Meaney A M, Croke M, Kirby M
Waterford Regional Hospital, Dublin, Ireland.
Int J Geriatr Psychiatry. 2005 Apr;20(4):322-9. doi: 10.1002/gps.1284.
Resource allocation and service development traditionally focuses on diagnostic categories and consequent perceived need. Identification of the actual level of need in the elderly with dementia, and the degree to which it is unmet is necessary to plan services both individually and as a group. The aim of this study was to characterise the needs of a sample of community dwelling elderly patients with dementia who were referred to an old age psychiatry service in Ireland between July 2002 and July 2003.
Eighty-two consecutively referred community dwelling patients with ICD-10 diagnosis of dementia were assessed on The Care Needs Assessment Pack for Dementia (CareNap-D). Data on needs across seven domains (health and mobility, self-care and toileting, social interaction, thinking and memory, behaviour and mental state, housecare, community living) is presented (Reynolds T et al., 1998).
Subjects had a mean of 33 (range: 13-56) identified needs. Approximately 1/3 of these were unmet with a mean of 13 (range: 0-37) and a mean of 20 (range: 4-39) were met. High levels of unmet need was identified in the domains of behaviour and mental state (84% of those with agitation) and of social interaction (79% of those with 'partaking in activities' need). The specific item of repetitive questioning occurred in 68 individuals and was unmet in 88% of these cases. Increasing age, lower MMSE score, and living alone were associated with greater total levels of unmet need.
This data underlines the degree of unmet need in the community dwelling elderly with dementia and the importance of developing a spectrum of services on the basis of the actual needs identified.
传统上，资源分配和服务发展侧重于诊断类别及由此产生的感知需求。确定老年痴呆症患者的实际需求水平以及需求未得到满足的程度，对于个体和群体层面的服务规划而言是必要的。本研究的目的是描述2002年7月至2003年7月间转介至爱尔兰老年精神病服务机构的社区居住老年痴呆症患者样本的需求特征。
对82例连续转介的符合ICD - 10痴呆诊断标准的社区居住患者进行了痴呆护理需求评估包（CareNap - D）评估。呈现了七个领域（健康与行动能力、自我护理与如厕、社交互动、思维与记忆、行为与精神状态、家务照料、社区生活）的需求数据（雷诺兹T等人，1998年）。
受试者平均有33项（范围：13 - 56项）已确定的需求。其中约三分之一未得到满足，平均为13项（范围：0 - 37项），平均20项（范围：4 - 39项）得到满足。在行为与精神状态领域（84%有激动情绪的患者）和社交互动领域（79%有“参与活动”需求的患者）发现未满足需求的比例较高。重复提问这一具体项目出现在68名个体中，其中88%的情况未得到满足。年龄增长、简易精神状态检查表（MMSE）得分较低以及独居与未满足需求的总体水平较高相关。
这些数据凸显了社区居住老年痴呆症患者未满足需求的程度，以及根据所确定的实际需求开展一系列服务的重要性。
