Unmet Care Needs in the Oldest Old Primary Care Patients with Cognitive Disorders: Results of the AgeCoDe and AgeQualiDe Study

Background: In the future, an increase in health care needs in the elderly is expected. Reports on unmet care needs of the oldest old with cognitive disorders are pending. This study aims at exploring unmet needs in the oldest old primary care patients with mild cognitive impairment (MCI) and dementia. Furthermore, the association between sociodemographic and clinical factors and unmet needs ought to be analyzed. Methods: Based on the study “Needs, Health Service Use, Costs and Health-Related Quality of Life in a Large Sample of Oldest-Old Primary Care Patients (85+)” (AgeQualiDe), 749 patients (unimpaired, MCI, and dementia) aged 85 years and older, their relatives (n = 421), and general practitioners (GPs) (n = 607) were assessed. Descriptive, inferential, and regression analyses were run. Results: Most unmet needs were observed in dementia patients, although needs were less frequently rated as unmet by dementia patients themselves as compared to relatives and GPs. Unmet needs were associated with MCI and dementia; other risk factors were age, education, and marital status. Conclusion: This study provides first data on unmet needs according to different perceptions in the elderly with MCI and dementia in Germany. Need assessments should be part of medical examinations to ensure a high-quality health care in the elderly.

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UNDERSTANDING DEMENTIA PREVALENCE AND HEALTH CARE USE PATTERNS IN RURAL NORTH CAROLINA

Innovation in Aging ◽

10.1093/geroni/igz038.3303 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S904-S905

Author(s):

Amanda N Grant ◽

Tsai-Ling Liu ◽

Nigel L Rozario ◽

Deanna A Mangieri ◽

Jennifer M Woodward ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

North Carolina ◽

Health Care Use ◽

Health Care Needs ◽

Care Needs ◽

Dementia Prevalence ◽

Care Services ◽

Dementia Patients ◽

Acute Care Services

Abstract Rural and remote communities have limited access to high quality dementia care, prompting a need for innovative solutions to meet the health care needs of affected older adults. As part of a study aimed at implementing a telehealth intervention for primary care patients with dementia in two rural North Carolina counties, we examined baseline dementia prevalence and compared health care use between patients with and without dementia. Electronic health records from January 2018 to December 2018 were examined for 2,288 patients aged 65 or older. A zero-inflated Poisson regression model was used to compare healthcare use between patients with and without dementia adjusting for patients’ demographic and clinical characteristics. Dementia prevalence was 8.7% based on diagnosis codes. Most patients with dementia were women (70%), not married (55%), Medicare-insured (78%), and had more comorbidities (mean: 2±2) than non-dementia patients. Dementia patients had a significantly higher number of primary care visits, emergency department visits, inpatient visits, and preventable hospitalizations than patients without dementia (risk ratio = 1.1, 1.8, 2.18, and 1.3, respectively; all P< 0.05). Dementia burden was higher among women and use of acute care services by patients with dementia in this rural setting was higher than patients without the disease, similar to urban settings. These findings suggest opportunities to improve care coordination and access to resources to help reduce the need for acute care services among patients with dementia and can help tailor interventions to address the health care needs of this group.

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

International Journal of Methods in Psychiatric Research ◽

10.1002/mpr.1872 ◽

2021 ◽

Author(s):

Janine Stein ◽

Margrit Löbner ◽

Alexander Pabst ◽

Steffi G. Riedel‐Heller

Keyword(s):

Primary Care ◽

Psychiatric Disorders ◽

Unmet Needs ◽

Oldest Old ◽

Psychometric Evaluation ◽

Primary Care Patients

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Sri Lankan-born women who have given birth in Victoria: a survey of their primary postpartum health-care needs

Australian Journal of Primary Health ◽

10.1071/py14067 ◽

2016 ◽

Vol 22 (2) ◽

pp. 133 ◽

Cited By ~ 1

Author(s):

Irosha Nilaweera ◽

Heather Rowe ◽

Hau Nguyen ◽

Joanna Burns ◽

Frances Doran ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Unmet Needs ◽

Sri Lankan ◽

Health Care Information ◽

Care Needs ◽

Child Health Nurse ◽

Born Child ◽

Adaptive Challenges ◽

Care Information

Women who migrate are vulnerable after giving birth. Normal postpartum adaptive challenges are heightened by separation from family and lack of familiarity with local services. The aim was to investigate primary care needs among Sri Lankan-born women with at least one Victorian-born child aged under 2 years. Health care, information and support needs and unmet needs were assessed in a structured Sinhala or English survey offered in print, online or by telephone. Fifty women provided data. Most (80%) had at least one relative from Sri Lanka to stay for postpartum support. Despite this, many had difficulties settling (62%), feeding (58%) and soothing (42%) their babies. They used significantly fewer health services on average (2.3) than mothers in the general community (2.8) (P < 0.004). Only 32% of primiparous women attended at least one First-Time Parents’ group session. Of women experiencing infant care difficulties, only two-thirds accessed care from a Maternal and Child Health Nurse and only one-third from a General Practitioner. Sri Lankan-born mothers have significant unmet needs for primary care, which are not reduced by informal support. A two-pronged approach is indicated in which women are informed about primary care availability, and the cultural competence and client friendliness of services is strengthened.

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Unmet care needs in the oldest old with social loss experiences: results of a representative survey

BMC Geriatrics ◽

10.1186/s12877-020-01822-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Janine Stein ◽

Margrit Löbner ◽

Alexander Pabst ◽

Hans-Helmut König ◽

Steffi G. Riedel-Heller

Keyword(s):

Health Care ◽

Old Age ◽

Unmet Needs ◽

Telephone Survey ◽

Oldest Old ◽

Well Being ◽

Close Relative ◽

German Version ◽

Care Needs ◽

Social Loss

Abstract Background Loss experiences such as the loss of a spouse, a close relative or significant others become more likely in old age and may be strongly related to specific unmet health care needs. These unmet needs may often remain undetected and undertreated followed by a negative impact on well-being and social role functioning. The present study aims at exploring the relationship between loss experiences and specific unmet care needs in old age. Methods As part of the study „Need assessment in the oldest old: application, psychometric examination and establishment of the German version of the Camberwell Assessment of Need for the Elderly (CANE)”, the adapted German version of the CANE was used in a population-representative telephone survey in a sample of 988 individuals aged 75+ years. Loss experiences within the last 12 months were assessed within the structured telephone survey. Descriptive and interferential statistical analyses were run in order to examine the association between loss experiences and occurring unmet care needs. Results Overall, 29.7% of the oldest old reported at least one social loss with other relatives losses being the most frequent (12.5%), followed by non-family losses (10.7%). A significant relationship between loss experiences and a higher number of unmet care needs was observed, especially for close family losses. Other risk factors for unmet care needs were age, marital status, depression, social support and morbidity. Conclusions This study provides, for the first time in Germany, data on the association between loss experiences and unmet needs. These findings may substantially contribute to the development of loss-specific interventions, effective treatment and health care planning for the bereaved elderly.

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Faculty Opinions recommendation of The impact of a diagnosis of fibromyalgia on health care resource use by primary care patients in the UK: an observational study based on clinical practice.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10199.467691 ◽

2006 ◽

Author(s):

Michael Ward

Keyword(s):

Primary Care ◽

Health Care ◽

Clinical Practice ◽

Observational Study ◽

Resource Use ◽

Health Care Resource ◽

Primary Care Patients ◽

Health Care Resource Use ◽

The Uk ◽

The Impact

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PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

Journal of Traumatic Stress ◽

10.1002/jts.20281 ◽

2008 ◽

Vol 21 (1) ◽

pp. 75-82 ◽

Cited By ~ 36

Author(s):

Melissa A. Polusny ◽

Barry J. Ries ◽

Jessica R. Schultz ◽

Patrick Calhoun ◽

Lisa Clemensen ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Utilization ◽

Physical Health ◽

Natural Disaster ◽

Ptsd Symptom ◽

Symptom Clusters ◽

Care Utilization ◽

Rural Primary Care ◽

Primary Care Patients

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463 - Evaluating the Implementation of a Memory Clinic using the RE-AIM model. The experience of the “Memory and Neuropsychiatry Clinic” in Hospital del Salvador, Chile

International Psychogeriatrics ◽

10.1017/s1041610220003154 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 184-185

Author(s):

T. Leon ◽

L. Castro ◽

F. Mascayano ◽

BA. Lawlor ◽

A. Slachevsky

Keyword(s):

Primary Care ◽

Health Care ◽

Latin American ◽

Care Service ◽

Care Center ◽

Health Care Service ◽

Multidisciplinary Teams ◽

Outpatient Services ◽

Health Care Center ◽

Dementia Patients

AbstractThe prevalence of dementia in Chile is 1.06 %, meaning that over 200,000 people are affected. In 2017, the Ministry of Health launched the National Plan of Dementia, which proposed establishing a range of health-care services from primary care to Memory Units (MU).MUs have emerged as a new health care service composed of multidisciplinary teams with the goal of improving diagnosis and management of dementia patients.The creation and implementation of a MU should take into consideration the organization of a particular healthcare system. In this context, the evaluation of a Chilean MU might provide information for the standardization and replication of such a health service on a regional basis.The objective of this paper was to evaluate the implementation processes of a MU using the RE-AIM model, a multi-component model aimed to assist the evaluation of the implementation of ongoing programs.Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed at the Hospital del Salvador. Most patients came from primary care (51.9 %) and from outpatient services at the Hospital (39.2 %), particularly from the Neurology (63.3%) and Psychiatry (16.0 %) departments. We estimated that the MU assessed 5.39% of dementia patients living in the area of referral.In relationship with “E” (Effectiveness): of patients evaluated by the MU, 60 (11%) were discharged. Of these, 41 (66%) were referred to primary health care, 9 (17%) to other outpatient services, 6 (10%) to a specialized mental health care center, and 4 (7%) to a daycare center.Due to the short lifespan of our MU, no other RE-AIM dimensions could be evaluated yet.This was the first evaluation of the implementation of a MU in Chile as part of the Chilean Dementia Plan. It showed that it is possible to implement a MU in a Latin American country and improve access to dementia diagnosis, management, and treatment. Ongoing challenges include continuing to collect clinical data, creating research projects as part of the MU, and developing a MU protocol that can be adopted elsewhere in Chile and other Latin American countries.

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COMBINING VARIOUS FORMS OF TREATMENT TO HEALTH: A STUDY OF ELDERLY IN PRIMARY CARE

Texto & Contexto - Enfermagem ◽

10.1590/0104-07072016003670015 ◽

2016 ◽

Vol 25 (3) ◽

Author(s):

Luciane Paula Batista Araújo de Oliveira ◽

Sílvia Maria Azevedo dos Santos

Keyword(s):

Primary Care ◽

Health Care ◽

Daily Life ◽

Rio Grande ◽

The Elderly ◽

Support Network ◽

Santa Cruz ◽

Primary Health ◽

Concurrent Use ◽

The Subject

ABSTRACT The study aimed to analyze the contextual conditions that influence the use of medications in elderly assisted in primary health care. Qualitative study with contribution of Grounded Theory, held in Santa Cruz, Rio Grande do Norte, Brazil, where 30 elderly patients on medications were interviewed . Data were coded and a model consisting of nine categories was generated. The two categories that explain the contextual conditions of the phenomenon are, Interacting with the support network and The concurrent use of medicines, teas, home remedies and faith, but only the latter is the subject of discussion in this article. To accommodate various treatments, the elderly tried to understand and compare their functions and exercise the faith in God. The act of reconciling different treatments is part of contextual conditions that influence the phenomenon studied, creating a set of circumstances to which these seniors accounted seeking strategies to deal with drug use in daily life.

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

BMC Family Practice ◽

10.1186/s12875-021-01528-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Vladimir Khanassov ◽

Laura Rojas-Rozo ◽

Rosa Sourial ◽

Xin Qiang Yang ◽

Isabelle Vedel

Keyword(s):

Primary Care ◽

Unmet Needs ◽

Social Care ◽

Phase 1 ◽

Lessons Learned ◽

Community Dwelling ◽

Care Plan ◽

Phase 2 ◽

Care Needs ◽

Health And Social Care

Abstract Background Persons 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. Methods This 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. Results The 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. Conclusions Our 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.

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