Caring for dementia caregivers: How well does social risk screening reflect unmet needs?

Victoria A Winslow, Stacy Tessler Lindau, Elbert S Huang, Spencer Asay, Amber E Johnson, Soo Borson, Katherine Thompson, Jennifer A Makelarski
{"title":"Caring for dementia caregivers: How well does social risk screening reflect unmet needs?","authors":"Victoria A Winslow, Stacy Tessler Lindau, Elbert S Huang, Spencer Asay, Amber E Johnson, Soo Borson, Katherine Thompson, Jennifer A Makelarski","doi":"10.1111/jgs.19200","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown.</p><p><strong>Methods: </strong>We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side. We assessed caregivers' (1) unmet social and caregiving needs by querying need for 14 resource types and (2) HRSRs using the Center for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) screening tool. Using unmet social needs as the reference, we examined the sensitivity of the AHC tool to detect food, housing, and transportation needs. Analyses were stratified by gender.</p><p><strong>Results: </strong>Most caregivers were women (78%), non-Hispanic (96%), Black (81%), partnered (58%) and had an annual household income ≥$50K (64%). Unmet social and caregiving needs were similarly prevalent among women and men caregivers (87% had ≥1 need, 43% had ≥5 needs). HRSRs were also prevalent. The most common HRSR was lack of social support (45%). Housing instability, difficulty with utilities and having any HRSRs were significantly more prevalent among women (all p < 0.05). The AHC screener had low sensitivity for detecting unmet food (39%, 95% confidence interval [CI]: 27%-53%), housing (42%, 95% CI: 31%-53%), and transportation (22%, 95% CI: 14%-31%) needs. Sensitivity did not differ by gender for food (41% for women and 30% for men, p = 0.72) or housing (44% for women and 29% for men, p = 0.37) needs. For transportation needs, sensitivity was 27% for women versus 0% for men (p = 0.01).</p><p><strong>Conclusions: </strong>Men and women caregivers have high rates of unmet social needs that are often missed by the CMS-recommended risk-based screening method. Findings indicate a role for need-based screening in implementing social care.</p>","PeriodicalId":94112,"journal":{"name":"Journal of the American Geriatrics Society","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1111/jgs.19200","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown.

Methods: We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side. We assessed caregivers' (1) unmet social and caregiving needs by querying need for 14 resource types and (2) HRSRs using the Center for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) screening tool. Using unmet social needs as the reference, we examined the sensitivity of the AHC tool to detect food, housing, and transportation needs. Analyses were stratified by gender.

Results: Most caregivers were women (78%), non-Hispanic (96%), Black (81%), partnered (58%) and had an annual household income ≥$50K (64%). Unmet social and caregiving needs were similarly prevalent among women and men caregivers (87% had ≥1 need, 43% had ≥5 needs). HRSRs were also prevalent. The most common HRSR was lack of social support (45%). Housing instability, difficulty with utilities and having any HRSRs were significantly more prevalent among women (all p < 0.05). The AHC screener had low sensitivity for detecting unmet food (39%, 95% confidence interval [CI]: 27%-53%), housing (42%, 95% CI: 31%-53%), and transportation (22%, 95% CI: 14%-31%) needs. Sensitivity did not differ by gender for food (41% for women and 30% for men, p = 0.72) or housing (44% for women and 29% for men, p = 0.37) needs. For transportation needs, sensitivity was 27% for women versus 0% for men (p = 0.01).

Conclusions: Men and women caregivers have high rates of unmet social needs that are often missed by the CMS-recommended risk-based screening method. Findings indicate a role for need-based screening in implementing social care.

关爱痴呆症护理人员:社会风险筛查在多大程度上反映了未满足的需求?
背景:未满足的社会和护理需求会使痴呆症患者的护理工作变得更加困难。尽管国家政策鼓励在临床环境中采用与健康相关的社会风险(HRSR)系统筛查,但这些基于风险的筛查工具在检测未满足的社会需求方面的准确性尚不清楚:我们使用了痴呆症照护者(N = 343)的基线数据,这些照护者参加了一项随机对照试验,对芝加哥南区的一项社会照护干预措施--CommunityRx-Dementia 进行了评估。我们通过查询 14 种资源类型的需求,评估了护理人员的(1)未满足的社会和护理需求,以及(2)使用医疗保险和医疗补助服务中心(CMS)负责任健康社区(AHC)筛查工具的 HRSR。以未满足的社会需求为参照,我们检查了 AHC 工具检测食物、住房和交通需求的灵敏度。分析按性别分层:大多数照顾者为女性(78%)、非西班牙裔(96%)、黑人(81%)、有伴侣者(58%),家庭年收入≥5 万美元(64%)。在女性和男性护理人员中,未满足的社会和护理需求同样普遍(87% 的护理人员≥1 项需求,43% 的护理人员≥5 项需求)。HRSR 也很普遍。最常见的 HRSR 是缺乏社会支持(45%)。住房不稳定、水电供应困难和任何 HRSR 在女性中的发生率都明显更高(均为 p):男性和女性护理人员未满足社会需求的比例都很高,而 CMS 推荐的基于风险的筛查方法往往会忽略这些需求。研究结果表明,基于需求的筛查在实施社会护理方面可以发挥作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
期刊介绍:
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信