Scharf Annelie, Michalowsky Bernhard, Rädke Anika, Kleinke Fabian, Schade Stefanie, Platen Moritz, Buchholz Maresa, Pfaff Michelle, Iskandar Audrey, van den Berg Neeltje, Hoffmann Wolfgang
Deutsches Zentum für Neurodegenerative Erkrankungen (DZNE), Rostock/Greifswald, Greifswald, Germany.
Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
Int J Geriatr Psychiatry. 2025 Apr;40(4):e70066. doi: 10.1002/gps.70066.
People with dementia often have various unmet care needs across physical, psychological, environmental, and social domains. There's a need to explore the association between domains of unmet needs and characteristics of people with dementia. The aim of this paper was to describe the domains of unmet and met needs among community-dwelling people living with dementia, focusing on the home environment, physical, psychological, and social areas, and to identify sociodemographic, clinical, and health-related parameters associated with unmet needs.
We analyzed the InDePendent trial's baseline data of N = 417 people with dementia. The Camberwell Assessment of Needs for the Elderly (CANE) was used to identify needs. Descriptive statistics were used to evaluate the distribution of needs and Logistic and Poisson regression models to detect sociodemographic and clinical factors associated with unmet needs in the four need domains.
People with dementia were on average 80.6 years old, mostly female (56%) and mildly to moderately cognitively impaired (85%). 98.6% of the participants had at least one need, of which just over a third (36.5%) were rated as met and just under two-thirds (63.5%) as unmet. Lacking a care grade (access to social care) and low education were found to be risk factors for the occurrence of unmet needs in almost all areas. Factors such as increased medication use (OR = 1.10 [95%CI 1.02 to 1.19]) and loneliness (OR = 2.51 [95%CI 1.44 to 4.36]) were associated with a higher likelihood of unmet environmental needs. Similarly, the absence of a caregiver (OR = 2.81 [95%CI 1.03 to 7.64]), lower social support (OR = 1.71 [95%CI 1.02 to 2.84]), and poor physical health (OR = 8.40 [95%CI 3.39 to 20.81]) correlated with unmet physical needs. Participants living alone demonstrated higher levels of unmet physical needs (β = 0.27 [95%CI 0.01 to 0.53]). Depression (OR = 2.13 [95%CI 1.10 to 4.08]), living alone (OR = 1.73 [95%CI 1.04 to 2.86]) and poor physical health (OR = 2.82 [95%CI 1.15 to 6.93]) significantly increased the risk of unmet psychological needs. Social needs are more likely to be unmet in females (OR = 1.88 [95%CI 1.05 to 3.37]). Sensitivity analyses showed the positive effects of regular General Practitioner (GP) visits on the fulfillment of social needs (β = -0.61 [95%CI -1.01 to -0.22]).
Access to comprehensive care, for example, through a care grade, education and regular visits to the GP, is just as important for meeting needs in various areas as psychosocial measures aimed at reducing loneliness, living alone, and social exclusion. Both areas must be given equal consideration to improve the living and care situation of people with dementia sustainably.
The study is registered as a clinical trial (ClinicalTrials.gov Identifier: NCT04741932). The study protocol is published elsewhere.
痴呆症患者在身体、心理、环境和社会领域往往有各种未得到满足的护理需求。有必要探讨未满足需求的领域与痴呆症患者特征之间的关联。本文旨在描述社区居住的痴呆症患者未满足和已满足需求的领域，重点关注家庭环境、身体、心理和社会领域，并确定与未满足需求相关的社会人口统计学、临床和健康相关参数。
我们分析了独立试验中N = 417名痴呆症患者的基线数据。使用坎伯韦尔老年人需求评估量表（CANE）来确定需求。描述性统计用于评估需求的分布，逻辑回归和泊松回归模型用于检测与四个需求领域中未满足需求相关的社会人口统计学和临床因素。
痴呆症患者平均年龄为80.6岁，大多数为女性（56%），认知功能轻度至中度受损（85%）。98.6%的参与者至少有一项需求，其中略超过三分之一（36.5%）被评为已满足，略低于三分之二（63.5%）为未满足。缺乏护理等级（获得社会护理）和低教育水平被发现是几乎所有领域未满足需求发生的风险因素。用药增加（OR = 1.10 [95%CI 1.02至1.19]）和孤独感（OR = 2.51 [95%CI 1.44至4.36]）等因素与未满足环境需求的可能性较高相关。同样，没有照顾者（OR = 2.81 [95%CI 1.03至7.64]）、社会支持较低（OR = 1.71 [95%CI 1.02至2.84]）和身体健康较差（OR = 8.40 [95%CI 3.39至20.81]）与未满足身体需求相关。独居的参与者未满足身体需求的水平较高（β = 0.27 [95%CI 0.01至0.53]）。抑郁（OR = 2.13 [95%CI 1.10至4.08]）、独居（OR = 1.73 [95%CI 1.04至2.86]）和身体健康较差（OR = 2.82 [95%CI 1.15至6.93]）显著增加了未满足心理需求的风险。女性的社会需求更有可能未得到满足（OR = 1.88 [95%CI 1.05至3.37]）。敏感性分析显示，定期看全科医生（GP）对满足社会需求有积极影响（β = -0.61 [95%CI -1.01至-0.22]）。
获得全面护理，例如通过护理等级、教育和定期看全科医生，对于满足各个领域的需求与旨在减少孤独感、独居和社会排斥感的心理社会措施同样重要。必须同等重视这两个方面，以可持续地改善痴呆症患者的生活和护理状况。
该研究已注册为临床试验（ClinicalTrials.gov标识符：NCT04741932）。研究方案已在其他地方发表。
