Perceived needs and unmet needs for formal services among people with HIV disease

This study presents estimates of the prevalence of perceived needs and unmet needs among people with HIV disease in the United States for six areas of community services: mental health, drug treatment, home care, housing, transportation, and entitlements. The prevalence of service needs and unmet needs within racial, gender, drug use history, and other subgroups was also examined. The study is based on a nonrandom cross-sectional sample of 907 people with HIV disease interviewed between November 1988 and May 1989 in nine major urban areas of the United States.Respondents reported high levels of need and unmet need across a variety of service areas. One third or more of all respondents reported a need for mental health services (57%), housing (39%), entitlements (34%), and transportation (32%). Within each of the six service areas, 40% or more reported unmet need. Women, people of color, and injected drug users were more likely to report unmet service need in a number of areas. Given the limitations of the sampling and the focus oncurrent needs, these estimates may represent a lower bound on the magnitude of service need and unmet need within this population.Dr. Piette is a Senior Research Associate at the Institute for Health Policy Studies, University of California-San Francisco. At the time this study was conducted, he served as the Project Coordinator for the Robert Wood Johnson Foundation (RWJF) Evaluation at Brown University. Dr. Fleishman is the Director of the RWJF Evaluation. Dr. Stein is Director of the HIV Clinic at Rhode Island Hospital, Providence Rhode Island. Dr. Mor is the Director of the Center for Gerontology and Health Care Research at Brown University. Dr. Mayer is Chief of Infectious Diseases, Memorial Hospital, Pawtucket, Rhode Island.This study was supported by a grant from the Robert Wood Johnson Foundation.     

Perceptions of biopsychosocial services needs among older adults with severe mental illness: met and unmet needs

This study sought to identify the psychiatric, physical, and social services needs experienced by older adults with severe mental illness (SMI) and to examine factors influencing their experience of need and service provision adequacy. Seventy-five older adults with SMI were recruited from a community mental health center to participate in the study. The typical client experienced a need for care in 10 areas, with the greatest needs occurring in the areas of psychological pain, physical illness, social contacts, looking after the home, and daily activities. The total number of unmet needs ranged from zero to 10, with the typical client having an average of 2.3 unmet needs (SD = 2.4). The highest proportions of unmet needs were in the areas of social contact, benefits, sight or hearing difficulties, and intimate relationships. Linear hierarchical regression analyses revealed that clients with lower income, greater impairments in independent daily living skills, and higher levels of depression experienced increased needs for care. Older clients who lived in private homes or apartments had higher levels of depression, and those who required assistance in the areas of intimate relationships and benefits experienced higher levels of unmet needs. Research and practice implications are discussed.     

Facilitating well-being through music for older people with special needs

This study examines the importance of music in facilitating well-being for older people who have special needs and discusses how music can contribute to well-being and quality of life. The data derive from qualitative interviews with a sample of older Australians aged 60 years and above who live in rural and urban settings. The findings reveal music can provide many people with ways of feeling competent, feeling less isolated, connecting with other people, and helping in the maintenance of a greater sense of good health. Music facilitates meaning in people's lives and is associated with a person's emotions and life experiences and allows them to engage in imaginative play and escape. The results reveal how music promotes quality of life for individuals living alone and also those who have responsibility in caring for others.     

Help-seeking intentions in college students: An exploration of eating disorder specific help-seeking and general psychological help-seeking

This study investigated help-seeking intentions for eating disorders and general psychological problems in college students. Participants reported that they would be more likely to seek help for a friend with an eating disorder than for themselves if they were experiencing an eating disorder. Multiple factors (i.e., sex, year in college, knowledge of eating disorders, and knowledge of available resources) were assessed to determine the prediction of help-seeking intentions. Only the knowledge of eating disorders significantly predicted whether or not a student would be willing to seek help for a friend with a general psychological disorder. None of these factors predicted willingness to seek help for friends with an eating disorder.     

Older people in receipt of home help: a group with high levels of unmet health needs

We describe a case control study in which our aim is to test the hypothesis that older people receiving home help have higher levels of unmet health needs than those not receiving home help and constitute an ‘at risk’ group. One hundred and twelve people aged over 60 years in receipt of home help were picked at random from a home help register and 31 controls who were not receiving home help were selected from two general practitioners age/sex registers. Domiciliary visit and assessment by a specialist health visitor for older people were undertaken followed by referral to appropriate agencies. The study showed that people in receipt of home help services had higher levels of unmet health needs than those in the control group not receiving home help (P≤ 0.01). One year after initial assessment all but 10 of the referrals had been acted upon, but there was no measurable difference in functional levels following referral, treatment and provision of aids to daily living. We conclude that using the home help register is a valuable method of identifying a group of individuals with significant levels of unmet health needs.     

An exploration of artists' perspectives of participatory arts and health projects for people with mental health needs

Objectives

This study addresses the views and experiences of artists who run participatory arts and health courses for those with mental health or social problems.

Study design

Qualitative research with 11 artists from three different organizations providing participatory arts and health courses.

Methods

Semi-structured in-depth interviews were conducted. Participants provided oral contributions that were transcribed and then thematically analysed by the authors.

Results

Participants described perceived positive benefits of participatory arts and health courses, including developing friendships, self-expression and creativity, a non-judgemental environment, along with key issues arising, including managing challenging behaviours and provision of follow-on options.

Conclusions

Results indicate that improvements in well-being can be identified by artists during courses, the activity can help develop friendships, courses can be well managed in community settings, and benefits of follow-on activities should be investigated in future.     

Subthreshold depression in older subjects: An unmet therapeutic need

Major depression, defined according to DSM IV TR criteria, is less common in older subjects, while other types of depression are two to three times more prevalent. This heterogeneous group of disturbances has received different names: depression not otherwise specified, minor depression, subthreshold or subsyndromal depression. Moreover, each condition has been defined using heterogeneous criteria by different authors. The term of subthreshold depression will be adopted in this position statement. Subthreshold depression has been associated with the same negative consequences of major depression, including reduced well being and quality of life, worsening health status, greater disability, increased morbidity and mortality. Nevertheless, there is a dearth of clinical trials in this area, and therefore older patients with subthreshold depression are either not treated or they are treated with the same non pharmacological and pharmacological therapies used for major depression, despite the lack of supporting scientific evidence. There is an urgent need to reach a consensus concerning the diagnostic criteria for subthreshold depression as well as to perform clinical trials to identify effective and safe therapies in this too long neglected patient group.     

Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults

OBJECTIVES: We sought to determine whether, among older adults (>65 years), a perception that their basic needs are not being met increased mortality risk and whether this risk varied by race/ethnicity. METHODS: We used Cox proportional hazards modeling to estimate the effect of perceived inadequacy in having one's basic needs (adequacy of income, quality of housing, and neighborhood safety) met on 10-year mortality rates. RESULTS: After control for age, gender, race/ethnicity, marital status, education, income, and cognitive and functional status at baseline, perceived inadequacy in having one's basic needs met was shown to be a significant predictor of mortality (P<.0001), but no significant differences by race/ethnicity were observed. CONCLUSIONS: Perceived inadequacy in having one's basic needs met predicted mortality during a 10-year follow-up among community-dwelling elderly persons.     

Addressing the nutritional needs of older people in residential care homes

In the UK and Europe, malnutrition in older people is a significant and continuing problem. Malnutrition predisposes to disease, impedes recovery from illness, increases mortality and is costly to society. Despite the high number of older people potentially at risk, malnutrition in care homes has been under explored. There is concern that national guidelines regarding the nutritional care of older people in residential care homes are not always implemented. This qualitative study explored the factors that influence the nutritional care provided to residents in two different types of local authority residential care homes (providing personal care) in Wales. One home had communal dining rooms; the other had eight bedded units with their own kitchen and dining facilities. The sample of 45 participants, comprised 19 staff (managers, care and catering staff), 16 residents and 10 residents' relatives. Data were collected using semi-structured interviews, focus groups, observation and documentary review between August 2009 and January 2010. This paper focuses on how staff assessed and addressed residents' nutritional needs. In both care homes, staff strove to be responsive to residents' dietary preferences, provided person-centred care and worked in partnership with residents and their families to provide nutritious food in a homely environment. Neither home conducted nutritional screening to identify those at risk of malnutrition, contrary to national guidelines, but relied on ad hoc observation and monitoring. The staff's knowledge of special dietary needs was limited. A need for further training for care home staff regarding the importance of nutrition in maintaining health in older people, use of nutritional screening and special dietary needs was identified. Shared nutrition training between health and social care staff needs expansion and policy implications in terms of an enhanced regulatory focus on maintaining nutritional needs in care homes are proposed.     

The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community

Purpose

For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life.

Methods

Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong.

Results

The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, χ²/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R ² = .24) and a greater number of unmet needs (R ² = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R ² = .45).

Conclusions

It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts.     

Access barriers to and unmet needs for home- and community-based services among older korean americans

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.     

Access to health care in an age of austerity: disabled people’s unmet needs in Greece

Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding, which in turn have led to widening inequalities in health. This article focuses on access to health care for people with disabilities in Greece in the context of these structural adjustments. We investigate possible differences in unmet health care needs between people with and without disabilities, using de-identified cross-sectional data from the European Health Interview Survey. The sample included 5400 community-dwelling men and women aged 15 years and over. The results of the logistic regressions showed that people with disabilities report higher unmet health care needs, with cost, transportation, and long waiting lists being significant barriers; experience of all barriers was positively associated with low socio-economic status. These findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services. Austerity policies impact on access to health care in both direct and indirect ways, producing long-term disadvantage for disabled people. Social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces.     

An assistive home care environment for people with special needs

We have developed a system for supporting people with special needs. It allows remote monitoring of electrocardiographic and other signals together with multimode environmental control. The multimodal approach allows users with disabilities to interact more with the home environment. Telemedicine devices were integrated into the system to provide a link to health services. The system provided support for the independent living of people with special needs. The pilot site was a rehabilitation service attached to the National Paraplegic Hospital of Toledo, Spain. During the six-week trial period, the system did not fail, nor was any unauthorized access reported. Twelve people with special needs and three staff evaluated aspects of the system on a scale from 0 to 9, on which higher scores indicated a positive assessment. The mean score for efficiency was 7.8, for satisfaction 8, for helpfulness 7.4, for controllability 7.2 and for learnability 8.     

Priorities in identifying unmet need in older people attending general practice: a nominal group technique study

BACKGROUND: Primary care practitioners are encouraged to identify unmet need in older people, but the best mechanisms for doing this are not known. OBJECTIVE: To identify common unmet needs, as perceived by older people and professionals, that could be enquired about during routine encounters in primary care. METHODS: This was a nominal group technique qualitative study conducted with older people in London and primary care professionals working in the same localities. Subjects were seven nominal groups of 5-12 participants each, four with culturally diverse user groups recruited through local community and voluntary sector resources and three with primary care professionals (GPs and nurses). Group interviews were conducted with two facilitators and one observer recording field notes and were tape-recorded and transcribed for data collection. RESULTS: Older people and professionals share some ideas about unmet need, but there are important differences. Older people may emphasize their autonomy and right to make choices, while professionals may use epidemiological knowledge to justify their own agendas, which may be considered intrusive. Nominal groups can be useful tools for capturing perspectives of different groups, but prioritization of themes identified by nominal groups may not always be feasible. CONCLUSIONS: Unmet need is a complex concept, with different interpretations according to the perspective taken. Professionals relying on epidemiological knowledge to guide their enquiries about unmet needs in older patients may find that the needs that they identify are not perceived as unmet, or even meetable, by their patients.     

Social networks and patterns of help-seeking behaviour

Previous research has suggested that patterns of help-seeking behaviour are influenced by who the sufferer consults when deciding whether to seek medical care or not. This research has been extended to include episodes of illness and injury where more formal contacts are brought into the consultation process. The results show that the perceived urgency with which medical care is required is influenced by who the person has contact with. Some groups such as the police, bystanders and neighbours and friends may be more likely to suggest that the sufferer should seek medical attention than other consultants. This difference was explained in terms of the social, economic, moral and legal pressures associated with these people's positions.     

The unmet needs of the elderly with diabetes in home health care

The implementation of the Prospective Payment System (PPS) in Medicare home health care has raised concern about health outcomes of elderly patients since its intention is to curb spending. This study examines the unmet needs of older diabetic patients while receiving home health care and post-discharge from home health care (N = 129) in order to explore any effects of PPS on patients' need. The study found that a higher proportion of elders had unmet needs 30 days post-discharge compared with while receiving home health care. The specific unmet needs identified by the elderly diabetic patients included social work services, home health aide, homemaker services, and need for medical equipment. The study explores the role of social work to better manage the unmet needs of diabetic elders who live in the community.     

Exploring improvement plans of fourteen European integrated care sites for older people with complex needs

Integrated care programmes are increasingly being put in place to provide care to older people living at home. However, knowledge about further improving integrated care is limited. In fourteen integrated care sites in Europe, plans to improve existing ways of working were designed, implemented and evaluated to enlarge the understanding of what works and with what outcomes when improving integrated care. This paper provides insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement. The seven components of the Expanded Chronic Care Model provided a conceptual framework for describing the fourteen sites. Although sites were spread across Europe and differed in basic characteristics and existing ways of working, a number of difficulties in delivering integrated care were similar. Existing ways of working and improvement plans mostly focused on three components of the Expanded Chronic Care Model: delivery system design; decision support; self-management. Two components were represented less frequently in existing ways of working and improvement plans: building healthy public policy; building community capacity. These findings suggest that broadly-based prevention efforts, population health promotion and community involvement remain limited. From the Expanded Chronic Care Model perspective, therefore, opportunities for improving integrated care outcomes may continue to be restricted by the narrow focus of developed improvement plans.