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Measuring dementia carers' unmet need for services--an exploratory mixed method study.

Stirling C, Andrews S, Croft T, Vickers J, Turner P, Robinson A - BMC Health Serv Res (2010)

Bottom Line: We found a statistically significant rank correlation (p = 0.01) between carer's use of in-home respite and the care-recipient's cognitive and functional status which is likely to have been related to increased requirement for carer vigilance, effort and the isolation of spouse carers.Otherwise, there were no statistically significant relationships between carer burden or stress and level of service provision.When carers are stressed or depressed, they can recognise that they would like more help from services, even if measures of carer burden and care recipient status do not clearly indicate unmet service needs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart TAS, 7000 Australia. Christine.Stirling@utas.edu.au

ABSTRACT

Background: To ensure carers of people with dementia receive support, community services increasingly use measures of caregiver (carer) burden to assess for unmet need. This study used Bradshaw's taxonomy of need to explore the link between measures of carer burden (normative need), service use (expressed need), and carer's stated need (felt need).

Methods: This mixed method exploratory study compared measures of carer burden with community services received and unmet needs, for 20 community-dwelling carer/care-recipient pairs.

Results: A simple one-item measure of carers' felt need for more services was significantly related to carer stress as measured on the GHQ-30. Qualitative data showed that there are many potential stressors for carers, other than those related to the care-giving role. We found a statistically significant rank correlation (p = 0.01) between carer's use of in-home respite and the care-recipient's cognitive and functional status which is likely to have been related to increased requirement for carer vigilance, effort and the isolation of spouse carers. Otherwise, there were no statistically significant relationships between carer burden or stress and level of service provision.

Conclusion: When carers are stressed or depressed, they can recognise that they would like more help from services, even if measures of carer burden and care recipient status do not clearly indicate unmet service needs. A question designed to elicit carer' felt need may be a better indicator of service need, and a red flag for recognising growing stress in carers of people with dementia. Assessment of service needs should recognise the fallibility of carer burden measures, given that carer stress may not only come from caring for someone with dementia, but can be significantly compounded by other life situations.

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Related in: MedlinePlus

Regression of hours of in-home respite by DRS-2. Regression of the total hours of in-home respite received by carers over a 12 week period by the Dementia Rating Scale - 2 of the care recipients where less IHR services were related to higher DRS-2 scores (better cognition).
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Figure 1: Regression of hours of in-home respite by DRS-2. Regression of the total hours of in-home respite received by carers over a 12 week period by the Dementia Rating Scale - 2 of the care recipients where less IHR services were related to higher DRS-2 scores (better cognition).

Mentions: The relationships between measures of normative and expressed need were limited. Counter-intuitively, there was no relationship between dementia severity indicators (BADLS; DRS-2; dementia related problems via carer checklist) and out-of-home respite or practical care. In contrast, a negative correlation (Spearman's rho = 0.646, p = 0.01) did exist between DSR-2 scores and in-home respite hours, meaning that in-home respite service use increases as cognition deteriorates in the care recipient, (See Figure 1). The total BADLS scores also had a moderate correlation with in-home respite hours (Spearman's rho = 0.574, p = 0.01), suggesting that both deterioration in cognition and function are related to the need for in-home respite. Severity of cognitive impairment, behavioural and psychological symptoms, and impairment to everyday living in the care recipients bore no relationship to the amounts of practical care and OHR used by carers.


Measuring dementia carers' unmet need for services--an exploratory mixed method study.

Stirling C, Andrews S, Croft T, Vickers J, Turner P, Robinson A - BMC Health Serv Res (2010)

Regression of hours of in-home respite by DRS-2. Regression of the total hours of in-home respite received by carers over a 12 week period by the Dementia Rating Scale - 2 of the care recipients where less IHR services were related to higher DRS-2 scores (better cognition).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875230&req=5

Figure 1: Regression of hours of in-home respite by DRS-2. Regression of the total hours of in-home respite received by carers over a 12 week period by the Dementia Rating Scale - 2 of the care recipients where less IHR services were related to higher DRS-2 scores (better cognition).
Mentions: The relationships between measures of normative and expressed need were limited. Counter-intuitively, there was no relationship between dementia severity indicators (BADLS; DRS-2; dementia related problems via carer checklist) and out-of-home respite or practical care. In contrast, a negative correlation (Spearman's rho = 0.646, p = 0.01) did exist between DSR-2 scores and in-home respite hours, meaning that in-home respite service use increases as cognition deteriorates in the care recipient, (See Figure 1). The total BADLS scores also had a moderate correlation with in-home respite hours (Spearman's rho = 0.574, p = 0.01), suggesting that both deterioration in cognition and function are related to the need for in-home respite. Severity of cognitive impairment, behavioural and psychological symptoms, and impairment to everyday living in the care recipients bore no relationship to the amounts of practical care and OHR used by carers.

Bottom Line: We found a statistically significant rank correlation (p = 0.01) between carer's use of in-home respite and the care-recipient's cognitive and functional status which is likely to have been related to increased requirement for carer vigilance, effort and the isolation of spouse carers.Otherwise, there were no statistically significant relationships between carer burden or stress and level of service provision.When carers are stressed or depressed, they can recognise that they would like more help from services, even if measures of carer burden and care recipient status do not clearly indicate unmet service needs.

View Article: PubMed Central - HTML - PubMed

Affiliation: Wicking Dementia Research and Education Centre, Menzies Research Institute, University of Tasmania, Private Bag 121, Hobart TAS, 7000 Australia. Christine.Stirling@utas.edu.au

ABSTRACT

Background: To ensure carers of people with dementia receive support, community services increasingly use measures of caregiver (carer) burden to assess for unmet need. This study used Bradshaw's taxonomy of need to explore the link between measures of carer burden (normative need), service use (expressed need), and carer's stated need (felt need).

Methods: This mixed method exploratory study compared measures of carer burden with community services received and unmet needs, for 20 community-dwelling carer/care-recipient pairs.

Results: A simple one-item measure of carers' felt need for more services was significantly related to carer stress as measured on the GHQ-30. Qualitative data showed that there are many potential stressors for carers, other than those related to the care-giving role. We found a statistically significant rank correlation (p = 0.01) between carer's use of in-home respite and the care-recipient's cognitive and functional status which is likely to have been related to increased requirement for carer vigilance, effort and the isolation of spouse carers. Otherwise, there were no statistically significant relationships between carer burden or stress and level of service provision.

Conclusion: When carers are stressed or depressed, they can recognise that they would like more help from services, even if measures of carer burden and care recipient status do not clearly indicate unmet service needs. A question designed to elicit carer' felt need may be a better indicator of service need, and a red flag for recognising growing stress in carers of people with dementia. Assessment of service needs should recognise the fallibility of carer burden measures, given that carer stress may not only come from caring for someone with dementia, but can be significantly compounded by other life situations.

Show MeSH
Related in: MedlinePlus