Camberwell Assessment Of Need Research Articles

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

AbstractBackgroundAlmost two‐thirds of people with dementia (PwD) living at home receive care from a family or other informal caregiver. For the caregiver this can result in a work load comparable or above a full‐time employment position. Evidence shows that family caregivers have a higher risk for psychiatric and non‐psychiatric diseases like depression, anxiety, and arterial hypertension compared to non‐caregivers. A dyadic approach on disease management and the assessment of unmet needs can help to reduce the burden of care and increase the quality of life of caregivers and PwD. The cluster randomized “Gesund Angehörige Pflegen” (GAIN) trial conducted in general practitioner (GP) practices and memory clinics in Northern Germany aims to evaluate the effectiveness of a digitally supported care management programme to reduce unmet needs of informal caregivers of PwD.MethodThe recruitment for the GAIN trial began in October 2020 and will end in January 2022 with an estimated sample size of n = 200 caregiver. The GAIN baseline assesses the caregiver’s self‐reported unmet needs (Camberwell Assessment of Need for the Elderly, CANE), health‐related quality of life (EQ‐5D‐5L), caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non‐medical services and resource utilisation.ResultA blinded interims data quality control analysis (n = 86) documented 10.45 unmet needs on average, 4.55 unmet needs for the caregivers and 5.9 unmet needs connected to the PwD triggering a maxium of 8 suggested interventions per unmet need. These results are higher compared to the previous studies on unmet needs of dementia caregivers. The recruitment for the trial is currently still ongoing. Complete baseline results will be presented at the conference.ConclusionThe use of a tablet‐based expert assessment system in memory clinics or GP praxis to identify unmet needs is well feasible. Caregivers of PwD recruited at GPs or memory clinics for the GAIN trial report a high number of unmet needs indicating the importance of a structured and in‐depth assessment to allow a personalized and dyadic treatment of family caregivers and PwD.

Care Needs Profiles and Their Association with Caregiver Strain among Community-Dwelling Older Adults with Cognitive Impairment

Introduction: This study examined distinct profiles of met and unmet care needs among community-dwelling older adults with cognitive impairment and their association with caregiver strain. Methods: Latent class analysis and multivariable regression were applied to data from 266 caregivers of older Singaporeans, aged 60 years and above, with cognitive impairment. Care needs were evaluated by caregivers using the Camberwell Assessment of Need for the Elderly. Caregiver strain was measured by the Zarit Burden Interview. Results: Four need profiles were identified: (1) no need (38% of caregivers), (2) met social and memory needs (29%), (3) no social and met memory needs (17%), and (4) unmet social and memory needs (16%). The unmet social and memory needs profile was associated with a higher level of caregiver strain, compared to the no need profile. Discussion: A person-centered approach captured heterogeneity in the care needs of community-dwelling older adults with cognitive impairment. Policymakers should develop tailored interventions based on need profiles that may help reduce caregiver strain.

Needs of forensic psychiatric patients with schizophrenia in five European countries

AimsThe purpose was to compare the frequency of needs of patients with schizophrenia in forensic services across five European countries as assessed by both the patients and their care staff.MethodsPatients with schizophrenia and a history of significant interpersonal violence were recruited from forensic psychiatric services in Austria, Germany, Italy, Poland and England. Participants’ needs were assessed using the Camberwell Assessment of Needs—Forensic Version (CANFOR). Multiple linear regression analyses were used to identify predictors of numbers of needs.ResultsIn this sample, (n = 221) the most commonly reported need according to patients (71.0%) and staff (82.8%) was the management of psychotic symptoms. A need for information was mentioned by about 45% of staff and patients. Staff members reported a significantly higher number of total needs than patients (mean 6.9 vs. 6.2). In contrast, staff members reported a significantly lower number of unmet needs than patients (mean 2.0 vs. 2.5). Numbers of total needs and met needs differed between countries. Unmet needs as reported by patients showed positive associations with the absence of comorbid personality disorder, with higher positive symptom scores and lifetime suicide or self-harm history. Significant predictors of unmet needs according to staff were absence of comorbid personality disorder and higher positive as well as negative symptom scores according to PANSS.ConclusionsStaff rated a significantly higher number of total needs than patients, while patients rated more unmet needs. This indicates that patients’ self-assessments of needs yield important information for providing sufficient help and support.

The Turkish version of the Camberwell Assessment of Need for the Elderly: A validity and reliability study.

The present study attempted to adapt and validate the Turkish version of the Camberwell Assessment of Need for the Elderly (CANE-T). The data of this methodological study were collected from 610 older people who volunteered between September 10 and December 15, 2019. The SPSS 20 and LISREL software were used to perform reliability (internal reliability, parallel forms reliability/equivalent forms, and test-retest reliability) and validity (exploratory factor analysis and confirmatory factor analysis) analyses for the CANE-T. The Kaiser-Meyer-Olkin test revealed the sampling adequacy to be 0.72. After deleting four items (psychological distress, behavior, alcohol, and money) with a factor loading below 0.30 from the dataset, it was found that the scores on the scale explained 55% of the total variance. Besides, the confirmatory factor analysis revealed the following fit indices: p < 0.05, root mean square error of approximation (RMSEA)=0.08, root mean square residuals (RMR)=0.07, standardized root mean square residual (SRMR)=0.07, goodness-of-fit index (GFI)=0.88, and adjusted goodness-of-fit index (AGFI)=0.84. Concerning reliability, Cronbach's α values were calculated to be 0.78 for 'Physical Needs', 0.74 for 'Psychophysiological Needs', 0.75 for 'Security Needs', 0.75 for 'Social Needs', and 0.75 for 'Health Needs'. Overall, it was concluded that the 20-item five-factor CANE-T is a valid and reliable tool to measure the needs of older adults in the Turkish context.

Health-Related Needs of Older Adults in Rafsanjan County, Kerman, Iran

Objectives The need for meeting the needs of the elderly to promote active aging among them is becoming more important. For appropriate planning in this field, accurate needs assessment is necessary. In this regard, this study aims to investigate the health-related needs of the elderly in Rafsanjan county, Kerman, Iran. Methods &amp; Materials This cross-sectional study was conducted on 267 older people in Rafsanjan county in 2020 who were randomly selected from among six comprehensive health centers. A demographic form and the Camberwell Assessment of Need for the Elderly questionnaire were completed and data were analyzed in SPSS v. 26 software. Results The highest frequency of unmet needs in terms of psychological needs was psychological distress (12.3 %); in terms of physical needs, it was memory (9.3 %); and in terms of environmental needs, it was accommodation (5.2%). The highest frequency of met needs was related to physical needs in terms of medication (67.5%) and physical health (64%). The most unnecessary needs were related to psychological needs in terms of receiving benefits, drinking alcohol, deliberate self-harm and accidental self-harm. The highest rate of received help from unofficial sources was in the field of psychological distress (0.4%), and highest rate of received help from official sources were the fields of accommodation and physical health (0.4%). Conclusion The elderly in Rafsanjan county need more help in the field of psychological and physical needs. Therefore, attention should be paid to these needs in policy-making and executing programs in the field of elderly care.

Advanced nursing practice and interprofessional dementia care (InDePendent): study protocol for a multi-center, cluster-randomized, controlled, interventional trial

BackgroundA redistribution of tasks between specialized nurses and primary care physicians, i.e., models of advanced nursing practice, has the potential to improve the treatment and care of the growing number of people with dementia (PwD). Especially in rural areas with limited access to primary care physicians and specialists, these models might improve PwD’s quality of life and well-being. However, such care models are not available in Germany in regular healthcare. This study examines the acceptance, safety, efficacy, and health economic efficiency of an advanced nursing practice model for PwD in the primary care setting in Germany.MethodsInDePendent is a two-arm, multi-center, cluster-randomized controlled intervention study. Inclusion criteria are age ≥70 years, cognitively impaired (DemTect ≤8) or formally diagnosed with dementia, and living in the own home. Patients will be recruited by general practitioners or specialists. Randomization is carried out at the physicians’ level in a ratio of 1:2 (intervention vs. waiting-control group). After study inclusion, all participants will receive a baseline assessment and a follow-up assessment after 6 months. Patients of the intervention group will receive advanced dementia care management for 6 months, carried out by specialized nurses, who will conduct certain tasks, usually carried out by primary care physicians. This includes a standardized assessment of the patients’ unmet needs, the generation and implementation of an individualized care plan to address the patients’ needs in close coordination with the GP. PwD in the waiting-control group will receive routine care for 6 months and subsequently become part of the intervention group. The primary outcome is the number of unmet needs after 6 months measured by the Camberwell Assessment of Need for the Elderly (CANE). The primary analysis after 6 months is carried out using multilevel models and will be based on the intention-to-treat principle. Secondary outcomes are quality of life, caregiver burden, acceptance, and cost-effectiveness. In total, n=465 participants are needed to assess significant differences in the number of unmet needs between the intervention and control groups.DiscussionThe study will provide evidence about the acceptance, efficacy, and cost-effectiveness of an innovative interprofessional concept based on advanced nursing care. Results will contribute to the implementation of such models in the German healthcare system. The goal is to improve the current treatment and care situation for PwD and their caregivers and to expand nursing roles.Trial registrationClinicalTrials.gov NCT04741932. Registered on 2 February 2021.

Patient-reported needs predict perceived psychosocial disability and quality of life beyond symptom severity in schizophrenia

Purpose We examined whether patient-rated or clinician-rated needs are more strongly associated with perceived psychosocial disability (PPD) and subjective quality of life (SQOL) of schizophrenia patients, beyond symptom severity. Methods Hierarchical regression analyses were computed to test patient and clinician-rated unmet and met needs (estimated by eighty-two patient-clinician pairs) as predictors of PPD and SQOL above and beyond demographics and psychopathology. Needs, symptomatology, PPD and SQOL were estimated using Camberwell Assessment of Need (CAN), PANSS, WHODAS 2.0 and WHOQOL-BREF respectively. Results Needs were significantly associated with all WHODAS 2.0 and WHOQOL-BREF domains above and beyond demographics and PANSS variables. Clinician-rated needs were better predictors of only one WHODAS 2.0 domain, while patient-rated needs were better predictors of all other WHODAS 2.0 and WHOQOL-BREF domains. Patient-rated unmet needs were more strongly than met needs associated with the most WHODAS 2.0 and WHOQOL-BREF subscores. Conclusion This study offers the first evidence that patient-rated needs, especially unmet needs, are strongly associated, above and beyond symptomatology, with global and domain-specific PPD of schizophrenia patients. Accordingly, strong relations of patient-rated needs with SQOL emerged. Identifying and addressing patient-reported needs could facilitate PPD and SQOL improvement more effectively than interventions confined solely to symptom remission. IMPLICATIONS FOR REHABILITATION Schizophrenia is associated with poor rehabilitation and recovery outcomes, i.e., perceived psychosocial disability (PPD) and subjective quality of life (SQOL). Assessment of patients’ needs constitutes the basis of determining treatment goals and planning tailor-made interventions to achieve crucial rehabilitative outcomes. Higher levels of patient-reported unmet needs are associated with poorer SQOL and higher global and domain-specific PPD of schizophrenia patients, above and beyond symptom severity. Addressing patient-reported needs through personalized interventions can facilitate more effectively PPD and SQOL improvement, than treatment confined to symptomatic alleviation.

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 in the care of the elderly. The Camberwell Assessment of Need for the Elderly (CANE) evaluates adults' care needs. This study aimed to assess the types of 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 assessment OR needs OR 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 were related to the physical (45%) and social (21%) dimensions, respectively. Furthermore, the highest unmet were observed in the physical and social dimensions (0.07%), and the lowest unmet were related to the psychological and environmental dimensions (0.04%). Conclusions: The CANE is sensitive enough to identify unmet in different samples and settings. Therefore, a new care model and appropriate interventions for the elderly can be designed based on the CANE results.

Development of a digital system to assess and manage care and support needs of family dementia caregivers

AbstractBackgroundA dementia diagnosis has an effect on an entire family who often takes on carer responsibilities for the person diagnosed. Due to this impact, taking on a dyadic perspective to identify care and support needs of caregivers to promote wellbeing and minimise caregiver related burden is necessary. Digitally supported interventions have the potential to be time‐efficient and ensure prompt service provision. Therefore, our aim was to develop a digital system to identify and manage care and support needs of family dementia caregivers.MethodThe development of the system was part of a randomised controlled trial examining the effectiveness of a computer‐based care management programme for family caregivers. Evidence‐based Dementia Care Management as conducted and adapted in several primary care studies in Germany was used as conceptual framework. Using a participatory approach with 27 caregivers and experts including neurologists, psychologists and psychiatrists, we developed a digital system including a self‐completion unmet needs assessment focusing on caregivers’ health und quality of life in connection to their caregiver responsibilities. The system was piloted for its content and technical usability in a memory clinic.ResultThe unmet needs assessment comprises several validated questionnaires with 57 questions examining a person’s self‐reported unmet needs (Camberwell Assessment of Need for the Elderly, CANE), health‐related quality of life (EQ‐5D‐5L), caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non‐medical services and resource utilisation. In total, the assessment covers 51 health and support related aspects. The system is able to instantly generate results identifying a person’s unmet needs through predefined algorithms. For each case, the system generates a systematic, written feedback for the participant’s treating GP and it provides a monitoring option capturing the progress of reducing a person’s unmet needs. The assessment, outcome data and system will be presented in detail.ConclusionThe digital system may improve healthcare and support provision for family caregivers of people with dementia by addressing their unmet needs in connection to their caregiver responsibilities. It is necessary to address multiple dimensions of health and provide dyadic assessment and care for better outcomes.

The older prisoner health and social care assessment and plan (OHSCAP) versus treatment as usual: a randomised controlled trial

BackgroundOlder people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU).MethodsThe study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016.ResultsData were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs – Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI − 0.276 to 0.449, p = 0.621).No adverse events were reported.ConclusionThe OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU.Trial registrationCurrent Controlled Trials: ISRCTN11841493, 25/10/2012.

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.

Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec

BackgroundPersons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers’ met and unmet needs and to describe their experience.MethodsThis is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers’ Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together.ResultsThe mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver’s attitude towards memory decline, their perception of community health services and of the family medicine practice.ConclusionsOur study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.

The impact of childhood sexual trauma on intimacy and sexuality needs among people with non-affective psychosis

BackgroundChildhood trauma, in particular childhood sexual abuse (CSA), and unmet sexuality and intimacy needs are prevalent among people with psychosis spectrum disorders. The association between CSA and sexuality and intimacy needs over time in adults with psychosis spectrum disorders were examined. MethodPatients (n = 1119) were recruited as part of the Genetic Risk and OUtcome of Psychosis (GROUP) study, a representative cohort of patients with non-affective psychotic disorder. At baseline, three-year and six-year follow-up, sexuality and intimacy needs were assessed with the Camberwell Assessment of Needs. CSA was assessed with the Childhood Trauma Questionnaire. ResultsAt baseline, sexuality (26%) and intimacy (40%) needs were prevalent; 90% of these needs remained unmet. Cross-sectionally, CSA was associated with sexuality needs (OR = 1.68, 95% CI: 1.13-2.04) and intimacy needs (OR = 1.75, 95% CI: 1.04- 1.77). Childhood emotional abuse (CEA) was also cross-sectionally associated with sexuality and intimacy needs. Others forms of trauma were not. Prospectively, CSA predicted incidence of a sexuality need (HR = 2.1, 95% CI: 1.23-3.74) as well as an intimacy need (HR = 1.7, 95% CI: 1.11-2.66), as did CEA (sexuality: HR = 1.8, 95% CI: 1.11-2.89; intimacy: HR = 1.4, 95% CI: 1.03-1.96). CSA and CEA were not associated with persistence of sexuality or intimacy. ConclusionCSA and CEA are associated with a higher prevalence and incidence of sexuality and intimacy needs in patients with psychotic disorders. High rates of unmet sexuality and intimacy needs may indicate an underlying need for trauma-related treatment as well as a need for novel interventions targeting these needs.

Effectiveness of a digitally supported care management programme to reduce unmet needs of family caregivers of people with dementia: study protocol for a cluster randomised controlled trial (GAIN)

BackgroundUp to two-thirds of dementia care is provided by family caregivers who often experience high burden, little support and adverse health outcomes. Enabling and supporting family caregivers to provide care at home prevents early institutionalisation of the person with dementia and alleviates the economic burden of dementia in the long term. General practitioners (GPs), as the first point of contact, have a key role in identifying and managing burden and care needs of family caregivers. However, in routine care, this opportunity is often limited by time constraints and even if caregiver needs are recognised, detailed information about regionally available support and advice on healthcare services is often lacking.MethodsThis is a cluster randomised, controlled trial investigating the clinical use and cost-effectiveness of a digitally supported care management programme for caregivers of people with dementia (PwD). Five hundred family caregivers will be randomised at GP offices, specialist practices and memory clinics, with about n=250 participants per arm. Participants are eligible if they are the primary family caregiver of a PwD, are at least 18 years of age and provide informed consent. Participants in the intervention group will receive an individualised care management plan, which will be carried out by qualified study nurses in collaboration with the treating GP. All participants will receive a baseline assessment and a 6-months follow-up assessment. Participants in the wait-list control group will receive usual care. Starting at the 6 months’ follow-up, the former controls will also receive an individualised management plan. Primary outcomes are the number of unmet needs (incl. the Camberwell Assessment of Need for the Elderly, CANE) and health-related quality of life (EQ-5D-5L) at 6 months. Secondary outcomes include caregiver burden (Zarit Burden Interview, ZBI), social support (Lubben Social Network Scale, LSNS), the use of medical and non-medical services (Questionnaire for the Use of Medical and Non-Medical Services, FIMA) and resource utilisation (Resource Utilisation in Dementia, RUD). The primary analysis will be based on intention-to-treat. Between- and within-group analyses and a cost-effectiveness analysis will be conducted to estimate the effect of the tablet PC-based care management programme. This trial is funded by the German Federal Joint Committee (G-BA) Innovation Fund.DiscussionThe findings of this trial will be useful in informing and improving current healthcare system structures and processes to support family dementia caregivers within routine care practices.Trial registrationClinicalTrials.gov NCT04037501. Registered on 30 July 2019.

Met and Unmet Needs in an Inpatient Psychiatry Setting in Spain.

PurposePatients with severe mental disorder have health and social needs that require care. The aim of the study was to determine the main areas of perceived needs among inpatients with severe mental disorders and to identify risk factors of the group of patients with the greatest unmet needs.Patients and MethodsA total of 150 patients with severe mental illness were assessed during admission prior to discharge from the hospital. Camberwell Assessment of Needs was used as evaluation measure, in addition to clinical status (The Brief Psychiatric Rating Scale), social functioning (Personal and Social Performance) and sociodemographic variables. A descriptive and a multivariate logistic regression analysis were used to analyse variables related to the group of patients with the highest number of unmet needs (≥3).ResultsMean number of needs was 7.93, being 4.61 the mean number of needs met and 3.32 the needs unmet. The highest proportion of unmet needs were intimate relationships (44.0%), company (40.7%) and daytime activities (38.7%). A relationship was also found between the presence of three or more unmet needs and the following variables: Brief Psychiatric Rating Scale score (p=0.004), Personal and Social Performance score (p = 0.013), marital status (p=0.018), employment status (p=0.009) and voluntary admission (p=0.032). The multivariate model explained 29.5% of the variance (Nagelkerke’s R2: 0.295).ConclusionTreatments aimed at improving social relationships and daytime activities could be a good option for inpatients with many unmet needs.

Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

BackgroundLong-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care.MethodsThe needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis.ResultsCluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters.ConclusionsClustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives.

Associations between unmet needs for daytime activities and company and scores on the Neuropsychiatric Inventory-Questionnaire in people with dementia: a longitudinal study

Objectives To examine prospectively the association between unmet needs for daytime activities and company and behavioural and psychological symptoms of dementia. Methods We included 451 people with mild or moderate dementia, from eight European countries, who were assessed three times over 12 months. Unmet needs were measured with the Camberwell Assessment of Need for the Elderly. Three sub-syndromes of the Neuropsychiatric Inventory-Questionnaire were regressed, one-by-one, against unmet needs for daytime activities and company, adjusting for demographic and clinical-functional covariates. Results Unmet needs for daytime activities were associated with more affective symptoms at baseline, six and twelve months, mean 0.74 (p < 0.001), 0.76 (p < 0.001) and 0.78 (p = 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.39 points, p = 0.007) and at six months follow-up (mean 0.31 points, p = 0.006). Unmet needs for company were associated with more affective symptoms at baseline, six and twelve months, mean 0.44 (p = 0.033), 0.67 (p < 0.001) and 0.91 (p < 0.001) points higher score respectively, and with more psychotic symptoms at baseline (mean 0.40 points, p = 0.005) and at six months (mean 0.35 points, p = 0.002) follow-up. Conclusion Interventions to reduce unmet needs for daytime activities and company could reduce affective and psychotic symptoms in people with dementia.

Unmet needs of the oldest old primary care patients with common somatic and psychiatric disorders-A psychometric evaluation.

ObjectivesUnmet 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.MethodsA 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.ResultsOn 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.ConclusionsPatients 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.

Patient needs four years after first psychiatric hospitalization in a Brazilian cohort.

Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.

Outcome Measures in Forensic Mental Health Services: A Systematic Review of Instruments and Qualitative Evidence Synthesis.

Abstract Background Outcome measurement in forensic mental health services can support service improvement, research, and patient progress evaluation. This systematic review aims to identify instruments available for use as outcome measures in this field and assess the evidence for the most common instruments, specific to the forensic context, which cover multiple outcome domains. Methods Studies were identified by searching seven online databases. Additional searches were then performed for 10 selected instruments to identify additional information on their psychometric properties. Instrument manuals and gray literature was reviewed for information about instrument development and content validity. The quality of evidence for psychometric properties was summarized for each instrument based on the COnsensus-based Standards for health Measurement INstruments (COSMIN) approach. Results A total of 435 different instruments or variants were identified. Psychometric information on the 10 selected instruments was extracted from 103 studies. All 10 instruments had a clinician reported component with only two having patient reported scales. Half of the instruments were primarily focused on risk. No instrument demonstrated adequate psychometric properties in all eight COSMIN categories assessed. Only one instrument, the Camberwell Assessment of Need: Forensic Version, had adequate evidence for its development and content validity. The most evidence was for construct validity, while none was identified for construct stability between groups. Conclusions Despite the large number of instruments potentially available, evidence for their use as outcome measures in forensic mental health services is limited. Future research and instrument development should involve patients and carers to ensure adequate content validity.