Camberwell Assessment Of Need Research Articles

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

The prevalence of mild cognitive impairment (MCI) and dementia is increasing as the oldest old population grows, requiring a nuanced understanding of their care needs. Few studies have examined need profiles of oldest old patients with MCI or dementia. Therefore, this study aimed to identify patients' need profiles. The data analysis included cross-sectional baseline data from N = 716 primary care patients without cognitive impairment (n = 575), with MCI (n = 97), and with dementia (n = 44) aged 85+ years from the multicenter cohort AgeQualiDe study "needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients [85+]". Patients' needs were assessed using the Camberwell Assessment of Needs for the Elderly (CANE), and latent class analysis identified need profiles. Multinomial logistic regression analyzed the association of MCI and dementia with need profiles, adjusting for sociodemographic factors, social network (Lubben Social Network Scale [LSNS-6]), and frailty (Canadian Study of Health and Aging-Clinical Frailty Scale [CSHA-CFS]). Results indicated three profiles: "no needs," "met physical and environmental needs," and "unmet physical and environmental needs." MCI was associated with the met and unmet physical and environmental needs profiles; dementia was associated with the unmet physical and environmental needs profile. Patients without MCI or dementia had larger social networks (LSNS-6). Frailty was associated with dementia. Integrated care should address the needs of the oldest old and support social networks for people with MCI or dementia. Assessing frailty can help clinicians to identify the most vulnerable patients and develop beneficial interventions for cognitive disorders.

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

The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions. To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs. We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews. Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken. PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.

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

BackgroundEarly 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.MethodsA 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.ResultsTwenty-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.ConclusionFindings 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 registrationRetrospectively registered NCT05915156 (22/06/2023).

Needs for Care, Service Use and Quality of Life in Dementia: 12-Month Follow-Up of the Actifcare Study in Portugal.

The intermediate stages of dementia are relatively under-researched, including in Portugal. The Actifcare (ACcess to TImely Formal Care) EU-JPND project studied people with mild-moderate dementia, namely their needs, access to and use of community services (e.g., day centers, home support). In our baseline assessment of the Portuguese Actifcare cohort, the unmet needs of some participants would call for formal support, which was not always accessible or used. We now report the main results of the 12-month follow-up, analyzing changes in needs, service (non)use, quality of life and related variables. This was a longitudinal, observational study using a convenience sample of 54 dyads of people with dementia and their family carers. Our main outcomes were the Camberwell Assessment of Need for the Elderly (CANE) and the Resources Utilization in Dementia. Clinical-functional, quality of life, psychological distress and caregiving-related assessments were also used. At follow-up, the cognitive and functional status of people with dementia declined (p < 0.001), and their neuropsychiatric symptoms increased (p = 0.033). Considering CANE interviewers' ratings, the total needs of people with dementia increased at follow-up (p < 0.001) but not the unmet needs. Quality of life was overall stable. The use of formal care did not increase significantly, but informal care did in some domains. Carers' depressive symptoms increased (p = 0.030) and perseverance time decreased (p = 0.045). However, carers' psychological distress unmet needs were lower (p = 0.007), and their stress and quality of life remained stable. People with dementia displayed complex biopsychosocial unmet needs. Their cognitive-functional decline over one year was not accompanied by a corresponding increase in any pattern of unmet need, nor of service use. Reliance on informal care (namely supervision) may have contributed to this. Caregiving-related outcomes evolved according to different trends, although stability was almost the rule. Primary carers were even more present at follow-up, without an apparently heavier toll on their own needs, burden, and quality of life. Overall, this longitudinal study comprehensively assessed Portuguese community-dwelling people with dementia. Despite the lack of generalizability, participants' needs remained overall stable and partly unmet over one year. Longer follow-up periods are needed to understand such complex processes.

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

BackgroundUnmet care needs have been associated with an increased risk of depression in old age. Currently, the identification of profiles of met and unmet care needs associated with depressive symptoms is pending. Therefore, this exploratory study aimed to identify profiles of care needs and analyze associated factors in oldest-old patients with and without depression. MethodsThe sample of 1092 GP patients aged 75+ years is based on the multicenter study “Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)”. Depression (i.e. clinically meaningful depressive symptoms) was determined using the Geriatric Depression Scale (GDS) (cutoff score ≥ 4). Needs of patients were assessed using the Camberwell Assessment of Need for the Elderly (CANE). Associated sociodemographic and clinical factors were examined, and latent class analysis identified the need profiles. ResultsThe main result of the study indicates three need profiles: ‘no needs’, ‘met physical needs’, and ‘unmet social needs’. Members of the ‘met physical needs’ (OR = 3.5, 95 %-CI: 2.5–4.9) and ‘unmet social needs’ (OR = 17.4, 95 %-CI: 7.7–39.7) profiles were significantly more likely to have depression compared to members of the ‘no needs’ profile. LimitationsBased on the cross-sectional design, no conclusions can be drawn about the causality or direction of the relationships between the variables. ConclusionsThe study results provide important insights for the establishment of needs-based interventions for GPs. Particular attention should be paid to the presence of unmet social needs in the oldest-old GP patients with underlying depressive symptoms.

Care needs assessment of older adults with dementia in a semi-rural district in Vietnam: A community-based cross-sectional study.

The increasing needs of people living with dementia (PLWD) in Vietnam present an enormous public health challenge. Vietnam is an understudied country, and little is known regarding the overall unmet needs of caregivers or the demographic risk factors associated with unmet caregiving needs. This study aimed to determine the burden of unmet care needs of community-dwelling PLWD and identify sociodemographic risks associated with unmet care needs. A cross-sectional study in a rural area facing urbanisation in Hanoi, Vietnam recruited PWLD-caregiver dyads with multistage sampling. We utilised the Camberwell Assessment of Need for the Elderly (CANE) instrument to evaluate care needs across four domains. Caregivers rated PLWD needs, with higher scores indicating greater unmet needs. The Mann-Whitney test was employed for comparing two groups, while the Kruskal-Wallis test was used for comparisons involving more than two groups in the analysis, and a P-value of less than 0.05 was considered statistically significant. Among 90 PLWD participating in the study, the overall mean care needs score was 11.6 ± 4.3, with only 16.2% of PLWD having their care needs met. Environmental and physical needs were more frequently met than psychological or social needs. Only 48.0% and 43.9% of environmental and physical needs were met respectively, and a meagre 20.9% and 23.6% for psychological and social needs. Unmet care needs were more frequent for PWLD who were female, single or divorced, had lower monthly household income, or who were in more advanced stages of dementia, as indicated by Clinical Dementia Rating scores ≥1. Unmet needs for PWLD are common. Increased caregiver education, resources, and services in Vietnam are urgently required to improve the quality of life for this population.

SELF- AND PROXY-REPORTED MET NEEDS IN PERSONS WITH DEMENTIA ARE ASSOCIATIED WITH A LOWER HEALTH-RELATED QUALITY OF LIFE

Abstract This study examined the dyadic association of self and informal caregiver proxy-reported met needs in persons living with dementia on the health-related quality of life (HRQOL). A total of 237 dementia care dyads were included from the Case Management of Persons With Dementia and Their Caregivers Study. HRQOL was assessed by the EuroQol-5D and the number of met needs by the Camberwell Assessment of Needs for the Elderly. The Actor-Partner Interdependence Model framework was used to analyze the effect of an individual’s self or proxy-reported met needs on their own HRQOL (actor effects), and an individual’s self or proxy-reported met needs on the other dyad member’s HRQOL (partner effects). The number of self-reported met needs by persons living with dementia was negatively associated with their own HRQOL (actor effect b = -0.200, p &amp;lt; 0.001), and the HRQOL of informal caregivers (partner effect b = -0.114, p = 0.001). The number of proxy-reported met needs by informal caregivers was negatively associated with their own HRQOL (actor effect b = -0.105, p &amp;lt; 0.001) but not the person living with dementia’s HRQOL (-0.025, p = 0.375). Study findings suggest that both self-reported and informal caregiver proxy-reported met needs in persons living with dementia should be considered in research and practice because they have different implications for each dyad members’ HRQOL.

FC32: Neuropsychiatric symptoms: Disentangling the role of unmet needs using the Camberwell Assessment of Need for the Elderly (CANE) interview

Objective:As the world’s population ages, the number of people with dementia is expected to increase. In addition to progressive cognitive and functional deterioration, dementia comprises neuropsychiatric symptoms (NPS). NPS present significant management challenges based on their high frequency and disruptive nature. Against the prevailing guidelines, their treatment is often over-reliant on psychotropic drugs and other restrictive care approaches, frequently without a thorough assessment of underlying and potentially modifiable causes, such as over- and under-stimulating environments, untreated medical illnesses, drug interactions, or unidentified unmet needs. Consistent with the latter, the unmet needs model proposes that these neuropsychiatric phenomena are needs-driven and constitute indicators of identifiable unmet physical, psychological, emotional, or social needs. Despite this backdrop, few studies have investigated this association using standardized and replicable measures. In this context, the present study aims to put the unmet needs model into a practical context in order to disentangle the contribution of the unmet needs, assessed with the Camberwell Assessment of Need for the Elderly (CANE), to the presence of NPS.Methods:A cross-sectional study was conducted. Participants were assessed with validated, accessible, and replicable measures, including the CANE interview and the Neuropsychiatric Inventory (NPI). Other variables collected included residents’ demographic characteristics, cognitive and functional impairment, and daily medication. Multivariate models were used to explore potential risk factors for NPS.Results:Residents from four nursing homes entered the study. Results found that those with unmet needs assessed using CANE and those taking hypnotic/sedative medications had a higher risk of presenting at least one NPS, even after adjusting for other demographic and clinical-functional covariates.Conclusion:Built on the main finding that unmet needs assessed with CANE can independently contribute to explaining the presence of NPS, a working model is proposed to find solutions for these symptoms based on uncovering unmet needs. The CANE, as a practical, low-cost, yet clinically relevant assessment of met and unmet needs may be used to signal need areas that can be useful for formulation and intervention purposes and may offer the first step towards individually-tailored non- pharmacological interventions for NPS.

P192: The Unmet Needs of People with Mild to Moderate Dementia During COVID-19 Pandemic in East Jakarta

Background:The number of elderly populations continues to increase as the advancement in healthcare grows, which is shown by the increase of life expectancy, the declining mortality rates, and the surge of people with dementia (PwD). This mental health issue is barely identifiable by health workers and the elderly themselves especially during COVID-19 pandemic. Therefore, it is important to evaluate and identify the unmet needs of people with dementia, especially mild to moderate dementia.Objective:To describe the unmet needs of people with mild to moderate dementia during COVID- 19 pandemic in 2021 in East Jakarta, Indonesia.Methods:This study is using the CDR (Clinical Dementia Rating Scale) to assess severity level of Dementia, then using the CANE (Camberwell Assessment of Need for the Elderly) instrument to assess the unmet needs of people with mild to moderate dementia.Results:96 participants were assessed suffer from mild dementia (75%) and moderate dementia (25%). This study procured five substantial unmet needs proportion, which are friendship (26.0%), psychological distress (20.8%), close relationships (19.8%), memory dysfunction (16.7%), and daily activities (10.4%). During interviews in conducting unmet needs assessments, people with mild to moderate dementia and accompanying families expressed their desire for an activity that would be useful to overcome their unmet needs.Conclusion:The COVID-19 pandemic for the people with mild to moderate dementia has an impact on friendships, psychological distress, memory dysfunction and daily activities so they need meaningful activities to overcome them.

Effectiveness of a digitally supported care management program for family and other informal dementia caregivers: baseline data and first results from the GAIN randomized controlled trial

AbstractBackgroundAlmost two‐thirds of people with dementia (PwD) living at home receive care from informal caregivers. The caregiver’s work load can be comparable or above a full‐time employment. Evidence shows that family caregivers have a higher risk for psychiatric and non‐psychiatric diseases compared to non‐caregivers. A dyadic approach on disease management can help to reduce the burden of care and increase the quality of life (QoL) of caregivers and PwD.MethodsThe cluster randomized controlled trial “Gesund Angehörige Pflegen” (GAIN; ClinicalTrials.gov Identifier NCT04037501) conducted in general practitioner (GP) practices and memory clinics in Northern Germany aimed to evaluate the effectiveness of a 6‐months digitally supported care management program delivered by specifically qualified study nurses to reduce unmet needs of informal caregivers of PwD. Primary outcomes were the number of self‐reported unmet needs, regarding the caregiver and the PwD, assessed with a modified version of the Camberwell Assessment of Need for the Elderly (CANE) and the health‐related quality of life with the EQ‐5D‐5L questionnaire. A generalized linear mixed effects model was used with intercept as random effect.ResultsThe recruitment for the GAIN trial (October 2020 to January 2022) yielded n = 192 participants (mean age: 65 years, women 75%). The number of identified unmet needs was on average 8.66 (range 1 – 30). Analyses of the primary endpoints revealed a statistically significantly higher reduction of unmet needs of caregivers in the intervention group compared to the control group. Evaluation of the EQ‐5D‐5L showed no significant difference between groups.ConclusionThe GAIN care management program was able to lower the number of unmet needs for informal dementia caregivers. Health related quality of life showed a major ceiling effect (high scoring at baseline), which might explain the lack of an effect. The study shows the benefit of a computerized self‐assessment system in primary care and should be further developed as an entry point to the existing health care system.

Aggressive behaviour and suicidal concerns during remand imprisonment and the relation to mental health(care)

ABSTRACT Prisoners display high levels of suicide risk and aggression and prisoners report unmet needs. The relation to mental healthcare is unclear. The current study analysed 226 prisoners on aggressive behaviour and suicidal concerns during general remand imprisonment in the Netherlands, in relation to mental health(care). Aggressive behaviour and suicidal concerns were assessed every four weeks during the first four months of remand imprisonment by the Social Dysfunction and Aggression Scale and Brief Psychiatric Rating Scale. Psychiatric disorders (Mini International Neuropsychiatric Interview – Plus) and unmet needs (Camberwell Assessment of Needs – Forensic Version) were assessed as was provided mental healthcare during imprisonment. The levels of aggressive behaviour and suicidal concern were consistent over time and overall displayed by 18% and 15% of the prisoners, respectively. Aggressive behaviour appeared related to psychiatric symptoms and prior mental health treatment, as was suicidal concern. However, in contrast to individuals with suicidal concerns, prisoners with aggressive behaviour less often received mental healthcare in prison. This appears to be related to the finding that aggressive prisoners do not report more unmet needs compared to non-aggressive prisoners. In conclusion, aggressive behaviour is more strongly related to mental health than might be expected. Prisontime perhaps could initiate mental healthcare.

Which needs assessment tool to use? Review of the needs assessment tools for service evaluation

Abstract Background Needs assessment enhance patient-centered care quality and is important within evaluation process, as well as for implementation of new services. Needs assessment tools can help clinicians to plan treatment and also to assess subsequent service impacts. Aim of the present research was to review quantitative tools for mental health needs assessment, that are either self-reported or can be used by professionals or researchers. Methods A comprehensive literature search in two bibliographic databases was carried out following the PRISMA protocol. Additional search was performed in specific review papers. Included papers are quantitatively assessing the needs of people with mental health problems and exclude people with dementia or disabilities. Also other inclusion and exclusion criteria were applied. Results The majority of all studies were published in English (n = 234). The majority of research papers (n = 163) were conducted in Europe between 2000-2010, while in other countries the trend followed the year 2011. Preliminary results are showing that there are 29 different tools for needs assessment and 17 of them can be used at the system level also as an outcome measure. The most frequently used tool for assessing the needs that can be also used as an outcome measure was Camberwell Assessment of Needs (CAN) also in combination with Health of the Nation Outcome Scales (HoNOS). As well Cardinal needs schedule (CNS) and Resident Assessment Instrument Mental Health (RAI-MH) were used more than once. Conclusions When choosing an appropriate assessment tool, it is vital to use the most widely used ones, focusing on validated tools (culturally adapted), tools modified for specific populations (elderly, children, etc.) and also to bear in mind the ultimate goal that the service is aiming. CAN, HoNOS and CNS are assessing psychiatric and social care needs comprehensively. While RAI-MH is also a tool that is supporting seamless approach to person-centered care. Key messages • When choosing an appropriate assessment tool, it is vital to use the most widely used ones, focusing on validated tools and tools modified for specific populations. • When choosing an appropriate assessment tool, it is important to focus on the ultimate goal the service is aiming.

The care needs of dementia patients in Nam Dong District, Thua Thien Hue Province: An observational study using the Camberwell Assessment of Need for the Elderly questionnaire

Objectives: This study aimed to describe the care needs among dementia patients in Nam Dong District, Thua Thien Hue Province by using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire, and to examine its related factors. Methods: A cross-sectional descriptive study was conducted on 182 dementia patients living in Nam Dong District, Thua Thien Hue Province. The care needs of dementia patients were examined by using the CANE questionnaire (score range: 0-30). The CANE has shown a good level of reliability (α = 0.87). The multivariate linear regression analysis was undertaken to explore the associated factors of the care needs among dementia patients. Results: The mean score of the subjects' needs was 8.21 ± 7.99 (Min: 0; Max: 30). Met needs were reported most commonly in the following areas: food (34.1%), drugs (29.7%), physical health (25.3%) and looking after the home (24.7%). Meanwhile, unmet needs with the highest proportions included accommodation (30.2%), memory (24.7%), money/budget (24.2%), and information regarding health conditions and treatment (18.1%). Higher health care needs were significantly related to Co Tu ethnic group; unmarried group (including single; widowed; divorced/separated); poor, near-poor household economic status group. Conclusions: Unmet needs are common among dementia patients. Primary health care providers should work with carers to promote social support services as well as health care services that meet all needs of dementia patients and improve their quality of life. Keywords: dementia, health care needs, the Camberwell Assessment of Need for the Elderly (CANE), mountainous area.

Self- reported and informal caregiver proxy-reported met needs in persons living with dementia are associated with lower health-related quality of life: a dyadic, cross-sectional study

Objective This study examined the dyadic association of self and informal caregiver proxy-reported met needs in persons living with dementia on the health-related quality of life (HRQOL). Methods A total of 237 persons with dementia and their caregivers were included from a previous observational study. HRQOL was assessed by the EuroQol-5D and the number of met needs by the Camberwell Assessment of Needs for the Elderly. The Actor-Partner Interdependence Model framework was used to analyze the effect of an individual’s self or proxy-reported met needs on their own HRQOL (actor effects), and an individual’s self or proxy-reported met needs on the other dyad member’s HRQOL (partner effects). Results The number of self-reported met needs by persons living with dementia was negatively associated with their own HRQOL (actor effect b = −0.200, p < 0.001), and the HRQOL of informal caregivers (partner effect b = −0.114, p = 0.001). The number of proxy-reported met needs by informal caregivers was negatively associated with their own HRQOL (actor effect b = −0.105, p < 0.001) but not the person living with dementia’s HRQOL (-0.025, p = 0.375). Conclusion Study findings suggest that both self-reported and informal caregiver proxy-reported met needs in persons living with dementia should be considered in research and practice because they have different implications for each dyad members’ HRQOL.

Living with young-onset dementia in the family – a mixed method study

Background: Studies on disease-related obstructions experienced in everyday life of younger people with dementia (YOD ≤ 65 years) and their families are encouraged. Aim: To explore how the family carers experience six predefined topics that influence the everyday life and needs of persons with YOD. Method: A quantitative and a qualitative study including family carers of persons with young-onset Alzheimer’s dementia (AD) and frontotemporal dementia (FTD). Seventy-four informants responded to the Camberwell Assessment of Needs in the Elderly (CANE) and individual interviews were conducted with 13 informants. Results: Family carers of persons with YOD reported few unmet needs in the CANE assessment. Needs related to behavior and close relationships were reported significantly more frequent (p < 0.1) in persons with FTD than in persons with AD. From the qualitative data, six main themes were emphasized: daily activities turned upside down, involuntary loss of previous social network, losing close relationship, but maintaining a friendship with the spouse, unpredictable behavior adds burdens to a changing life, health and life risks, and economic insecurity for future life and caring costs. Conclusion: Whilst family carers quantitatively reported unmet needs, the individual interviews reported several major difficulties in everyday life.

Psychological/Personal recovery and its correlates in patients with first episode psychosis.

Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP. To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission. One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales. The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization. The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Self-perceived care needs and quality of life in people with cognitive impairment during routine care at home: cross-sectional results of the interventional study

BackgroundCognitive impairment (CI) is one of the most common disabling symptoms in the elderly, and people with CI face a variety of unmet care needs. There is limited evidence on the relationship between unmet needs and quality of life (QoL) of people with CI. The aim of this study is to analyse the current situation of unmet needs and QoL among people with CI, and to explore the correlation between QoL and unmet needs.MethodsThe analyses use baseline data of the intervention trial, which recruited 378 participants to complete the questionnaire including the Camberwell Assessment of Need for the Elderly (CANE), and the Medical Outcomes Study 36-item Short-Form (SF-36). The SF-36 was further gathered into physical component summary (PCS) and mental component summary (MCS). Multiple linear regression analysis was conducted to explore the correlations between unmet care needs and PCS and MCS of SF-36.ResultsThe mean score of each of the eight domains of SF-36 was significantly lower than the Chinese population norm. The incidence of unmet needs ranged from 0 to 65.1%. Multiple linear regression results showed that living in rural areas (Beta=-0.16, P < 0.001), having unmet physical needs (Beta=-0.35, P < 0.001), and unmet psychological needs (Beta=-0.24, P < 0.001) were associated with lower PCS scores, whereas duration of CI > 2 years (Beta=-0.21, P < 0.001), unmet environmental needs (Beta=-0.20, P < 0.001), and unmet psychological needs (Beta=-0.15, P < 0.001) were associated with lower MCS scores.ConclusionThe main results support the important view that lower QoL scores are associated with unmet needs in people with CI, depending on the domain. Given that the more unmet needs can further worsen QoL, it is recommended that more strategies should be taken, especially for those with unmet care needs, so as to improve their QoL.

Indicators of integrated care for patients with chronic cardiovascular disease in ambulatory care.

Patients with cardiovascular disease (CVD) have an increased need for medical care and a high risk of hospitalization. It is necessary to improve the integration between healthcare, long-term care and social care for these individuals, as poor integration limits the full potential of care. This study aims to identify effective indicators of CVD management, including variables that promote the horizontal and vertical integration of planned interventions. Patients with chronic CVD managed by a general practitioner (GP) or a primary care cardiologist will be enrolled in the study. The study will use the World Health Organization Quality of Life Questionnaire (WHOQOL)-BREF, the Health Behavior Inventory (HBI) questionnaire, the Camberwell Assessment of Need (CAN) Short Appraisal Schedule, the Hospital Anxiety and Depression Scale-Modified Version (HADS-M), a Self-Description Questionnaire, and the authors' self-prepared questionnaire to collect data. The main results will allow for the identification of the variables that influence the effectiveness of healthcare (understood as the synergy of high quality of life, intensification of health behaviors and high satisfaction of needs) for patients with CVD. In addition, an examination of the relationships between quality of life and health behaviors, assessment of needs (health and social), level of religiosity and spirituality, expectations, and variables affecting anxiety and depressive symptoms will allow for the identification of indicators that favor the integration of care both horizontally and vertically. The results of this study will support the development of systems aimed at identifying CVD patients at risk for lower effectiveness of care in integrated care. In addition, the results may help to develop clinical information and decision support systems aimed at designing personalized care models for patients with CVD. They may also help to develop coordinated care plans and patient education programs, and obtain data useful for implementing system changes.

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

BackgroundThe 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.MethodsIn 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.ResultsThe 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).ConclusionUnderstanding 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.

DIFFERENCES AND SIMILARITIES OF ELDERLY PERSONS IN SWEDEN WITH A DIAGNOSIS OF PSYCHOSIS OR NON-PSYCHOSIS (SMI)

Abstract Psychiatric care in Sweden is jointly organized by psychiatric practice and municipal social services. To determine who is entitled to support from the municipalities, the concept of “psychiatric disability” was created in connection with psychiatric reform in 1995. Psychiatric disability is a poorly identified concept and in Sweden, a person has severe mental illness (SMI) if they have difficulties in carrying out activities in crucial areas of life, these difficulties are caused by a mental disorder, and they are prolonged. Internationally, SMI is often synonymous with psychosis, but in Sweden other severe psychiatric conditions are included, but not dementia. Both practically and ethically, the unclear definition of SMI is a problem because it determines whether a person is granted interventions and what forms the interventions take. We investigated similarities and differences in people defined as SMI, divided into two groups, psychosis (Nf222) and non-psychosis (Nf253). Adults with SMI aged 65 or over (in 2016) have been assessed using data from four surveys carried out between 1996 and 2011, as well data available from national registers. People with psychosis had worse functional levels on the Global Assessment of Functioning and more unmet needs, according to Camberwell Assessment of Needs. However, differences between psychosis and non-psychosis groups varied across measures (e.g., education, income, living situation) and results differed depending on age at onset, year of first admission to a mental hospital, and length of institutionalization. These variables had a greater impact on the similarities and differences between measures than the diagnosis itself.