Needs of older persons living in long-term care institutions: on the usefulness of cluster approach

Background Long-term care units’ residents do not constitute a homogeneous population. Providing effective care, tailored to individual needs, is crucial in this context. It can be facilitated by suitable tools and methods, which include needs assessment along with the physical, psychological and social aspects of care. We thus applied a cluster approach to identify their putative groupings to enable the provision of tailored care. Methods The needs of 242 residents of care homes in four Polish cities (Poznan, Wroclaw, Bialystok and Lublin), aged 75–102 years (184 females), with the Mini-Mental State Examination (MMSE) score ≥ 15 points, were assessed with the CANE (Camberwell Assessment of Need for the Elderly) questionnaire. Their independence in activities of daily living was evaluated by the Barthel Index (BI), and symptoms of depression by the Geriatric Depression Scale (GDS). The results of MMSE, BI and GDS were selected as variables for K-means cluster analysis. Results Cluster 1 (C1), n = 83, included subjects without dementia according to MMSE (23.7 ± 4.4), with no dependency (BI = 85.8 ± 14.4) and no symptoms of depression (GDS = 3.3 ± 2.0). All subjects of cluster 2 (C2), n = 87, had symptoms of depression (GDS = 8.9 ± 2.1), and their MMSE (21.0 ± 4.0) and BI (79.8 ± 15.1) were lower than those in C1 (p = 0.006 and p = 0.046, respectively). Subjects of cluster 3 (C3), n = 72, had the lowest MMSE (18.3 ± 3.1) and BI (30.6 ± 18,8, p < 0.001 vs. C1 & C2). Their GDS (7.6 ± 2.3) were higher than C1 (p < 0.001) but lower than C2 (p < 0.001). The number of met needs was higher in C2 than in C1 (10.0 ± 3.2 vs 8.2 ± 2.7, p < 0.001), and in C3 (12.1 ± 3.1) than in both C1 and C2 (p < 0.001). The number of unmet needs was higher in C3 than in C1 (1.2 ± 1.5 vs 0.7 ± 1.0, p = 0.015). There were also differences in the patterns of needs between the clusters. Conclusions Clustering seems to be a promising approach for use in long-term care, allowing for more appropriate and optimized care delivery. External validation studies are necessary for generalized recommendations regarding care optimization in various regional perspectives

Prevalence of anaemia in older persons: systematic review

<p>Abstract</p> <p>Background</p> <p>Ageing populations will impact on healthcare provision, especially since extra years are not necessarily spent in good health. It is important to identify and understand the significance of common medical problems in older people. Anaemia may be one such problem. We report on the prevalence of anaemia in cohorts of elderly people in the general population. The presence of anaemia is associated with a worse prognosis for both morbidity and mortality.</p> <p>Methods</p> <p>Electronic searching and reference lists of published reports were used to identify studies that reported on prevalence of anaemia in cohorts of at least 100 individuals predominantly aged 65 years and over living in developed countries, together with criteria used to define anaemia. Studies of anaemia prevalence in specific disease groups or published before 1980 were excluded. Prevalence data for the entire cohort, for men and women separately and for different age bands were extracted.</p> <p>Results</p> <p>Forty-five studies contributed data. Thirty-four studies (n = 85,409) used WHO criteria to define anaemia. The weighted mean prevalence was 17% (3–50%) overall, and 12% (3–25%) in studies based in the community (27, n = 69,975), 47% (31–50%) in nursing homes (3, n = 1481), and 40% (40–72%) in hospital admissions (4, n = 13,953). Anaemia prevalence increased with age, was slightly higher in men than women, and was higher in black people than white. Most individuals classified as anaemic using WHO criteria were only mildly anaemic.</p> <p>Conclusion</p> <p>Anaemia, as defined by WHO criteria, is common in older people living in the community and particularly common in nursing home residents and hospital admissions. Predicted demographic changes underline the need to understand more about anaemia in older people.</p

Needs of older adults living in long-term care institutions: an observational study using Camberwell Assessment of Need for the Elderly

Sławomir Tobis,1 Katarzyna Wieczorowska-Tobis,2 Dorota Talarska,3 Mariola Pawlaczyk,1 Aleksandra Suwalska4 1Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznan, Poland; 2Laboratory of Geriatrics, Department of Palliative Care, Poznan University of Medical Sciences, Poznan, Poland; 3Department of Preventive Medicine, Poznan University of Medical Sciences, Poznan, Poland; 4Laboratory of Neuropsychobiology, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland Introduction: No comprehensive needs assessment is performed routinely in Poland. Purpose: The goal of the study was to investigate the patterns of needs in older individuals living in long-term care institutions (LTCIs) using the Camberwell Assessment of Need for the Elderly (CANE) questionnaire, based on a previously published study protocol.Participants and methods: The study included 306 LTCI residents (age: &ge;75&nbsp;years) with the a Mini-Mental State Examination (MMSE) score of at least 10 points. The dependence in basic activities of daily living was measured using the Barthel index (BI). A screening for depression was performed using the Geriatric Depression Scale (GDS) in subjects with an MMSE score of &ge;15 points. Thereafter, CANE was used to analyze needs receiving adequate support (met needs) and those without appropriate interventions (unmet needs).Results: The mean age of studied individuals was 83.2&plusmn;6.0&nbsp;years. They had 10.4&plusmn;3.2 met needs and 0.8&plusmn;1.2 unmet needs. Unmet needs were reported most commonly in the following areas: company (15.9%), psychological distress (14.0%), intimate relationship (11.4%), eyesight/hearing/communication (11.4%), and daytime activities (11.0%). The OR of having a large number of met needs (ie, above the median) was almost eight times higher in residents with a BI score of 0&ndash;49 points versus those with &ge; 80 points. The group between (with 50&ndash;79 points) had this parameter almost four times higher. The OR of having a large number of unmet needs depended neither on BI nor on GDS and was more than four times higher in the group of 10&ndash;19 MMSE points (ie, with symptoms of moderate dementia) versus subjects with 24&ndash;30 MMSE points (ie, without symptoms of dementia).Conclusion: We defined the target group with high probability of unmet needs and the areas in which resources and efforts should be concentrated. We believe that the results can be used to optimize care in LTCIs. Keywords: met needs, unmet needs, determinants, aged 75 and older, long-term care, optimization, CAN

Pain as a challenge in nursing home residents with behavioral and psychological symptoms of dementia

Tomasz Nowak,1 Agnieszka Neumann-Podczaska,2 Ewa Deskur-Śmielecka,1 Arkadiusz Styszyński,1 Katarzyna Wieczorowska-Tobis1 1Laboratory of Geriatrics, Department of Palliative Medicine, Poznan University of Medical Sciences, Poznań, Poland; 2Department of Geriatric Medicine and Gerontology, Poznan University of Medical Sciences, Poznań, Poland Introduction: In patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia.Patients and methods: The research was conducted in 2 nursing home facilities in Wielkopolska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen&ndash;Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed.Results: Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) - as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p&lt;0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p&lt;0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia.Conclusion: Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential. Keywords: pain, analgesics, nursing home residents, older individuals, Abbey Pain Scale, CMA