Sociodemographic and Clinical Characteristics of People Living with Dementia and Their Associations with Unmet Healthcare Needs: Insights from the Baseline Assessment of the InDePendent Study

Overview

Journal J Alzheimers Dis

Publisher Sage Publications

Specialties Geriatrics
Neurology

Date 2024 Apr 26

PMID 38669533

Authors

Annelie Scharf

Fabian Kleinke

Bernhard Michalowsky

Anika Radke

Stefanie Pfitzner

Franka Muhlichen

Maresa Buchholz

Neeltje van den Berg

Wolfgang Hoffmann

Affiliations

Soon will be listed here.

Abstract

Background: The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions.

Objective: To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs.

Methods: We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews.

Results: Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken.

Conclusions: PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.

References

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

Blotenberg I, Hoffmann W, Thyrian J . Dementia in Germany: Epidemiology and Prevention Potential. Dtsch Arztebl Int. 2023; 120(27-28):470-476. PMC: 10487668. DOI: 10.3238/arztebl.m2023.0100. View

Shin C, Park M, Lee S, Ko Y, Kim Y, Han K . Usefulness of the 15-item geriatric depression scale (GDS-15) for classifying minor and major depressive disorders among community-dwelling elders. J Affect Disord. 2019; 259:370-375. DOI: 10.1016/j.jad.2019.08.053. View

Thyrian J, Hertel J, Wucherer D, Eichler T, Michalowsky B, Dreier-Wolfgramm A . Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry. 2017; 74(10):996-1004. PMC: 5710469. DOI: 10.1001/jamapsychiatry.2017.2124. View

Eikelboom W, Pan M, Ossenkoppele R, Coesmans M, Gatchel J, Ismail Z . Sex differences in neuropsychiatric symptoms in Alzheimer's disease dementia: a meta-analysis. Alzheimers Res Ther. 2022; 14(1):48. PMC: 8978393. DOI: 10.1186/s13195-022-00991-z. View

Guhne U, Stein J, Riedel-Heller S . [Depression in Old Age--Challenge of an Ageing Society]. Psychiatr Prax. 2015; 43(2):107-10. DOI: 10.1055/s-0035-1552661. View

Black B, Johnston D, Leoutsakos J, Reuland M, Kelly J, Amjad H . Unmet needs in community-living persons with dementia are common, often non-medical and related to patient and caregiver characteristics. Int Psychogeriatr. 2019; 31(11):1643-1654. PMC: 6679825. DOI: 10.1017/S1041610218002296. View

Thyrian J . [People with dementia in primary care : Prevalence, incidence, risk factors and interventions]. Z Gerontol Geriatr. 2017; 50(Suppl 2):32-38. DOI: 10.1007/s00391-017-1223-5. View

Dunkel D, Antretter E, Frohlich-Walser S, Haring C . [Evaluation of the short-form social support questionnaire (SOZU-K-22) in clinical and non-clinical samples]. Psychother Psychosom Med Psychol. 2005; 55(5):266-77. DOI: 10.1055/s-2004-834746. View

10.

Forbes D, Jansen S, Markle-Reid M, Hawranik P, Morgan D, Henderson S . Gender differences in use and availability of home and community-based services for people with dementia. Can J Nurs Res. 2008; 40(1):39-59. View

11.

Ortega-Bastidas P, Gomez B, Aqueveque P, Luarte-Martinez S, Cano-de-la-Cuerda R . Instrumented Timed Up and Go Test (iTUG)-More Than Assessing Time to Predict Falls: A Systematic Review. Sensors (Basel). 2023; 23(7). PMC: 10098780. DOI: 10.3390/s23073426. View

12.

Eichler T, Thyrian J, Hertel J, Richter S, Wucherer D, Michalowsky B . Unmet Needs of Community-Dwelling Primary Care Patients with Dementia in Germany: Prevalence and Correlates. J Alzheimers Dis. 2016; 51(3):847-55. DOI: 10.3233/JAD-150935. View

13.

Khanassov V, Rojas-Rozo L, Sourial R, Yang X, Vedel I . Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec. BMC Fam Pract. 2021; 22(1):186. PMC: 8441033. DOI: 10.1186/s12875-021-01528-3. View

14.

Reynolds T, Thornicroft G, Abas M, Woods B, Hoe J, Leese M . Camberwell Assessment of Need for the Elderly (CANE). Development, validity and reliability. Br J Psychiatry. 2000; 176:444-52. DOI: 10.1192/bjp.176.5.444. View

15.

Black B, Johnston D, Rabins P, Morrison A, Lyketsos C, Samus Q . Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the maximizing independence at home study. J Am Geriatr Soc. 2014; 61(12):2087-2095. PMC: 4001885. DOI: 10.1111/jgs.12549. View

16.

Podsiadlo D, Richardson S . The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39(2):142-8. DOI: 10.1111/j.1532-5415.1991.tb01616.x. View

17.

Kerpershoek L, de Vugt M, Wolfs C, Woods B, Jelley H, Orrell M . Needs and quality of life of people with middle-stage dementia and their family carers from the European Actifcare study. When informal care alone may not suffice. Aging Ment Health. 2017; 22(7):897-902. DOI: 10.1080/13607863.2017.1390732. View

18.

Kleinke F, Michalowsky B, Radke A, Platen M, Muhlichen F, Scharf A . Advanced nursing practice and interprofessional dementia care (InDePendent): study protocol for a multi-center, cluster-randomized, controlled, interventional trial. Trials. 2022; 23(1):290. PMC: 8996202. DOI: 10.1186/s13063-022-06249-1. View

19.

Eichler T, Thyrian J, Fredrich D, Kohler L, Wucherer D, Michalowsky B . The benefits of implementing a computerized intervention-management-system (IMS) on delivering integrated dementia care in the primary care setting. Int Psychogeriatr. 2014; 26(8):1377-85. DOI: 10.1017/S1041610214000830. View

20.

Holt S, Schmiedl S, Thurmann P . Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010; 107(31-32):543-51. PMC: 2933536. DOI: 10.3238/arztebl.2010.0543. View