Integrating unmet needs into dementia health-related quality of life research and care: Introduction of the Hierarchy Model of Needs in Dementia.
OBJECTIVE
To make an inventory of needs assessment instruments in dementia, to explore the interaction between unmet needs and health-related quality of life (HRQoL) and to relate these to the conceptual model of Maslow's Hierarchy of needs in order to design a dementia-specific model.


METHODS
Narrative review of literature on (measures of) needs of patients and caregivers and HRQoL determinants important in dementia. Relating these needs to individual goal setting instruments and Maslow's Hierarchy of needs model.


RESULTS
The Camberwell Assessment of Needs for the Elderly (CANE) turns out to be a valid tool to assess needs of dementia patients, suitable for research and clinical use. The Carers' Needs Assessment for Dementia (CNA-D) is a valid instrument to assess needs of caregivers. Patients identified significantly fewer needs than (in)formal caregivers. The most important needs, that also determine large part of HRQoL, are need for information; support with regard to symptoms of dementia; social contact and company; and for health monitoring and safety. Goal attainment scaling in dementia is an important but not yet valid outcome measure, with only few data on feasibility in dementia patients.


CONCLUSIONS
There are several instruments to assess needs of dementia patients and caregivers. Domains of unmet needs and HRQoL overlap. The Hierarchy Model of Needs in Dementia (HMND) offers a new theoretical framework to address the interplay between meeting of needs and improvement of HRQoL in dementia. By identifying unmet needs in dementia-research and focussing on unmet needs in dementia-care, much can be done to improve HRQoL.
Multidisciplinary Memory Clinic Slingeland Hospital/Alzheimer Centre Nijmegen, Radboud University Medical Centre Nijmegen, 7009 BL Doetinchem, The Netherlands. c.scholzel@slingeland.nl
Carla J M
CJ
Scholzel-Dorenbos
Els J
EJ
Meeuwsen
Marcel G M
MG
Olde Rikkert
D000375:Aging / Q000523:psychology; D003704:Dementia / Q000523:psychology* / Q000628:therapy*; D006304:Health Status; D006801:Humans; D008962:Models, Theoretical; D020380:Needs Assessment; D011788:Quality of Life; D012106:Research; D012196:Review Literature as Topic; D011795:Surveys and Questionnaires