Demand For Care Research Articles

Societal Costs of Dementia: 204 Countries, 2000-2019.

Dementia prevalence is expected to increase as populations grow and age. Therefore, additional resources will be needed to meet the global demand for care for Alzheimer's disease and related dementias (ADRD). Estimate global and country-level health care spending attributable to ADRD and the cost of informal care for people living with ADRD. We gathered data from three systematic literature reviews and the Global Burden of Disease 2019 study. We used spatiotemporal Gaussian process regression to impute estimates for the many countries without underlying data. We projected future costs to 2050 based on past trends in costs, diagnosis rates, and institutionalization rate. We estimated that in 2019, the direct health care spending attributable to ADRD across 204 countries reached $260.6 billion (95% uncertainty interval [UI] 131.6-420.4) and the cost of informal ADRD care was $354.1 billion (95% UI 190.0-544.1). On average, informal care represents 57% (95% UI 38-75%) of the total cost of care. We estimated that direct health care spending attributable to ADRD will reach $1.6 trillion (95% UI 0.6-3.3) in 2050, or 9.4% (95% UI 3.9-19.6%) of projected health spending worldwide. We estimated the cost of informal care will reach $0.9 trillion (95% UI 0.3-1.7) in 2050. These cost estimates underscore the magnitude of resources needed to ensure sufficient resources for people living with ADRD and highlight the role that informal care plays in provision of their care. Incorporating informal care cost estimates is critical to capture the social cost of ADRD.

Factors affecting physicians’ specialty selection: A demographic and socioeconomic perspective

Objectives: The medical field is advancing toward increasing specialization in knowledge, technology, and expertise. To meet the demands of quality health care, a practical, pragmatic, and well-balanced enrollment and distribution of physicians among specialties is crucial. The process of selecting a specialty as an ultimate future career is sensitive and conveys multidimensional implications on physicians, the health systems and society as a whole. Numerous complex and miscellaneous factors contribute to the development and adjustment of that decision that needs rigorous efforts to understand and hopefully control. Material and Methods: This is a cross-sectional and descriptive study, conducted through a comprehensive questionnaire encompassing demographic information, socioeconomic indicators, and components of the modified Kuppuswamy and MacArthur Scales. Data were collected using simple random sampling with considering design efficiency. Two-variable analysis with Pearson correlation and Chi-squared test was used to identify the associations and their significance. P < 0.05 was considered statistically significant. Results: A total of 389 respondents completed the questionnaire: 58.87% females, 41.13% males. Among them, 67.8% were internship physicians, and 32.2% were general practitioners. The mean Kuppuswamy score was 15.17, and the mean subjective socioeconomic status (SES) score was 4.28. Female physicians presented a critical propensity toward choosing obstetrics and gynecology, and pediatrics as their primary future career (P ≤ 0.01), whereas male physicians were more willing to specialize in surgical specialties (P ≤ 0.01). Obstetrics, gynecology, and family medicine correlated with below-average Kuppuswamy scores (P = 0.010359), while surgical specialties correlated with higher scores (P < 0.01). Physicians with above-average subjective SES scores preferred surgical specialties (P = 0.036596). Family medicine, obstetrics, gynecology, and pediatrics correlated with below-average subjective SES scores (P = 0.041828). Conclusion: Demographic and socioeconomic factors have a significant influence on physicians’ specialty preferences and selection.

The role of knowledge and attitudes toward older adults in understanding nursing students’ inclination to work with them: A cross-sectional study

ABSTRACT Singapore’s population is aging. Currently, 15% of Singapore’s population is 65 years and above. Low birth rates and high life expectancy have fueled a high demand for geriatric care in Singapore. This research explores the role of knowledge that nursing students have about aging, their attitudes toward older adults, and their inclination to pursue careers in geriatric nursing. This cross-sectional study administered standardized scales to understand 347 nursing students’ knowledge (Palmore Facts on Aging Quiz), attitudes (Kogan’s Attitudes toward Older People) and inclinations (Nolan’s Intent to Work with Older People). Results showed that Singapore nursing students have a moderate level of knowledge about aging and showed a strong willingness to work with older adults. Younger students displayed higher knowledge, better attitudes, and a greater inclination to work with older adults than older students. Furthermore, local students exhibited higher knowledge, more positive attitudes, and greater interest in working with older adults than their international counterparts. This study, conducted during the COVID-19 pandemic, revealed valuable insights into our nursing students’ perspectives on aging. Nursing students displayed a moderate understanding of aging, a positive attitude toward older adults and a strong desire to serve them, suggesting a potential future workforce ready to fulfill the demands of Singapore’s aging population. This insight is valuable for educators, guiding them to bridge knowledge gaps and foster open conversations about aging.

Evaluation of Two Different Approaches to Health Education (Tailored Leaflet vs Video) on Referral Compliance for Prosthetic Replacement of Missing Teeth Among the Patients at a University Dental Care Center.

To assess whether a health education video increased prosthodontic treatment demand for replacing missing teeth compared to a traditional health education (IEC) leaflet among patients visiting a university dental care center in Saudi Arabia. A nonrandomized educational intervention was conducted among patients with missing teeth. A total of 350 participants were divided equally into two health-education intervention groups: leaflet group and video group. Two major variants were ascertained: demand for prosthodontic dental care and awareness (knowledge) about the importance of replacing missing teeth. These two variants were studied for the difference in the scores between base line and at the end of the program (after 3 months). Bivariate analysis was done with chi-square test, McNemar chi-square test, and Wilcoxon matched-pairs tests, and finally binary logistic regression analysis was done. The final analysis included 324 participants. There was improvement in both knowledge and demand for prosthodontic care in both the groups after health education, but a statistically significant improvement in demand for dental care was observed in the video group compared to the leaflet group (42.9% vs 63.2%). Logistic regression analysis identified that missing teeth in the anterior region and being in the video group were two significant factors associated with increased demand for care. The health education video method was found to be a more effective method compared to leaflets in improving knowledge and demand for replacing missing teeth.

Rehab-AMD: co-design of an application for visual rehabilitation and monitoring of Age-related Macular Degeneration

BackgroundThe increasing demand for remote medical care, driven by digital healthcare advancements and the COVID-19 pandemic, necessitates effective solutions tailored to patients and healthcare practitioners. Co-design, involving collaboration between software developers, patients, and healthcare practitioners, prioritizes end-user needs. Research indicates that integrating patient perspectives enhances user experience and usability. However, its application in healthcare has been limited to small projects. This work focuses on co-designing a technological solution to enhance the monitoring and visual rehabilitation of individuals with Age-Related Macular Degeneration (AMD), a condition that significantly impacts the quality of life in people over 60. Current vision rehabilitation systems lack personalization, motivation, and effective progress monitoring. Involving patients and healthcare practitioners in the design process aims to ensure the final product meets their needs.MethodsThe project employs iterative and collaborative principles, involving a vision rehabilitation expert and two AMD patients as active users in the application’s development and validation. The process begins by establishing requirements for user accounts and rehabilitation exercises. It continues with an initial approach extended through user validation. Co-design is facilitated by specific workshops marking each project iteration, totaling four workshops, along with continuous communication sessions between experts and developers to validate design decisions. Initial requirements gathering and constant feedback from end-users, the visual rehabilitator, and patients are crucial for refining the product effectively.ResultsThe workshops produced a prototype featuring a test to monitor changes and progression and 15 visual rehabilitation exercises. Numerous patient and vision rehabilitation-driven software modifications led to a final design that is responsive and adaptive to end-user needs.ConclusionsThe Rehab-AMD pilot project aims to develop a collaborative and adaptive software solution for AMD rehabilitation by actively involving stakeholders and applying iterative design principles. Co-design in the Rehab-AMD solution proves to be a methodology that identifies usability issues and needs from the initial design stages. This approach ensures that software developers create a final product that is genuinely useful and manageable for people with AMD and the targeted vision rehabilitators.

Aging in Place

What Is the Issue? Canada is experiencing an important demographic transition toward an increasingly diverse aging population with an increased need for care and support during the later stages of life. Despite older adults’ strong preferences to live in their home or community for as long as possible, health systems are challenged to keep up with growing demands for home care, community care and support services to support conditions to age in place, when appropriate. What Did Canada’s Drug Agency Do? Canada’s Drug Agency prepared an Evidence Assessment report that identified and described the current context of aging and hinderances to aging in place in Canada, considerations relevant to aging in place for equity-deserving groups, strategies and initiatives intended to address unmet needs and improve outcomes, and systemic considerations related to implementing initiatives supporting aging in place. The Health Technology Expert Review Panel (HTERP) used the Canada’s Drug Agency Evidence Assessment report to inform deliberations and to develop objective, impartial, trusted pan-Canadian guidance for decision-makers when considering evidence-informed aging-in-place initiatives to support equitable aging in place in jurisdictions in Canada. What Is HTERP’s Position on Aging in Place? Everyone has the right to age with dignity. Aging is a normal part of life and may be accompanied by changes in health status and/or abilities to complete everyday self-care tasks. Older adults comprise a heterogenous population with a continuum of health care needs and risks, including people living with vitality, those with moderately complex care issues, and those with complex care issues. Health and social systems were originally designed to meet the less complex acute care needs of a younger population and operate largely in silos. They cannot adequately or proactively address the continuum of needs of many older adults and their caregivers. Aging in place is a dynamic and complex experience that occurs within a larger context that is not limited to health systems. Older adults’ autonomy and preferences for care are realized by the active role of informal unpaid caregivers. The population of older adults in Canada is diverse with varying needs, risks, and cultural norms and values related to aging in place. Barriers to aging in place may disproportionately affect members of equity-deserving groups that experience multiple and often intersecting historical, social, cultural, medical, structural, institutional, and environmental barriers to care and support. There must be equity in access to safe, appropriate, and ongoing care to support dignity in living in a place of one’s choosing for older adults as they age. What Is HTERP’s Guidance to Support Aging in Place? foster a system that prioritizes integrated models of care to address current and future unmet needs and bridge gaps in and between services identify interventions that are aligned within an integrated model of care and are responsive to the unique and complex needs of older adults and their unpaid caregivers ensure culturally appropriate and equitable opportunities for positive outcomes standardize core measures or indicators to guide data collection, analysis, use, and reporting that support robust evaluation and cross-jurisdictional comparisons of interventions.

Validation of SIPI and comparison with objective nursing workload

ABSTRACT Background Accurately estimating nursing care workload upon hospital admission is crucial for resource allocation. Despite the introduction of tools like the ‘Information System of Nursing Performance’ (SIPI) in Italy, studies evaluating their effectiveness are lacking. Aim This study aimed to validate SIPI based on nursing care demands in an internal medicine ward. Design Single-centre, observational study of all patients admitted to an internal medicine department in an Italian hospital from 1 September to 31 December 2022. Methods Nursing activities were documented over the first 3 days of hospitalization using a standardized form, measured as performance/5 min/patient/day. Multivariate analysis assessed SIPI’s association with nursing workload. SIPI’s ability to predict excessive nurse workload was evaluated using the AUROC curve. Results The study included 306 patients. Mean SIPI value was 53.9 (20.6). Daily average care demands varied by SIPI category: 20.7 performances in very low, 26.8 in medium-low, 28.7 in medium-high, and 32.4 in very high (P = 0.001). SIPI was independently associated with increased care demands (OR: 1.024; 1.002–1.047, P = 0.033). The AUROC for SIPI predicting excessive workload was 0.614 (95% CI: 0.545–0.683). Conclusions SIPI is useful for identifying nursing workload and correlates with patient care demands.

Environmental sustainability, medical waste management, energy and medicine consumption of the surgical intensive care nurses: A qualitative study.

In intensive care units, it is noticeable that there is intensive use of resources in the treatment and care process, leading to a significant amount of waste generation. In addition, the demand for intensive care, increasing life expectancy and surgical interventions, complex comorbidities and ecological crisis make it necessary to make critical care more sustainable. To explore the perspectives of nurses working in surgical intensive care units regarding responsible medical waste management, energy and medication consumption. This qualitative descriptive study was conducted in surgical intensive care units of a university hospital in Turkey in November 2023. Twenty-three nurses filled in an introductory form and participated in a semi-structured interview. Data were analysed using inductive content analysis. Three main themes were determined: environmentally sustainable intensive care, prevention of waste in intensive care; responsible consumption and recycling; suggestions for institutional and individual behavioural change regarding environmental sustainability. The majority of nurses lack knowledge about sustainable development goals. However, in the intensive care unit, they provided effective and creative solutions for medical waste management, energy and medication consumption and individual and institutional behavioural change regarding environmental sustainability. Sustainability strategies should be created in institutions to ensure responsible medical waste management, energy and medicine consumption and reduce carbon footprint. In accordance with this purpose, 'Green teams' including unit-based doctors, nurses and paramedics should be established. Training should be provided and awareness should be raised to reduce energy use resulting from heating, lighting, ventilation and air conditioning.

Statistical analysis and prediction of the construction demand of smart elderly care

Statistical analysis and prediction of the construction demand of smart elderly care

Gynecologic health care for LGBTQIA+ people.

Gender relations are a set of socially determined norms and rules that assign values, characteristics, and expectations to individuals based on their biological sex. These aspects also influence the clinician-patient relationship, since it has been for a long time based on cisheteronormativity. However, this attitude alienated the LGBTQIA+ community from health services. Global and specific gynecologic care needs to be offered to the LGBTQIA+ population, which has demands for sexual and reproductive health care. In this narrative review, we bring conceptual aspects, gender identity and expression, sexual history, screening for cancer and other care to the community.

Pre-existing chronic illnesses as a risk factor for the onset of respiratory failure due to COVID-19

Problem consideredHaving cardiovascular, pulmonary and metabolic illnesses increases the likelihood of developing critical COVID-19. As the global population is aging, people with chronic illnesses may have high demands for health care, including critical care, in future health crises. The purpose of this research was to examine whether presence of different pre-existing chronic illnesses were associated with the onset of respiratory failure among patients who were treated and discharged from the intensive care unit. MethodsA retrospective cohort study was conducted at the University Hospital “Dr Dragiša Mišović-Dedinje” in Belgrade (Serbia) during the January–March 2021 epidemic wave, which had the highest mortality rate in Serbia. The study included COVID-19 patients who were treated and discharged from the intensive care unit (ICU). Data on chronic illnesses and clinical parameters regarding COVID-19 were retrieved from the electronic medical records. ResultsOf 299 surviving ICU-treated patients during the study period, 47.5 % required mechanical ventilation. The adjusted logistic regression models adjusted for body mass index (BMI), platelet count, C-reactive protein, interleukin-6, lactate dehydrogenase, urea, oxygen saturation on admission and CT score showed that diabetes, neurological disorders (predominantly stroke), and recent injuries/fractures were independently associated with the onset of respiratory failure. Patients who had respiratory failure also had a higher BMI, laboratory parameters, and CT severity scores on admission. ConclusionPeople with pre-existing diabetes, neurological disorders (especially stroke), and recent injuries/fractures are at higher risk of respiratory failure in COVID-19 and should strictly adhere to COVID-19 prevention measures to minimize the risk of getting infected.

A Disputed Hegemony: Negotiating Neurosurgical Patient Care in the Netherlands, 1930-1952.

The emergence of the neurosurgical patient as a novel clinical entity in the Netherlands was marked by a lingering conflict between neurologists and neurosurgeons, in which both types of specialists sought to assume the clinical and institutional leadership of neurosurgical patient care. In the 1920s and 1930s, neurologists had facilitated the establishment of the first generation of neurosurgeons in the country, and in the process, had managed to clinically and institutionally subordinate neurosurgery to neurology. As the demand for neurosurgical patient care grew, the neurosurgeons began to challenge this hegemonic relationship. The neurologists, however, were unwilling to give up their control, fearing that they would be bypassed in the diagnosis of patients eligible to neurosurgery. These conflicting aims and interests resulted in an intricate demarcation battle, in which the boundary work between neurologists and neurosurgeons was directly played out at the local workplace and at the meetings of the Study Club for Neuro-Surgery, and indirectly at various other sites of contestation, such as medical journals and academic lecture halls, as both parties sought to rally external stakeholders to their cause. During these negotiations, local, national, and international forces increasingly intertwined to shape the particular organization of Dutch neurosurgery in the middle of the twentieth century. By analyzing this multilayered demarcation process, this article draws attention to the complexity of medical boundary work, and to the way in which, despite pervasive international influences, specialist practice was ultimately negotiated at the local and national levels.

Increased demand for in-home aged care impeded by a lack of HRM supports for in-home care workers: a scoping review

PurposeThe purpose of the scoping review is to develop understandings around the high demand for in-home healthcare for the aged and how to find ways to better support declining numbers of in-home care workers and healthcare professionals. The scoping review highlights the role of human resource management (HRM) in this sector.Design/methodology/approachThis scoping review of literature takes a systematic approach to identify themes on the aged care sector and levels of support for in-home care. We map the literature from specific databases to find themes.FindingsIt is important for HRM of aged care service providers to understand the key issues around homecare workers and healthcare professionals. There are key issues for stakeholders, such as clients’ health needs, organizations struggling to recruit and retain healthcare workers, and it is critical to know how such issues impact on clients and the healthcare workforce.Originality/valueThere is a dearth of literature on in-home care for the aged, and therefore, we contribute to understandings about the competing pressures surrounding the demand for in-home care versus the declining number of homecare workers and professional healthcare workers in this sector. We highlight the lack of HRM support from aged care providers and the impact on homecare workers.

Will older adults be represented in patient-reported data? Opportunities and realities.

Policy makers and health professionals are grappling with the high costs of and demand for health care, questions of sustainability and value, and changing population demographics-in particular, ageing populations. Digital solutions, including the adoption of patient-reported measures, are considered critical in achieving person-centred and value-based health care. However, the utility of patient-reported measures and the data they produce may be subject to ageist beliefs, prejudices and attitudes, rendering these data ineffective at promoting improved patient experiences and outcomes for older adults. This article explores the ethical considerations raised in relation to patient-reported measures and the digital agency of older patients.

Experiences of parenting for autistic children in Australia and Italy: a qualitative cross-cultural comparison.

Parents vary in their gradual adaptation to the demands of caring for an autistic child. Their experiences can be positive, negative, or a combination of both, depending on the severity of the cases and various personal and social factors. Cross-cultural comparisons can aid in understanding how contextual factors, such as the availability of social and health services, and cultural factors, such as family relationships and the distribution of care burden, may influence the caregiving experience. However, there is a limited amount of cross-cultural research on this topic, which is almost exclusively quantitative. From an ecocultural perspective, our interview-based study aimed to explore the experiences of Australian (15) and Italian (11) parents of autistic children living in their respective countries. The analysis identified three main themes. Life through autism, autism through life: coexisting with an unexpected life partner, Parenting autistic children: reorganization of parents' subjectivity and familiar dynamics, and The unseen side of disability: autism communities between inclusion and segregation. Our comparative approach reveals both commonalities and differences between the two groups of participants. The similarities support features previously identified in the literature: the emotional and physical burden on parents and the positive impact on parental identity. The differences relate to the diagnostic process, interactions with health professionals, the impact of autism on family dynamics and parental perspectives, and the role assigned to siblings. Despite facing similar challenges, these differences reveal how Italian and Australian parents articulate different understandings linked to social and cultural differences.

Digital Health and Caregiving Resources Used by Family Caregivers of Older Adults During the COVID-19 Pandemic.

Caregiving is often associated with negative physical and mental health outcomes, and as the COVID-19 pandemic escalated, caregivers experienced more burden and provided more care with substantially less support. Digital resources may have been one way caregivers managed demands for care and needs for information. This mixed-methods study included surveys and semi-structured interviews with caregivers (n = 11) to describe experiences and use of digital health resources during the COVID-19 pandemic. Caregivers most often provided significant physical care and experienced reduced or no social support during the pandemic. Caregivers reported the need for improving the quality of telehealth services and digital health resources. COVID-19 will not likely be the last pandemic faced by contemporary society. Measures should be taken to reduce the anticipated negative impacts on caregivers and those receiving care during future pandemics.

Geospatial Demand for Approved Cleft Care in the United States.

Geographic information systems are powerful tools for characterizing the geospatial factors influencing access to care. As patients with cleft lip and/or palate (CL/P) require long-term care, with numerous operations and therapies, access to timely, quality care is extremely important. This study uses population level analysis and geographic information systems to identify United States counties with limited access to American Cleft Palate Association-approved cleft teams. Natality data were queried from the National Vital Statistics System. Population and geographic data were obtained from the US Census Bureau. The Social Vulnerability Index (SVI) was utilized to account for social inequality. Total births with CL/P, population estimates, SVI, distance to the nearest center, and total centers within 50 km were used to generate the cleft care demand index (CCDI). Ninety-two counties had CCDIs between 66.7 and 100. The highest scoring county, Hidalgo County, Texas, had 62 births with CL/P, population estimate of 888,367 persons, distance to the nearest cleft center of 368.4 km, and SVI of 0.99. This study demonstrates the power of geographic information systems for identifying areas with limited access to approved cleft teams. The CCDI measures cleft burden, socioeconomic disadvantage, and geographic barriers to quantify the demand for approved cleft care in each county. Utilizing these scores can help direct future interventions, outreach efforts, and cleft care center planning.

Synergistic patient factors are driving recent increased pediatric urgent care demand.

We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.

Multimorbidity in Older Adult Acute Care Hospital Patients: Impacts on Patient Flow, Medical Management, Care Transitions and Cost.

The healthcare system is wrestling with the impact of demographics on demand for care. We hear anecdotally of heightened patient acuity and increased prevalence of chronic disease. Southlake is a leading healthcare organization serving the northern York Region and southern Simcoe County. We have analyzed all in-patient data over the last four years and observed massive increases in multi-comorbidity levels in older in-patient cohorts. This article will review the analysis and highlight the impact of this phenomenon on critical areas of hospital operations such as patient flow, care transitions and cost. It will also review the medical management implications of increased chronic disease prevalence in this patient population. Finally, we share a series of initiatives that have been successful in helping the hospital respond to these challenges. We believe these are relevant for acute hospitals and their community-based partners across Canada.

Crisis Intercept Mapping for Community-Based Suicide Prevention: An Assessment of the Crisis Infrastructure and Future Considerations for 988.

Suicide is a significant public health problem, yet barriers to treatment remain. To address barriers and meet needs, Congress designated a new 988 dialing code to increase utilization of the National Suicide Prevention Lifeline. As a result, call volume increased, and demand for community-based crisis services is expected. To examine the availability of community-based crisis care, we analyzed information collected from 2020 to 2022 Crisis Intercept Mapping (CIM) technical assistance workshops conducted with communities across the country. We found that training and implementation of suicide risk screening, safety planning, lethal means safety, and follow-up were limited and inconsistent among communities in our study. Collaboration was variable, impacting the ability of communities to support care transitions. Participants described multiple barriers to the routine implementation of evidence-based care and identified potential solutions for addressing them. Findings suggest a need for relationship building and targeted education and training to meet future demand for crisis care.