Unmet Needs of Community-Residing Persons with Dementia and Their Informal Caregivers: Findings from the Maximizing Independence at Home Study
Unmet Needs of Community-Residing Persons with Dementia and Their Informal Caregivers: Findings from the Maximizing Independence at Home Study
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DOI：
10.1111/jgs.12549
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发表时间：
2013-12-01
影响因子：
6.3
通讯作者：
Samus, Quincy M.
中科院分区：
文献类型：
--
作者：
Black, Betty S.;Johnston, Deirdre;Samus, Quincy M.
目的：确定居住在社区的痴呆症患者(PWD)及其非正式照顾者的需求未得到满足的发生率及其相关性。在一项护理协调干预试验中，对随机分组前的横断面基线参与者特征进行设计分析。背景设在马里兰的巴尔的摩。参与者居住在社区的PWD(n=254)及其非正式照顾者(n=246)。测量基于约翰霍普金斯痴呆症护理需求评估的痴呆相关需求的家庭评估。结果未满足需求的平均数分别为7.74.8和4.6+/-2.3，几乎所有的残疾患者(99%)和照顾者(97%)都有一个或多个未满足的需求。在认知功能较高的人中，PWD中未得到满足的需求明显更大。90%的残疾人的安全需求没有得到满足，超过一半的人对有意义的活动的需求没有得到满足，几乎三分之一的人没有得到事先的评估或诊断。PWD中未满足的需求较高与非白人种族、较低的收入、较少的日常生活能力损害和较多的抑郁症状显著相关。对于护理者，超过85%的人在资源转介和护理者教育方面的需求没有得到满足。较高的未满足照顾者需求与非白人种族、较少的教育和更多的抑郁症状显著相关。结论许多居住在社区的PWD及其照顾者在护理、服务和支持方面存在未满足的痴呆症相关需求。提供者应该意识到，在少数族裔和低收入社区居民、教育程度较低的照顾者和早期痴呆症患者中，未得到满足的需求可能更高。识别和治疗PWD和照顾者的抑郁症状可能使他们能够解决其他未得到满足的需求。
ObjectivesTo determine the prevalence and correlates of unmet needs in a sample of community-residing persons with dementia (PWD) and their informal caregivers.DesignAnalysis of cross-sectional, baseline participant characteristics before randomization in a care coordination intervention trial.SettingBaltimore, Maryland.ParticipantsCommunity-residing PWD (n=254) and their informal caregivers (n=246).MeasurementsIn-home assessments of dementia-related needs based on the Johns Hopkins Dementia Care Needs Assessment. Bivariate and multivariate regression analyses were conducted to identify demographic, socioeconomic, clinical, functional, and quality-of-life correlates of unmet needs.ResultsThe mean number of unmet needs was 7.74.8 in PWD and 4.6 +/- 2.3 in caregivers, with almost all PWD (99%) and caregivers (97%) having one or more unmet needs. Unmet needs in PWD were significantly greater in those with higher cognitive function. Ninety percent of PWD had unmet safety needs, more than half had unmet needs for meaningful activities, and almost one-third had not received a prior evaluation or diagnosis. Higher unmet needs in PWD was significantly associated with nonwhite race, lower income, less impairment in activities of daily living, and more symptoms of depression. For caregivers, more than 85% had unmet needs for resource referrals and caregiver education. Higher unmet caregiver needs was significantly associated with nonwhite race, less education, and more symptoms of depression.ConclusionMany community-residing PWD and their caregivers have unmet dementia-related needs for care, services, and support. Providers should be aware that unmet needs may be higher in minority and low-income community residents, caregivers with lower education, and individuals with early-stage dementia. Identifying and treating symptoms of depression in PWD and caregivers may enable them to address their other unmet needs.