Date Published: July 7, 2017
Publisher: Springer International Publishing
Author(s): Lotte A. H. Hermsen, Emiel O. Hoogendijk, Johannes C. van der Wouden, Martin Smalbrugge, Stephanie S. Leone, Henriëtte E. van der Horst, Joost Dekker.
The aim of this study was to explore self-perceived care needs and determinants of identified needs in older adults with joint pain and comorbidity.
This is a cross-sectional study using baseline data from a cohort study of older adults in the Netherlands (≥65 years) with joint pain and comorbidity (n = 407). We used the Camberwell Assessment of Need for the Elderly (CANE) to assess self-perceived care needs. Regression analyses were conducted to examine the associations between needs and sociodemographic factors (age, gender, partner status and educational level), physical factors (pain intensity, comorbidity, frailty and physical functioning) and psychosocial factors (anxiety, depression and social support).
Older adults with joint pain and comorbidity reported on average 4.0 care needs out of 13 CANE items, of which 0.3 were unmet. High levels of environmental and physical needs were reported, such as needs with regard to physical illness (91%), household (61%) and mobility/falls (53%). However, most of these needs were met. Only few people reported psychosocial needs, but a large proportion of these needs was unmet, especially regarding company (66.7%) and daytime activities (37%). Psychosocial needs were more often present in frail participants (OR 2.40, 95% CI 1.25–4.61), and those with less perceived social support (OR 1.05, 95% CI 1.01–1.08) and more depressive symptoms (OR 1.17, 95% CI 1.07–1.26).
Unmet needs are mainly present in the psychosocial domain. Specific attention targeted at these unmet needs may improve psychosocial well-being of older adults with joint pain and comorbidity.
In later life, joint pain is a common complaint. Previous research showed that 68–85% of older adults with joint pain also have at least one other chronic disease (comorbidity), like diabetes or ischemic heart disease [1, 2]. The distinct consequences of joint pain and those of several other health conditions such as disability are well documented [3, 4]. However, less is known about the impact of joint pain, in the presence of comorbidity, on levels of functioning and subsequent care needs of this specific population. Identifying care needs is regarded as an essential first step in optimizing health care, as it facilitates the implementation of early treatment strategies that aim to improve health, physical functioning and quality of life and subsequently can prevent or delay deterioration in functioning, hospital (re)admission, placement in nursing homes and mortality [5–8]. Therefore, it is important to assess the needs of older adults with joint pain and comorbidity [9, 10].
The baseline characteristics of the 407 participants are outlined in Table 1. Our sample was on average 76.8 years old (range 65.2–92.8) and about 62% was female. About 60% of the participants lived together with someone else, mostly their partner. The mean number of joint pain sites was 4.0 (SD 1.9); worse pain was most often reported in the back (27%), knee (18%), hand/wrist (15%) or hip (13%). Furthermore, almost half had more than two chronic diseases. The top ten of comorbid conditions included ischemic heart disease (62%), diabetes (37%), asthma or COPD (28%), cerebrovascular disease (24%), hearing problems (20%), malignancies (15%), chronic thyroid disorder (13%), peripheral arterial heart disease (12%), dizziness (9%) and visual problems (8%).
In this study, we explored self-perceived care needs and factors that are related to identified needs in older adults with joint pain and comorbidity. Our sample reported an average of 4.0 needs on 13 care items, mostly in the physical and environmental domains. The multivariable models showed that participants who were older, female, frail, had more chronic diseases or poor physical functioning reported more environmental and physical needs, of which especially poor physical functioning was related to more unmet needs. However, most needs in these domains were met. In contrast, although only few people reported psychosocial needs, a large proportion of these needs were unmet. It were especially the participants who lived alone, perceived less social support and reported more depressive symptoms that had more psychosocial needs.