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Dementia severity among institutionalized elderly: Are there more unmet needs?

Published online by Cambridge University Press:  23 March 2020

A.R. Ferreira*
Affiliation:
PhD Program in Clinical and Health Services Research/PDICSS, Health Information and Decision Sciences Department, Faculty of Medicine of University of Porto, Porto, Portugal
S. Martins
Affiliation:
Center for Health Technology and Services Research/CINTESIS, Faculty of Medicine of University of Porto, Porto, Portugal
C.C. Dias
Affiliation:
Health Information and Decision Sciences Department. Center for Health Technology and Services Research/CINTESIS, Faculty of Medicine of University of Porto, Porto, Portugal
L. Fernandes
Affiliation:
Center for Health Technology and Services Research/CINTESIS, Faculty of Medicine of University of Porto. Psychiatry Service- CHSJ Porto, Porto, Portugal
*
*Corresponding author.

Abstract

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Introduction

The ageing population and the resulting increase in chronic diseases, including dementia, make the evaluation of their emergent needs a crucial step in psychogeriatric care. Unmet needs are found to be important clinical targets that should be followed by active management in order to improve health status and survival.

Objectives

To analyze the relation between unmet needs and cognition, and explore the nature of these needs across dementia severity stages.

Methods

A cross-sectional study was conducted in three nursing homes. Residents were excluded if they were terminally ill, unresponsive or presented delirium. All participants were assessed by Mini-Mental State Examination/MMSE (cognition) and Camberwell Assessment of Need for the Elderly/CANE (needs). Additionally, cognitive decline was staged as: absent (MMSE = 30), questionable (26–29), mild (21–25), moderate (11–20) and severe (≤ 10).

Results

The study included 175 elderly with a mean age of 80.6 (SD = 10.1) years, of which 58.7% presented cognitive decline. For these, the mean number of unmet needs was greater than for those without (4 vs 3, P < 0.001), and they differed significantly in the domains of daytime activities (P < 0.001), memory (P < 0.001) and psychotic symptoms (P = 0.005). A significant negative correlation was found between MMSE and number of unmet needs (rs = −0.369, P < 0.001). Considering the severity stages, unmet needs also differed: more needs in early stages in daytime activities (73.3%), and in advanced ones in memory (63.9%) and psychotic symptoms (23%).

Conclusions

Greater cognitive decline was related with more unmet needs, which agree with previous studies. The different nature of needs across severity stages also suggests that interventions should be tailored comprising this specificity and complexity, when effective care is planned.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
EW301
Copyright
Copyright © European Psychiatric Association 2016
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