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Unmet care needs and risk profiles of very old people with dementia - a quantitative analysis based on established cohort studies

Applicant Dr. Janine Stein
Subject Area Public Health, Healthcare Research, Social and Occupational Medicine
Term from 2022 to 2024
Project identifier Deutsche Forschungsgemeinschaft (DFG) - Project number 502412194
 
Final Report Year 2024

Final Report Abstract

In the course of current demographic and social developments, with a steadily growing number of very old people and increasing morbidity in old age, a significant increase in the treatment, care and nursing needs of older people and higher costs can be expected in the coming decades. The Camberwell Assessment of Need for the Elderly (CANE) is used for the multidimensional assessment of the physical, psychological and environmental needs of older people in order to record their needs for medical and nursing care and other treatment. Dementia and depression belong to the most common conditions in old age and can be associated with specific unmet care needs that often go undetected and untreated, especially in older GP patients. The reliable identification of unmet needs is of great importance in order to determine the required level of support and assistance and to provide targeted and needs-oriented interventions. Previous research has mainly assessed the frequency of unmet needs, particularly among older, multimorbid residents of care homes. Elaborated analyses of specific risk profiles of unmet needs, including further socio-demographic and clinical factors as well as assessor perspectives, especially in very old patients with common diseases such as dementia and depression, represent a promising approach. This was the starting point for the present project, which aimed to analyze risk profiles of unmet needs by considering further socio-demographic and clinical characteristics based on established cohort studies with older GP patients (75+ and 85+ years). The latent class analyses (LCA) showed specific needs profiles depending on the clinical condition: “no needs”, “met physical needs” and “unmet social needs” for depression (AgeMooDe) and “no needs”, “met physical and environmental needs” and “unmet physical and environmental needs” for dementia (AgeQualiDe). Profiles of unmet needs were significantly associated with depression and dementia. Unmet social needs played the main role in depression. Frailty and smaller social networks were associated with dementia. Further analysis indicated that social functioning differed significantly across dementia severity. A higher level of social functioning was associated with lower caregiver burden. The identification of specific needs profiles with an increased likelihood of certain risk constellations of unmet needs represents a crucial starting point for the development and use of tailored interventions and can substantially improve the care of very old patients with dementia and depression as well as their caregivers.

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