Identifying and Addressing Unmet Needs in Dementia: The Role of Care Access and Psychosocial Support

IF 2.8 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-03-27 DOI:10.1002/gps.70066

Annelie Scharf, Bernhard Michalowsky, Anika Rädke, Fabian Kleinke, Stefanie Schade, Moritz Platen, Maresa Buchholz, Michelle Pfaff, Audrey Iskandar, Neeltje van den Berg, Wolfgang Hoffmann

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引用次数: 0

Abstract

Objectives

People with dementia often have various unmet care needs across physical, psychological, environmental, and social domains. There’s a need to explore the association between domains of unmet needs and characteristics of people with dementia. The aim of this paper was to describe the domains of unmet and met needs among community-dwelling people living with dementia, focusing on the home environment, physical, psychological, and social areas, and to identify sociodemographic, clinical, and health-related parameters associated with unmet needs.

Methods

We analyzed the InDePendent trial’s baseline data of N = 417 people with dementia. The Camberwell Assessment of Needs for the Elderly (CANE) was used to identify needs. Descriptive statistics were used to evaluate the distribution of needs and Logistic and Poisson regression models to detect sociodemographic and clinical factors associated with unmet needs in the four need domains.

Results

People with dementia were on average 80.6 years old, mostly female (56%) and mildly to moderately cognitively impaired (85%). 98.6% of the participants had at least one need, of which just over a third (36.5%) were rated as met and just under two-thirds (63.5%) as unmet. Lacking a care grade (access to social care) and low education were found to be risk factors for the occurrence of unmet needs in almost all areas. Factors such as increased medication use (OR = 1.10 [95%CI 1.02 to 1.19]) and loneliness (OR = 2.51 [95%CI 1.44 to 4.36]) were associated with a higher likelihood of unmet environmental needs. Similarly, the absence of a caregiver (OR = 2.81 [95%CI 1.03 to 7.64]), lower social support (OR = 1.71 [95%CI 1.02 to 2.84]), and poor physical health (OR = 8.40 [95%CI 3.39 to 20.81]) correlated with unmet physical needs. Participants living alone demonstrated higher levels of unmet physical needs (β = 0.27 [95%CI 0.01 to 0.53]). Depression (OR = 2.13 [95%CI 1.10 to 4.08]), living alone (OR = 1.73 [95%CI 1.04 to 2.86]) and poor physical health (OR = 2.82 [95%CI 1.15 to 6.93]) significantly increased the risk of unmet psychological needs. Social needs are more likely to be unmet in females (OR = 1.88 [95%CI 1.05 to 3.37]). Sensitivity analyses showed the positive effects of regular General Practitioner (GP) visits on the fulfillment of social needs (β = −0.61 [95%CI −1.01 to −0.22]).

Conclusion

Access to comprehensive care, for example, through a care grade, education and regular visits to the GP, is just as important for meeting needs in various areas as psychosocial measures aimed at reducing loneliness, living alone, and social exclusion. Both areas must be given equal consideration to improve the living and care situation of people with dementia sustainably.

Trial Registration: The study is registered as a clinical trial (ClinicalTrials.gov Identifier: NCT04741932). The study protocol is published elsewhere

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识别和解决痴呆症未满足的需求：护理机会和社会心理支持的作用

痴呆症患者通常在身体、心理、环境和社会领域有各种未满足的护理需求。有必要探索未满足需求领域与痴呆症患者特征之间的联系。本文的目的是描述社区居住的痴呆症患者未满足和已满足需求的领域，重点关注家庭环境、身体、心理和社会领域，并确定与未满足需求相关的社会人口统计学、临床和健康相关参数。方法我们分析了独立试验的基线数据，N = 417例痴呆患者。坎伯韦尔老年人需求评估（CANE）被用来确定需求。使用描述性统计来评估需求的分布，并使用Logistic和泊松回归模型来检测与四个需求域中未满足需求相关的社会人口和临床因素。结果痴呆患者平均年龄80.6岁，女性居多（56%），轻度至中度认知障碍（85%）。98.6%的参与者至少有一个需求，其中超过三分之一（36.5%）被评为满足，略低于三分之二（63.5%）被评为未满足。缺乏护理等级（获得社会护理的机会）和教育程度低被发现是几乎所有地区发生未满足需求的危险因素。药物使用增加（OR = 1.10 [95%CI 1.02至1.19]）和孤独感（OR = 2.51 [95%CI 1.44至4.36]）等因素与未满足环境需求的可能性较高相关。同样，缺乏照顾者（OR = 2.81 [95%CI 1.03至7.64]）、较低的社会支持（OR = 1.71 [95%CI 1.02至2.84]）和较差的身体健康（OR = 8.40 [95%CI 3.39至20.81]）与未满足的身体需求相关。独居的参与者表现出更高水平的未满足的身体需求（β = 0.27 [95%CI 0.01至0.53]）。抑郁（OR = 2.13 [95%CI 1.10 ~ 4.08]）、独居（OR = 1.73 [95%CI 1.04 ~ 2.86]）和身体健康状况不佳（OR = 2.82 [95%CI 1.15 ~ 6.93]）显著增加了未满足心理需求的风险。社交需求在女性中更容易得不到满足（OR = 1.88 [95%CI 1.05 ~ 3.37]）。敏感性分析显示，定期全科医生（GP）就诊对满足社会需求有积极影响（β = - 0.61 [95%CI - 1.01 ~ - 0.22]）。获得综合护理，例如通过护理等级、教育和定期看全科医生，与旨在减少孤独感、独居和社会排斥的心理社会措施一样，对于满足各个领域的需求同样重要。必须平等考虑这两个方面，以可持续地改善痴呆症患者的生活和护理状况。试验注册：该研究注册为临床试验（ClinicalTrials.gov标识符：NCT04741932）。研究方案发表在其他地方

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.