Needs of the family caregivers of frail elderly.

The purpose of the study was to determine the needs of family caregivers of frail elderly. Forty-one caregivers were interviewed. More than two-thirds of the caregivers were spouses and about 85% of them had health problems which affected their caregiving. Ninety-eight percent of the caregivers were living with the care recipients and the cumulative stress from their continual involvement had affected their lifestyle. Also more than 58% felt that the care recipients needed more care than they could provide. More than 68% of the caregivers were seniors. Differential planning based on each of the caregivers' needs can maximize the care they provide.     

失能老人代际照顾需求未满足状况及影响因素分析

目的 了解我国65岁以上失能老人的代际照顾现状及其需求未满足的影响因素,为提高失能老人代际照顾能力提供参考依据。方法 本研究基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据,分析1 908名失能老人代际照顾需求满足状况,再通过多元logistic回归探讨代际照顾需求未满足的影响因素。结果 49.6%的失能老人的代际照顾需求未完全满足。多元logistic回归分析显示,失能老人的年龄、居住地、失能程度、居住方式、子女个数、生活来源是否够用、代际经济支持、照顾者类别、照顾时间、照顾表现是影响失能老人代际照顾需求满足的主要因素（P＜0.05）。结论 失能老人长期照顾问题亟需受到关注,应根据失能老人及其照顾者特点给予针对性的干预措施,提高失能老人的代际照顾水平,满足代际照顾需求。     

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.     

Relational aspects of mastery for frail,older adults: The role of informal caregivers in the care process

Frail, older care recipients are often thought of as individuals with a decreased mastery of everyday life skills. Various authors have proposed to acknowledge a relational dimension of mastery, defined as the ability to maintain control over one's life with the help of others. This study explores how frail, older adults experience relational aspects of mastery and the role of their informal caregivers in maintaining these aspects of mastery over the care process. Qualitative interviews (N = 121) were conducted in 2016 with potentially frail, community‐dwelling older adults participating in the Detection, Support and Care for Older people: Prevention and Empowerment (D‐SCOPE) project. A secondary analysis of 65 interviews reveals that, according to frail, older adults, informal caregivers contribute in various ways to the preservation of their mastery. This differs across the four elements of care: caring about (attentiveness), taking care of (responsibility), care‐giving (competence), and care‐receiving (responsiveness). However, in some cases, older adults experienced a loss of mastery; for example, when informal caregivers did not understand their care needs and did not involve them in the decision, organisation, and provision of care. A relational dimension of mastery needs to be acknowledged in frail, older care recipients since stimulating mastery is a crucial element for realising community care objectives and person‐centred and integrated care.     

The housing needs of disabled people

This paper presents the results from a study of the housing needs of disabled people in Shropshire. The study involved interviews with disabled people, representatives of a county-wide disabled people's organization, and staff from social services, housing and health agencies. A questionnaire was sent to a sample of disabled people in the county, and quantitative data were examined. The study highlighted: the high level of unmet housing need amongst disabled people, in relation to both adaptations and more appropriate housing; the need for more involvement by disabled people in the planning and provision of services; the need for greater flexibility within the housing regulations, so that services are more responsive to people's individual needs; and the inadequacy of the resources currently available to meet those needs.     

北京市城区失能老人家庭照顾者照顾负担现状及其影响因素的研究

目的 了解城市失能老人家庭照顾者的照顾负担及其影响因素.方法 采用方便抽样对北京市东城区744名失能老人的家庭照顾者应用照顾者负担量表(Zarit burden interview,ZBI)、抑郁自评量表(self-rating de-pression scales,SDS)、社会支持评定量表(social support rating scale,SSRS)和自制人口社会学情况调查表进行调查,并对数据进行单因素分析和多因素分析.结果 失能老人家庭照顾者的照顾负担总分为(40.3±15.2)分,多因素分析显示,失能老人的失能水平、照顾者是否与失能老人同住、照顾者的自我感觉健康状况、照顾者是否抑郁、社会支持水平是照顾负担的影响因素,多元相关系数R =0.546,决定系数R2=0.298.结论 失能老人家庭照顾者的照顾负担处于中度水平,照顾者负担的影响因素来自失能老人以及照顾者多方面.     

Information needs of family caregivers of terminal cancer patients in Taiwan

Previous studies have indicated that when family caregivers are provided with enough of the right information their coping strategies in caring for terminal cancer patients are enhanced. In Taiwan, family caregivers are highly involved in their ill family member's symptom management and must stay at the bedside to share the nursing and caregiving tasks in the palliative care unit. The cross-sectional survey described here used a structured questionnaire to identify six domains of information needed among family caregivers who stay in the palliative care units to prepare them to provide hospice homecare after discharge. The six domains for which family members needed specific information included the basic tenets of caregiving, the disease, the social welfare of the patient, psychosocial issues, palliative care, and spirituality/religion. This study indicated that information about the disease itself was of greatest importance, with the least importance attached to spiritual and religious information. Age, gender, educational level, and socioeconomic status (SES) of family caregivers were factors in how they viewed the importance of each domain. Situation-related variables, such as the extent of each caregiver's role in decision making, duration of the patient's disease, and the treatment the patient was undergoing were also related to how caregivers valued each type of information. Study results indicated that the education of caregivers in the palliative care unit should be individualized based on each patient's condition and each family's characteristics.     

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.     

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.     

Immigrant status and unmet health care needs

OBJECTIVES: To compare whether unmet health needs differ between immigrants and non-immigrants, and examine whether help-seeking characteristics account for any unmet needs disparities. METHODS: The data are from the Canadian Community Health Survey Cycle 1.1, conducted by Statistics Canada in 2000-2001. The study sample includes 16,046 immigrants and 102,173 non-immigrants aged 18 and older from across Canada. The study employs logistic regression models to examine whether help-seeking behaviours explain unmet needs differences. RESULTS: Logistic regression analysis indicates that immigrants have a 12% (95% CI: 6-18) lower all-cause unmet needs risk (odds ratio) than non-immigrants after controlling for differences in help-seeking characteristics. The unmet needs risk among long-term immigrants (15 years of residence and more), however, is similar to non-immigrants after considering these characteristics. We found differences between immigrants and non-immigrants in reasons for unmet needs, with more immigrants believing that the care would be inadequate, not knowing where to access health care, and having foreign language problems. CONCLUSIONS: The Canadian health care system delivers sufficient health care to immigrants, even though the poverty rate and proportion of visible minorities are comparatively higher within this subpopulation. Nonetheless, these results indicate that some immigrant-specific health care access barriers may exist.     

The prevalence and determinants of unmet health care needs in Turkey

This study aims to examine the prevalence and determinants of unmet health care needs in Turkey. The nationally representative “Health Survey” data for the latest available year, 2016, is used in the analysis. The reasons for unmet health care needs are divided into three categories which are waiting time, affordability (cost), and the distance to health facilities. The probit methodology is employed to investigate the factors affecting unmet health care needs. Approximately 25% of participants (4392 of 17242) reported an unmet need for health care. Overall, females, individuals in lower income groups, those with chronic illness, those with lower education levels and those in younger age groups are more likely to report unmet health care needs. Estimation results point out that age and having a chronic illness have more influence on the reporting of unmet health care needs as compared to other variables included in the model. Therefore, it seems necessary to reorganize the health care system in Turkey to target the needs of individuals with chronic diseases.     

Nutrition education may reduce burden in family caregivers of older adults

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.     

The needs of hospice patients and primary caregivers.

It would appear that hospice care providers in the program investigated here are highly accurate in their perceptions of their clients' needs. The program therefore is in an excellent position to accomplish its goals. However, findings also suggest that nurses are most accurate in their perceptions of social, emotional, and physical needs. They don't do as well in estimating the importance of material needs, such as financial and legal concerns. Nurses are also more likely to misperceive the importance of religious and spiritual needs. Hospice programs might consider implementing a structural mechanism to assist nurses in the task of understanding these patient and family concerns. Encouraging nurses to routinely inquire about the need for assistance with these issues is one potential remedy. Specific in-service training to teach nurses how to cue in on material and religious needs may also be beneficial. Another approach would be to further integrate staff persons who have specific training in understanding these types of needs into hospice programs. Attorneys, financial consultants, and clergy may need direct contact with patients and families rather than being called into a specific case only after nurses identify the need. Another implication of these results stems from the finding that nurses' perceptions become more similar to caregivers over time. This is particularly true for the assessment of patients' needs. Previous research shows that a substantial proportion of patients do not enter hospice until a few days prior to their deaths.(ABSTRACT TRUNCATED AT 250 WORDS)     

Discourse of needs versus discourse of rights: family caregivers responding to the sexuality of young South African adults with intellectual disability

Although most people with intellectual disability remain under the lifelong care and support of their families, there is a hiatus in research that explores the sexuality of people with intellectual disability within the family setting. Little is known about how the responses of family caregivers align with a human rights approach to the sexuality of people with intellectual disability, particularly in the South African context. This study used a constructivist grounded theory approach to explore how 25 South African family caregivers responded to the sexuality of their young adults with intellectual disability. Findings revealed that family caregivers prioritise what they deem as being the immediate needs of themselves and the young adults, over the young adults’ rights to sexual autonomy. Practitioners, guided by the human rights approach, need to understand the individual and family context so as to better collaborate with family caregivers in supporting people with intellectual disability to realise their sexual rights. We apply two theories of needs to illuminate the conflict between needs-centred ethics and human rights approaches in a context where the family caregivers are the ones determining the sexuality needs of young adults with intellectual disability.