Healthcare Needs Patterns and Pattern-Predicting Factors in Dementia: Results of the Comprehensive, Computerized Unmet Needs Assessment from the Randomized, Controlled Interventional Trial InDePendent

Article type: Research Article

Authors: Michalowsky, Bernhard^{a; *} | Rädke, Anika^a | Scharf, Annelie^a | Mühlichen, Franka^a | Buchholz, Maresa^a | Platen, Moritz^a | Kleinke, Fabian^b | Penndorf, Peter^b | Pfitzner, Stefanie^b | van den Berg, Neeltje^b | Hoffmann, Wolfgang^{a; b}

Affiliations: [a] German Center for Neurodegenerative Diseases – DZNE, Rostock/Greifswald, Greifswald, Germany | [b] Section of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany

Correspondence: [*] Correspondence to: Dr. Bernhard Michalowsky, German Center for Neurodegenerative Diseases – DZNE, Rostock/Greifswald, Ellernholzstrasse 1-2, Greifswald D-17489, Germany. Tel.: +0049 3834 86 8530; Fax: +0049 3834 86 19551; E-mail: [email protected].

Abstract: Background:Determining unmet need patterns and associated factors in primary care can potentially specify assessment batteries and tailor interventions in dementia more efficiently. Objective:To identify latent unmet healthcare need patterns and associated sociodemographic and clinical factors. Methods:This Latent Class Analysis (LCA) includes n = 417 community-dwelling people living with dementia. Subjects completed a comprehensive, computer-assisted face-to-face interview to identify unmet needs. One-hundred-fifteen predefined unmet medical, medication, nursing, psychosocial, and social care needs were available. LCA and multivariate logistic regressions were performed to identify unmet needs patterns and patient characteristics belonging to a specific pattern, respectively. Results:Four profiles were identified: [1] “few needs without any psychosocial need” (n = 44 (11%); mean: 7.4 needs), [2] “some medical and nursing care needs only” (n = 135 (32%); 9.7 needs), [3] “some needs in all areas” (n = 139 (33%); 14.3 needs), and [4] “many medical and nursing needs” (n = 99 (24%); 19.1 needs). Whereas the first class with the lowest number of needs comprised younger, less cognitively impaired patients without depressive symptoms, the fourth class had the highest number of unmet needs, containing patients with lower health status, less social support and higher comorbidity and depressive symptoms. Better access to social care services and higher social support reduced unmet needs, distinguishing the second from the third class (9.7 versus 14.3 needs). Conclusions:Access to the social care system, social support and depressive symptoms should be assessed, and the patient’s health status and comorbidities monitored to more comprehensively identify unmet needs patterns and more efficiently guide tailored interventions.

Keywords: Alzheimer’s disease, dementia, latent class analysis, primary care, profiles, unmet needs

DOI: 10.3233/JAD-240025

Journal: Journal of Alzheimer's Disease, vol. 100, no. 1, pp. 345-356, 2024