Camberwell Assessment Of Need Research Articles

Unmet Needs in Outpatients with Psychotic Disorders in Brazil

Introduction The assessment of needs among patients with severe mental disorders is one of the most studied measures in treatment planning and monitoring of mental health services. Nevertheless, studies on this subject are scarce in Brazil, even following the recent expansion of community services. Objectives To investigate the prevalence and correlates of unmet needs among outpatients with psychotic disorders in Brazilian community mental health services. Methods This is a cross-sectional study with a random sample of 401 outpatients with psychotic disorders in the city of Santos, Brazil. Needs were assessed through interviews with patients using the Camberwell Assessment of Needs (CAN), which investigates 22 clinical, social and basic needs. The Positive and Negative Symptom Scale (PANSS) was used to assess symptoms. Data were analyzed with multiple linear regression, using p Results The most reported needs were psychotic symptoms (67.0%), information needs (55.0%), psychological distress (41.8%) and money (41.5%). The mean number of unmet needs was 2.91 (+-2.56). A greater number of unmet needs was significantly associated to lower education, more negative symptoms and general psychopathology, all with p = 0.001. Conclusions The most reported needs were clinical and social. The number of unmet needs was consistent with the results of international studies. Furthermore, the association of greater unmet needs with lower education and higher symptoms severity may indicate the need for further and comprehensive psychosocial interventions.

The Relationship Between Patients’ Needs and Psychopathology in Schizophrenia: Do Patients and Therapists Agree?

Meeting patients’ needs is of great importance for ensuring quality of life and reducing social disability in severe mental disorders, such as schizophrenia. However, the degree of agreement between patients and their therapists in the assessment of needs warrants further investigation, regarding that high patient-therapist agreement is associated with improved outcomes. Current symptomatology might differentially affect the self-report and clinician-rated appraisal of schizophrenia patients’ needs. To examine the potential impact of current symptoms on patients’ and therapists’ assessment of patients’ needs. Fifty-three schizophrenia patient–staff pairs were interviewed using the Greek research version of the Camberwell Assessment of Need (CAN-R). Patients’ symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). The degree of agreement between staff and patients in the assessment of needs was high. Significant correlations were found between the total number of needs and all the dimensions of PANSS (positive, negative, general psychopathology) in the staff group but not in the patient group. In both groups, the total number of unmet needs was significantly correlated with the general psychopathology and the total PANSS scores. The constancy of the therapeutic context might contribute to a high rate of agreement between patients and staff about needs of the latter. The severity of symptoms may influence clinicians’ assessment of schizophrenia patients’ needs. Nevertheless, according to both patients’ and therapists’ assessments symptom severity is associated with greater number of unmet needs.

Needs in Elderly in Residential Care and Their Relationship to Dependency

Introduction The world's population is aging rapidly. Along with age, other challenges, like increased levels of dependency and new, complex and often expensive needs of an aged population are rising. Since unmet needs are associated with key prognostic outcomes such as excess disability or premature institutionalization, they are major health concerns. Objectives To study the relationship between levels of dependency and needs presented by an elderly sample. Methods A cross-sectional study with an institutionalized sample (≥50years) from three Portuguese residential homes was carried out. All permanent residents were eligible. However, those with delirium, who were terminally ill, unable to communicate or who refused to participate were not included. Participants were assessed with the Adults and Older Adults Functional Assessment Inventory/IAFAI and the Camberwell Assessment of Need for the Elderly/CANE. Each resident and a respective staff carer were interviewed for residents’ current needs. Results The sample included 175 elderly, with a mean age of 81 (sd=10). The majority were female (90%) and widowed (50%) with low educational level (86%, 0-4 years). The mean functional impairment (IAFAI score) was 43.45% (sd=23.52) and the number of global needs was 12 (sd=4). A significant correlation between the IAFAI score and the total of met (r s =0.642, p s =0.505, p s =0.796, p Conclusions In this sample higher levels of dependency were related with more met/unmet needs. Despite the cross-sectional nature of the study, the findings convey an important message regarding the influence of functional disability on unmet needs.

Needs and Depressive Symptoms in Elderly Living in Residential Care: is There a Relationship?

Introduction An ageing population requires new and different approaches to care. In institutionalized settings it is well known that depression, among other psychiatric symptoms, is presented by a high proportion of residents, associated with an increase in needs, which are nevertheless often underestimated. Objectives To analyze the relation between met/unmet needs and depression in an elderly institutionalized sample. Methods This cross-sectional study included an elderly sample (≥50years) recruited from three Portuguese residential homes. All permanent residents were eligible, but residents with delirium or who were unresponsive or unwilling to complete the assessment were not included. Participants were assessed with Geriatric Depression Scale/GDS and Camberwell Assessment of Needs for the Elderly/CANE. Results The sample (n=175) had a mean age of 81(sd=10), the majority were female (90%), widowed (51%), had a low educational level (86.1%, 0-4 years) and had been institutionalized for 7(sd=11) years on average. According to GDSscore, 45.2% presented depression. Daytime activities (73.1%), Eyesight/Hearing (67.4%), Psychological distress (52.0%), Company (40.6%) and Memory (37.1%) were the most frequent unmet needs. A significant correlation between the GDSscore and the total of unmet (r s =0.683,p s =0.407,p Conclusions In this residential sample the presence of depressive symptoms was correlated with the number of needs. This association is coherent with previous findings and highlights the importance of an early assessment of these symptoms, in order to cover the unmet needs that were mostly psychological and amenable to interventions with improvement in wellbeing.

A standardised tool for assessing needs in forensic psychiatric population: clinical validation of the Italian CANFOR, staff version.

The Camberwell Assessment of Need - Forensic Version (CANFOR) is a standardised assessment tool specifically designed to assess needs for care in forensic psychiatric populations. The original English version of the instrument has shown good psychometric properties. The aim of this study was to validate the Italian version of the CANFOR-staff tool. After translation and back-translation, the Italian CANFOR tool was administered to a sample of 50 forensic psychiatric patients. Convergent validity was tested using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) by applying Kendall's tau-b. Inter-rater and test-retest reliabilities were measured by ICCs for need dimensions (total and unmet) and Cohen's kappa coefficients for individual need items. Regarding convergent validity, a higher number of needs (total and unmet) were associated with more severe psychiatric symptoms (BPRS). Higher numbers of unmet needs were also associated with lower levels of global functioning (GAF). ICCs for total and unmet needs scores indicated a good level of agreement for inter-rater reliability and a very good level for test-retest, respectively. Regarding the specific items, inter-rater Cohen's kappa was high (moderate to very good agreement) for 18 items in relation to the presence of a need and for 15 items in the rating of an unmet need, whereas Cohen's kappa for test-retest reliability was very high for all the items in the presence of a need and high for 18 of the unmet need domains. The Italian version of CANFOR has adequate psychometric properties. It can be considered a promising instrument for the assessment of needs of forensic psychiatric patients.

Client and key worker ratings of need in first-episode psychosis early intervention programmes.

The aim of this study was to fill a gap in the literature by examining agreement on need as rated by clients and their key workers from first-episode psychosis early intervention programmes. Compared with adult populations and more chronic courses of illness, these clients may have unique needs given the onset of their illness in adolescence or early adulthood. Needs agreement between clients and key workers was assessed using the Camberwell Assessment of Need in a sample of 188 client-key worker pairs recruited from six early intervention programmes in Ontario, Canada. Ratings were assessed with percentage agreement and prevalence-adjusted Cohen's kappa. At the aggregate level, both clients and key workers rated a mean of 2.6 unmet needs. Compared with other diagnoses, key workers rated significantly more unmet need in clients with primary psychotic disorders. Agreement between individual client and key worker ratings was highest (adjusted κ > 0.85) in the domains of telephone, risk to others, child care and accommodation. Lowest agreement (adjusted κ < 0.4) was found in the domains of psychological distress, sexual expression, company, daytime activities and intimate relationships. While congruence is present in concrete domains, there is substantial variability in how clients and their key workers perceive need in more personal areas. The initial focus of care may necessarily be on needs such as shelter, food and treatment; however, subsequent care should incorporate a shared assessment of need to support strong relationships with providers and ongoing engagement in treatment.

Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia.

BackgroundA community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. ObjectiveAssess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia.MethodsA total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as ‘self-determined medication discontinuation’.ResultsCompared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort.ConclusionsCase management is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients’ medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects.

Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service

Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

BackgroundFor the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level.MethodFifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN).ResultsPsychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS measures of psychopathology, similarly moderated by momentary interactions with emotions and context.ConclusionThe results suggest that psychopathology, represented as an interactome at the momentary level of temporal resolution, is informative in diagnosing clinical needs, over and above traditional symptom measures.

Need for Care and Life Satisfaction in Adult Substance Use Disorder Patients With and Without Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD)

To identify care needs of adult substance use disorder (SUD) patients with and without co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). An exploratory study using the European Addiction Severity Index, the Camberwell Assessment of Needs, and the Manchester Short Assessment of Quality of Life to assess and compare care needs and perceived quality of life. All patients are dissatisfied with parts of their existence. SUD patients have fewer care needs than SUD patients with co-occurring ADHD or ASD. The SUD and SUD + ADHD groups report needs in similar domains. The SUD + ASD group shows a greater number of and more extensive care needs. Differences in the care needs of adult SUD patients with and without ADHD or ASD should be taken into account when developing evidence-based nursing care interventions.

EPA-1030 – The greek version of the camberwell assessment of need: psychometric properties and associations with quality of life and social disability in schizophrenia

Needs assessment has been highlighted as a crucial factor in the development, organisation and evaluation of mental health services. Moreover, meeting self-reported needs is of prime importance for ensuring quality of life and reducing social disability for people with severe mental disorders. Service evaluation based on patients’ need assessments has never taken place in Greece. Furthermore there are no standardized needs assessment instruments. Given the underfunding of psychiatric services due to the current economic crisis, systematic need assessment is expected to contribute to the efficient use of their limited resources. To examine the concurrent validity, inter-rater and test-retest reliability of the Greek research version of the Camberwell Assessment of Need (CAN-R). Fifty-three schizophrenia patient–staff pairs were interviewed twice to test the inter-rater and test-retest reliability of the CAN-R (Greek version). The WHOQOL-BREF and WHODAS 2.0 were administered to the patients to examine concurrent validity. The inter-rater and test-retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instrument's four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS 2.0 domains for patient and staff ratings, indicating good concurrent validity. Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients’ needs. This is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS 2.0 as criterion variables.

Planning a Patient-Centered Parkinson’s Disease Support Program: Insights from Narrative Medicine

Background: We desired relevant information from patients with Parkinson’s disease (PD) and their caregivers for help in planning a long-term support program. Methods: We compared 3 ap-proaches: 1) a standard needs assessment questionnaire, the Camberwell assessment of need in the elderly, 2) an open-ended listing of needs, and 3) participation in a narrative medicine program in which health care professionals were involved. Results: On the questionnaire, patients reported physical needs as the most important while their caregivers were more concerned about psychological needs. The open-ended listings revealed additional needs, particularly access to re-liable information about PD and to opportunities to participate in clinical research. The narrative medicine process yielded a number of new insights and proposed solutions, particularly related to the heterogeneity of needs across individuals, the importance of providing hope, and the fact that caregivers expressed that their needs had been largely neglected. Participation in the narrative medicine sessions led to an increase in measured empathy by health care professionals, an im-provement in measured depression among PD patients, but a worsening of measured depression among the caregivers. Conclusions: We have identified important needs and potential solutions to be considered in providing long-term support to patients with PD and their caregivers.

Young Onset Dementia study – A Prospective Cohort Study of Quality of Life and Specific Needs in Persons with Young Onset Dementia and their Families

Background: Young-Onset Dementia (YOD) causes challenges and concerns that are likely to affect quality of life and generate specific needs for health care, which may be different from what is observed in late onset dementia. The knowledge about the impact of YOD, in particular Fronto Temporal Dementia (FTD), on the affected families is scarce, and previous studies have underscored the importance of differentiating between diagnostic subgroups of YOD in future research. Accordingly, the aims of this study are to identify and compare factors influencing quality of life between persons with young onset FTD and Alzheimer’s Dementia (AD) and their families as the condition progresses. An additional aim is to compare the use of health care services among younger and older persons with dementia, and to investigate the life-stage specific needs for health care services in persons with YOD. Methods/Design: This is a two-year observational Nordic multicentre cohort study of community-dwelling persons with YOD and their families. Two diagnostic subgroups, each consisting of 75 dyads with AD and 75 dyads with FTD with symptom debut 70 years. Participants are recruited from nine Nordic memory clinics. Comprehensive assessments are made at baseline, 12 and 24 months, supplemented with telephone follow-ups at 6 and 18 months. Primary outcome measure is Quality of life measured by Quality of Life in Alzheimer’s Disease (QoL-AD) and EuroQol-5D (EQ-5D). Secondary outcome measures are needs for health care services measured by Camberwell Assessment of Needs in the Elderly (CANE) and Resource Utilization in Dementia Lite (RUD Lite). The inclusion period is from February 2014 to February 2015, with follow-up data collection until February 2017. Conclusion: The sample size, the outcome measures, and the explanatory factors chosen in this study will provide new knowledge of quality of life in families with young onset FTD and AD, and contribute to tailoring the health care services to the life stage-specific needs of families with YOD. ClinicalTrials.gov identifier: NCT02055092

EPA-0778 – Older people with mental health problems: needs, cognition and functionality

Introduction The growth of the older population worldwide has been followed by an increase of mental illness, an important cause of morbidity. In the elderly, the coexistence of disability, physical and mental illness and social problems means that older people often have complex needs, which require comprehensive and systematic assessment. Aims To identify met and unmet needs and their relationship with cognition and functionality. Methods Elderly patients (≥ 65 years old), with mental disorders (ICD-9), were recruited consecutively from ULSAM, in Portugal. All patients were assessed with the Camberwell Assessment of Need for the Elderly/CANE, Mini Mental State Examination/MMSE, Clock Draw Test/CDT, Geriatric Depression Scale/GDS, Zung Anxiety Scale/ZAS, Barthel Index/BI and Lawton & Brody Index/LI. Results In this sample (n=306), the most frequent unmet needs were daytime activities (46.7%), psychological distress (25.8%), memory (13.4%), social benefits (11.4%) and company (8.2%). A significant relation between global needs - CANE (met and unmet) and psychiatric diagnoses ( F =12,888, p =.000) was found. Patients with dementia had a higher number of global needs and lower functionality. The global needs correlated negatively with MMSE ( r =−.666, p =.000), CDT ( r =−.512, p =.000), BI ( r =−.541, p =.000) and LI ( r =−.854, p =.000), and positively with GDS ( r =.385, p =.000). Conclusions Cognitive deficits, higher depression and lower functionality were associated with a greater number of needs. These results also suggest that dementia is an important determinant of the functional status and needs.

EPA-0363 - Unmet needs of the elderly from nursing homes- different perspectives.

The aging of the population and popularisation of the long-term care institutions in Poland confronts us with the challenge of improving the quality of these institutions and to evaluate the current state of its functioning. The aim of the study was to evaluate and analyze needs of residents living in nursing homes using the Polish version of the Camberwell Assessment of Need for Elderly (CANE). A sample of 300 residents from three urban cities was investigating using the Polish version of CANE. Data were collected from users, rater and staff involved. Subjects ranged in age from 74 to 102 with a mean age of 83,36±5,88. The most frequent unmet needs highlighted by users, rater as well as by staff were: psychological distress, company, intimate relationships, information, eyesight/hearing/communication and daytime activities. However, the comparison of total number of needs illustrated that overall users reported significantly fewer met needs compared with staff involved (Z=8,25; p<0,0001) and rater (Z=8,29; p<0,0001) and significantly more unmet needs comparing with staff involved (Z=6,36; p<0,0001). This study provides us with better understanding of an individual perspective of residents living in nursing houses in Poland perceived from different points of views. The results illustrated the differences in the unmet needs perception and pointed out that taking into account only staff perception may lead to under recognition of unmet needs.

EPA-0420 – Unmet needs in portuguese elderly people: data from services research and the 10/66 prevalence surveys on dementia and depression

The healthcare needs of the elderly are seldom assessed in practice. Research in clinical populations with neuropsychiatric disorders generally unravels high levels of unmet needs. Although there are Portuguese studies in needs assessment, explorations of community or social services’ scenarios have been scarce. By gathering data from health and social services research, and from an epidemiological survey in the same region, we aimed to better characterize the unmet needs of Portuguese elderly. We report on studies with old age people in Seixal, near Lisbon: 1) the Camberwell Assessment of Need for the Elderly was used for auditing a non-profit organization, with day-centre and home support services (n=95), and in a survey of family carers of dementia outpatients (n=116); 2) the 10/66 DRG community prevalence study (n=670) used comprehensive assessments to provide psychiatric diagnoses, data on health and psychosocial needs, and the use of services. In the social service audit, unmet needs were mainly related to food, company, physical health and daytime activities. Domiciliary care users had more unmet needs than day centre users (p<0.001). Informal caregivers of dementia patients reported information and psychological distress needs. Finally, these 10/66 DRG study partial results highlighted a high prevalence of depression (20.4%; 95%CI 17.4-23.7) and huge health services’ utilization needs. Systematic assessments of needs for care generally unravel high proportions of health and psychosocial problems lacking adequate interventions, in clinical and community populations. This may provide a more consistent basis for health services planning.

Measuring the needs of mental health patients in Greece: Reliability and validity of the Greek version of the Camberwell Assessment of Need

Evaluation of mental health services based on patients' needs assessments has never taken place in Greece, although it is a crucial factor for the efficient use of their limited resources. To examine the inter-rater and test-retest reliability and the concurrent/convergent validity of the Greek research version of the Camberwell Assessment of Need-Research (CAN-R). A total of 53 schizophrenic patient-staff pairs were interviewed twice to test the inter-rater and test-retest reliability of the Greek version of the CAN-R. The World Health Organization Quality of Life-Brief Form (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule-2.0 (WHODAS-2.0) were administered to the patients to examine concurrent validity. The inter-rater and test-retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instrument's four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS-2.0 domains for both patient and staff ratings, indicating good concurrent validity. Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients' needs. Moreover, it is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS-2.0 as criterion variables.

Assessing met and unmet needs in the oldest-old and psychometric properties of the German version of the Camberwell Assessment of Need for the Elderly (CANE) – a pilot study

The current demographic and social developments in our society will lead to a significant increase in treatment and healthcare needs in the future, particularly in the elderly population. The Camberwell Assessment of Need for the Elderly (CANE) was developed in the United Kingdom to measure physical-, psychological-, and environment-related treatment as well as healthcare needs of older people in order to identify their unmet needs. So far, the German version of the CANE has not been established in health services research. Major reasons for this are a lack of publications of CANE's German version and the missing validation of the instrument. The aims of the present study were to evaluate the currently available German version of the CANE in a sample of older primary care patients. Descriptive statistics and inference-statistical analyses were calculated. Patients reported unmet needs mostly in CANE's following sections: mobility/falls, physical health, continence, company, and intimate relationships. Agreement level between patients' and relatives' ratings in CANE was moderate to low. Evidence for the construct validity of CANE was found in terms of significant associations between CANE and other instruments or scores. The study results provide an important basis for studies aiming at the assessment of met and unmet needs in the elderly population. Using the German version of the CANE may substantially contribute to an effective and good-quality health and social care as well as an appropriate allocation of healthcare resources in the elderly population.

Self-perceived met and unmet care needs of frail older adults in primary care

In order to provide adequate care for frail older adults in primary care it is essential to have insight into their care needs. Our aim was to describe the met and unmet care needs as perceived by frail older adults using a multi-dimensional needs assessment, and to explore their associations with socio-demographic and health-related characteristics. Cross-sectional baseline data were used from the Frail older Adults: Care in Transition (ACT) study in the Netherlands, consisting of 1137 community dwelling frail older adults aged 65 and above. Patients were recruited through 35 primary care practices. Self-perceived care needs were assessed using the Camberwell Assessment of Need for the Elderly (CANE). Socio-demographic characteristics included age, sex, partner status and educational level. Health-related characteristics included functional capacity, hospital admissions, chronic diseases and the degree of frailty. Frail older adults reported on average 4.2 care needs out of 13 CANE topics, of which 0.5 were unmet. The physical and environmental domain constituted the highest number of needs, but these were mostly met. Unmet needs were mainly found in the psychosocial domain. Regression analyses revealed that Activities of Daily Living (ADL) limitations and a higher frailty score were the most important determinants of both met and unmet care needs. A younger age and a higher educational level were associated with the presence of unmet care needs.In conclusion, most frail older adults in primary care report to receive sufficient help for their physical needs. More attention should be paid to their psychosocial needs.

The relationship between unmet care needs in young-onset dementia and the course of neuropsychiatric symptoms: a two-year follow-up study

Little is known about care needs in young-onset dementia (YOD) patients, even though this information is essential for service provision and future care planning. We explored: (1) care needs of people with YOD, (2) the level of agreement within patient-caregiver dyads on care needs, and (3) the longitudinal relationship between unmet needs and neuropsychiatric symptoms. A community-based prospective study of 215 YOD patients-caregiver dyads. Care needs were assessed with the Camberwell Assessment of Need for the Elderly. The level of agreement between patient and caregivers' report on care needs was calculated using κ coefficients. The relationship between unmet needs and neuropsychiatric symptoms over time, assessed with the Neuropsychiatric Inventory, was explored using linear mixed models. Patients and caregivers generally agreed on the areas in which needs occurred. Only modest agreement existed within patient-caregiver dyads regarding whether needs could be met. Patients experienced high levels of unmet needs in areas such as daytime activities, social company, intimate relationships, and information, leading to an increase in neuropsychiatric symptoms. Our findings indicate that in YOD, there are specific areas of life in which unmet needs are more likely to occur. The high proportions of unmet needs and their relationship with neuropsychiatric symptoms warrant interventions that target neuropsychiatric symptoms as well as the prevention of unmet needs. This underlines the importance of the periodic investigation of care needs, in which patient and caregiver perspectives are considered complementary.