Care Need Combinations for Dementia Patients with Multiple Chronic Diseases

Abstract

Purpose The purpose of this study was to find care need combinations for dementia patients with multiple chronic diseases and their caregivers. Patients and Methods A cross-sectional study was conducted with 83 patients who had multiple chronic diseases. Variables from patients included age, gender, severity of clinical dementia rating, feeding, hypnotics, mobility, getting lost, mood symptoms, and behavioral and psychological symptoms. Moreover, 26 types of care needs were included in this study. The Apriori algorithm was employed to first identify care need combinations and then to find the relationships between care needs and variables from dementia patients with multiple chronic diseases. Results Six rules were generated for care need combinations. Four care needs could be formed as a basic care need bundle. Moreover, two additional care needs could be added to provide a wider coverage for patients. In the second stage, 93 rules were found and categorized into three groups, including 2, 6, and 28 general rules with support of 30% but less than 40%, 20% but less than 30%, and 10% but less than 20%, respectively. When the support value is 10% but less than 20%, more variables from patients were found in rules which help the dementia collaborative care team members provide tailor-made care need bundles. Conclusion Four basic care needs were social resources referral and legal support (Care (1)), drug knowledge education (Care (3)), memory problem care (Care (5)), and fall prevention (Care (8)). Besides, disease knowledge education (Care (2)) and hypertension care (Care (16)) were frequent unmet needs in this specific population. Moreover, care for the mood of the caregiver (Care (11)) should be considered especially in dementia patients with preserved ambulatory function or with symptoms of hallucination. The collaborative care team should pay more attention to those care needs when assessing this specific population.

Caregivers’ Burden on Patients with Dementia Having Multiple Chronic Diseases

“…There were 20,1936,35,661, and 2254 rules found for caregivers with severe burden, moderate-to-severe burden, mildto-moderate burden, and little or no burden, respectively. Studies had found that caregivers who cared for patients with dementia reported higher levels of depression and anxiety, engagement in fewer protective health behaviors, and were at an increased risk of medical illness and mortality.…”

“…19,32 When PLWD had MCCs, "care for the mood of the caregiver" should be considered especially in dementia patients with preserved ambulatory function or with symptoms of hallucination. 20 For patients with dementia, there were few reports showing that caregivers with a low education level had a higher caregiving burden. 22,30 For patients with frailty and MCCs, a nonsignificant trend of a higher burden was found in caregivers with higher education than those with informal education.…”

“…51 The case management program helps PLWD and caregivers discover their unmet needs and may also improve the severity of neuropsychiatric symptoms. 19,20,32,52 The implementation of the caregiver training program may reduce caregivers' burden and improve their quality of life. 21 Multicomponent or home-based non-exercise interventions such as cognitive stimulation therapy may be effective in reducing caregivers' burden, especially if the intervention improved the PLWD's functional status.…”

“…18 Determining factors predicting the caregiving burden was important for addressing care needs for both PLWD and their care partners. 19,20 Strategies to alleviate the caregiving burden might help maintain patients' living in the community and improve caregivers' quality of life. 21 Factors associated with caregiving burden were complex and varied with time.…”