outcomes.

RESULTS

The first of three components identified accounted for 9.08% of the variance and related to a core internal component of psychological distress. The two other components related to external and physiological functioning, specifically social support networks and sleep. Spearman's Rho correlations indicated significant associations of walking speed, age, Berg Balance Scale and living alone with all three components. Additionally, the core component of psychological distress significantly correlated with the Fried Frailty Index, illness co-morbidity, ADL, IADL and nutrition.

CONCLUSION

These results characterise the variation in psychosocial functioning in older adults and identifies psychological distress as a core facet of psychosocial functioning which has associations with frailty.

[Use and acceptance of a basic geriatric assessment in primary care setting]

BACKGROUND

Aim of this study was to evaluate the acceptance and use of a basic geriatric assessment (BGA), as it is covered by the German pay system, in primary care practices.

METHODS

We conducted qualitative interviews and collected quantitative data by an online questionnaire.

RESULTS

A total of 17 (10 men) general practitioners (GPs) agreed to be interviewed; 161 patients (134 men) completed the online questionnaire. GPs mainly performed BGA to substantiate the suspicion of cognitive impairment. Most of the German general practices accomplished not more than 5-10 BGA per quarter. Although those GPs who conducted BGA were convinced of its usefulness with regard to further patient care, concrete interventions were rarely named. The tests used within the BGA were not always in line with recommendations from the specific guidelines. The main reasons not to conduct BGA were the amount of time required and the lack of therapeutic consequences.

CONCLUSION

Hitherto BGA is not an established tool in German primary care practices. The question, which single instruments are most suitable for older general practice patients, still needs clarification.

Unmet needs of outpatients with late-life depression; a comparison of patient, staff and carer perceptions

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.

Diagnosing dementia: no easy job

Background

From both clinical experience and research we learned that in complex progressive disorders such as dementia, diagnosis includes multiple steps, each with their own clinical and research characteristics.

Discussion

Diagnosing starts with a trigger phase in which the GP gradually realizes that dementia may be emerging. This is followed by a disease-oriented diagnosis and subsequently a care -oriented diagnosis. In parallel the GP should consider the consequences of this process for the caregiver and the interaction between both. As soon as a comprehensive diagnosis and care plan are available, monitoring follows.

Summary

We propose to split the diagnostic process into four diagnostic steps, followed by a monitoring phase. We recommend to include these steps when designing studies on screening, diagnosis and monitoring of patients with dementia and their families.

Common, important, and unmet needs of cancer outpatients

PURPOSE

To maximize patient well-being, health and social care should, whenever possible, address individual patient needs. The present study aims firstly, to identify prevalent, salient and unmet needs amongst cancer outpatients, and secondly, to explore socio-demographic and clinical influences on expressed need.

METHODS

One-hundred and ten outpatients registered at a UK cancer treatment centre completed a self-report questionnaire measuring the presence, salience and degree to which 80 need items were met. Six broad cancer sites were represented: urology, colorectal, breast, gynaecology, haematology, and head and neck.

RESULTS

The mean number of needs reported was 27. The top five needs concerned the treatment, care and health information patients receive from healthcare professionals, all of which were rated as well met. Least met needs included receiving genetic information, information about lifestyle changes, help with worries about spread or recurrence, and parking near treatment centres. Salient needs showed greater variation across the sample and were often unmet, for example the need for genetic information, and the need for information about symptoms/indicators of recurrence. Gender (female), age (younger), having an informal caregiver, and cancer site all affected aspects of need; whereas time since diagnosis and type of treatment did not.

CONCLUSIONS

Acknowledging these influences on patient need could help guide patient-centred support services with potential gains to patient satisfaction and well-being.