Does standardized needs assessment improve the outcome of psychiatric day hospital care for older people? A randomized controlled trial

Abstract

There is little evidence to indicate how far psychiatric day hospitals for older people can identify and address the needs of older people who attend. The current practice of Care Programme Approach (CPA) in which multidisciplinary team members, patients and their families meet, may provide a suitable forum for needs to be discussed and interventions planned and implemented. One hundred and twelve new day hospital patients over a period of one year were randomly allocated to an experimental group in which the Camberwell Assessment of Need for the Elderly (CANE). Assessment reports were fed back to day hospital staff but not to the control group in which routine practice was maintained. Similar follow-up assessments were performed after three months in the day hospital or at the time of discharge. At follow-up, both the experimental and control groups had over 60% of their initial unmet needs being adequately met. In both groups, the Health of the Nation Outcome Scales 65+ scores and number of unmet needs were reduced indicating an improvement for both groups. However, there were no significant differences in outcome at follow-up between the experimental and control groups. Day hospitals for older people with mental health problems appear effective in identifying and meeting needs. The feedback from CANE made no difference in terms of outcome.

The needs of older people with dementia in residential care

“…The number of unmet needs in this sample of people with dementia is greater than that found in other residential care studies (M ¼ 2.5, Martin et al, 2002), and other settings such as sheltered housing (M ¼ 1.9, Field et al, 2004), primary care (M ¼ 1.9, Walters et al, 2000), or new admissions to day hospitals (M ¼ 3.5, Ashaye et al, 2003). This high prevalence of unmet needs in residential care coincides with increases in the rates of other problems, such as depression, anxiety, dementia, physical dependence, and behavioural problems, compared to the prevalence found in other settings (Godlove .…”

Validity and reliability of the Dutch version of the Camberwell Assessment of Need for the Elderly in community-dwelling people with dementia

“…Only two intervention studies have used the CANE as an outcome measure (Ashaye et al, 2003;Orrell et al, 2007). Only two intervention studies have used the CANE as an outcome measure (Ashaye et al, 2003;Orrell et al, 2007).…”

A European consensus on outcome measures for psychosocial intervention research in dementia care

“…Given the continued worldwide societal costs of informal care (Wimo, Winblad, & Jonsson, 2007), pan-European measurement of family burden may require refining, using results of the factors associated with carer burden, such as family concerns (Richards, Duggan, Carr, Wang, & Moniz-Cook, 2003); attention to their subjective experience (Murray, Schneider, Bnerjee, & Mann, 1999); and difficulties with behaviour . For the latter, the RMBPC emerges with strong potential for development across Europe as an outcome measure that targets the day-to-day difficulties faced by family carers, since it has demonstrated sensitivity to change in their coping with, and management of, behaviour following psychosocial intervention in the US and Canada (Hebert et al, 2003;Mittelman, Roth, Haley, & Zarit, 2004;Teri et al, 2005) (Orrell & Hancock, 2004;Reynolds et al, 2000) has been used for psychosocial intervention research in the UK (Ashaye, Livingston, & Orrell, 2003), is widely translated across Europe (www.thecane.co.uk), has been used in observational research in the UK and the Netherlands and measures needs of people with dementia as well as those of informal and paid carers. It therefore has strong potential for development as outcome measure in future pan-European psychosocial intervention research.…”