Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life

Abstract

Objectives: To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). Design: Cross-sectional Setting: US – 50 states, District of Columbia, and Puerto Rico Participants: Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015-–2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). Measurements: We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. Results: In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12–2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. Conclusions: Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

The Role of Cognitive Complaints in the Relationship Between Trait Anxiety, Depressive Symptoms, and Subjective Well-Being and Ill-Being in Adult Community Volunteers

“…Unmet medical needs related to cognitive complaints have attracted attention in recent years. 38 However, the role of cognitive complaints in mental health, particularly their moderating role, has not been fully understood. The interactions between trait anxiety and cognitive complaints, and between depressive symptoms and cognitive complaints on SWB and SIB, respectively, need to be evaluated in the future.…”

The Association Between Trajectories of Perceived Unmet Needs for Home and Community-Based Services and Life Satisfaction Among Chinese Older Adults: The Moderating Effect of Psychological Resilience

“…Although the unmet need is a complex multi-faceted concept (Smith & Connolly, 2020, Vlachantoni et al, 2011) and measured in different ways in previous studies, it has been consistently identified as a risk factor for health and well-being (Allen et al, 2014, Beach et al, 2020, Chong et al, 2021). Specifically, unmet needs for assistance in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) can lead to lower levels of health-related quality of life (Bouldin et al, 2021), higher risks of hospital readmission and mortality (DePalma et al, 2013, He et al, 2015), and higher levels of depressive symptoms (Choi & McDougall, 2009). In addition, perceived unmet needs for HCBS are negatively associated with life satisfaction (Lu et al, 2021), while older adults with met home care needs report higher levels of life satisfaction and lower levels of loneliness and perceived life stress (Kadowaki et al, 2015).…”

Does “one size fit all” in subjective cognitive decline?

“…Additionally, lower income, lower education, reporting poorer physical health, and being a dual-eligible beneficiary (i.e. those enrolled in both medicare and medicaid) or not having health insurance are all associated with higher odds of SCD (Babulal et al, 2019;Bouldin et al, 2020;Molinuevo et al, 2017). In the US, non-Whites are more likely to experience these demographic factors (Sohn, 2017) and are more likely to experience more negative life events (Zlatar et al, 2018).…”

“…Moreover, understanding unmet needs in this population might help to guide new early interventions to improve the quality of life of patients facing cognitive decline and their families. Bouldin et al (2020), in their population-based cohort study, provided a thoughtful overview of the prevalence of unmet needs in SCD individuals aged 45 years and older in the US, and the related mental, physical, and social features. The main finding was that 40% of individuals with SCD who need help are not getting it.…”

“…Bouldin et al (2020), in their population-based cohort study, provided a thoughtful overview of the prevalence of unmet needs in SCD individuals aged 45 years and older in the US, and the related mental, physical, and social features. The main finding was that 40% of individuals with SCD who need help are not getting it.…”