Factorial structure of the German Care Dependency Scale for self-assessment among older adults in supported housing.

AIM: To determine the factorial structure of the German Care Dependency Scale (CDS) for self-assessment in supported housing in Austria. BACKGROUND: The CDS is a well-established tool for the assessment of care dependency. However, several versions of the scale showed different factorial structures depending on the country and the setting where they were applied. The factorial structure of the CDS, therefore, needed clarification prior to its application in supported housing. DESIGN: Cross-sectional study. METHODS: Self-assessments of care dependency were obtained from residents in supported housing in Austria. The factorial structure of the scale was determined by exploratory factor analysis. The resulting factor models were compared by confirmatory factor analyses with a single factor model regarding the best fit. CDS total score and sum scores of the identified factors were correlated with externally assessed care levels according to the Austrian care insurance. RESULTS: 48.2% of the residents in supported housing participated, but some of them were younger than 60. Exploratory factor analysis resulted in a three-factor model with two variants in the distribution of items, depending on whether people over 59 were included in the analysis or not. The second variant showed the best fit in confirmatory factor analysis. CDS total score and sum scores of the identified factors showed statistically significant correlations with externally assessed care levels. CONCLUSION: The three-factorial structure differentiates between various aspects of support and results from the particular characteristics of the setting and the care recipients. Several cross-loadings of items indicate an ambiguous understanding of support needs. It is suggested to modify the scale to adapt it to the target group and setting. IMPLICATIONS FOR THE PROFESSION: Self-assessments with a modified version of CDS in supported housing can be useful to identify the various support needs in this setting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Psychometric Properties of the Persian Version of Care Dependency Scale in Nursing Homes.

PURPOSE: The purpose of the study was to examine the psychometric properties of the Persian version of the Care Dependency Scale (CDS) in nursing homes. DESIGN: Instrument development. METHODS: The English version of the CDS was translated into Persian. A convenience sample of 140 (100 older people without dementia and 40 patients with dementia) Persian-speaking people were selected from the nursing homes in Ahvaz, Iran. Cronbach's alpha, discriminant validity, and construct validity (exploratory factor analysis) were examined. FINDINGS: Exploratory factor analysis indicated that the CDS has two factors, including psychosocial and somatic factors. Discriminant validity showed that the CDS can differentiate patients with dementia from the older adults without dementia. CONCLUSIONS: The results of the study showed that the Persian CDS is a reliable and valid scale when used in nursing homes. CLINICAL RELEVANCE: The Persian version of the CDS can help clinicians and nurses to assess patients' need and the degree of care dependency among older adults in Persian-speaking areas.

Identifying residents at risk of care complications in care homes.

Care complications are common conditions which affect residents in care homes and often arise from risks associated with their illness. They can be serious and affect the health and quality of life of residents. It is important that nurses are able to assess an individual's risk of developing complications of care, and determine appropriate prevention and treatment measures. This article discusses three common care complications for residents in care homes: pressure ulcers, malnutrition and falls. Assessment tools commonly used to identify these conditions are discussed, as well as the use of clinical reasoning to assist nurses in implementing appropriate care. Nurses have a central role in risk assessment, identifying problems, planning interventions and monitoring complications of care.

Using the Care Dependency Scale for identifying patients at risk for pressure ulcer.

AIM: The aim of this study was to evaluate risk screening for pressure ulcer by using the Care Dependency Scale (CDS) for patients receiving home care or admitted to a residential or nursing home in the Netherlands. BACKGROUND: Pressure ulcer is a serious and persistent problem for patients throughout the Western world. Pressure ulcer is among the most common adverse events in nursing practice and when a pressure ulcer occurs it has many consequences for patients and healthcare professionals. DESIGN: Cross-sectional design. METHODS: The convenience sample consisted of 13,633 study participants, of whom 2639 received home care from 15 organisations, 4077 were patients from 67 residential homes and 6917 were admitted in 105 nursing homes. Data were taken from the Dutch National Prevalence Survey of Care Problems that was carried out in April 2012 in Dutch healthcare settings. RESULTS: For the three settings, cut-off points above 80% sensitivity were established, while in the residential home sample an almost 60% combined specificity score was identified. The CDS items 'Body posture' (home care), 'Getting dressed and undressed' (residential homes) and 'Mobility' (nursing homes) were the most significant variables which affect PU. CONCLUSIONS: The CDS is able to distinguish between patients at risk for pressure ulcer development and those not at risk in both home care and residential care settings. In nursing homes, the usefulness of the CDS for pressure ulcer detection is limited.

Health related quality of life and care dependency among elderly hospital patients: an international comparison.

Many countries in Europe and the world have to cope with an aging population. Although health policy in many countries aims at increasing disability-free life expectancy, elderly patients represent a significant proportion of all patients admitted to different hospital departments. The aim of the research was to investigate the relationship between health-related quality of life (HRQOL) and the care dependency status among elderly hospital patients. In 2012, a descriptive survey was administered to a convenience sample of 325 elderly hospital patients (> 60 years) from The Netherlands (N = 125), from Poland (N = 100), and from Turkey (N = 100). We employed the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System and the Care Dependency Scale. FACIT is a collection of HRQOL questionnaires that assess multidimensional health status in people with various chronic illnesses. From demographic variables, gender (female) (r = -0.13, p < 0.05), age and informal care given by family members (r = -0.27 to 0.27, p < 0.01) were significantly correlated with the care dependency status for the whole samples. All HRQOL variables, hearing aid and duration of illness correlated with care dependency status (r = -0.20 to 0.50, p < 0.01). Moreover, the FACIT sum score (Poland and Turkey) and functional wellbeing (The Netherlands) are significantly associated with the decrease in care dependency status. Thus, the FACIT variables are the most powerful indicators for care dependency. The study provides healthcare professionals insight into improvement of quality of care in all three countries.

Functional assessment of geriatric patients in regard to health-related quality of life (HRQoL).

PURPOSE: The main aim of our research was to evaluate general health, functioning, and performance parameters, as well as care problems of Geriatric Clinic inpatients in relation to deficits in fulfilling needs. The assessment of health-related quality of life was also performed. PATIENTS AND METHODS: The research subjects were patients attending the Clinic of Geriatrics: 149 women and 78 men; 227 persons in total. The research was carried out using a diagnostic poll method, with the application of the Activities of Daily Living questionnaire of assessment of daily efficiency on the basis of the Katz index, the Instrumental Activities of Daily Living questionnaire, the Care Dependency Scale used to measure the level of care dependency and human needs, and the Nottingham Health Profile scale. RESULTS: The results showed that the majority of respondents achieved high and medium levels of functional capability. The main problems associated with the fulfillment of needs were difficulties with the adoption of appropriate body posture, movement restrictions, and problems related to participating in unassisted leisure activities outside the home. The general deficit in fulfilling the needs of the patients was low. The most significant problems were related to sleep disorders, restrictions in freedom of movement, loss of vital energy, and ailments resulting in the observable presence of pain. CONCLUSION: Good daily functioning of elderly patients significantly depended on their intellectual and mental efficiency. Elderly patients require a comprehensive, holistic approach to a variety of problems that occur with aging.

Relationship between care dependency and behavioral symptoms among elderly in-patients with Alzheimer's disease in Japan and the Netherlands.

OBJECTIVE: This study investigates the influence of personal characteristics and health-related variables on the care dependency status among elderly in-patients with clinically diagnosed Alzheimer's disease in two countries. METHODS: A descriptive cross-cultural survey was administered to a convenience sample of 137 elderly in-patients. Patients were recruited from a hospital in Japan (N = 77) and from a nursing home in the Netherlands (N = 60). RESULTS: In both countries, almost all participants are assessed on the severity level of care dependency in the range of "completely care dependent" (Japan: 35.1%; the Netherlands: 20.0%), or "to a great extent care dependent" (Japan: 24.7%; the Netherlands: 45.0%), to "partially care dependent" (Japan: 22.1%; the Netherlands: 21.7%). CONCLUSION: This study demonstrates that there is no interdependence between the severity level of care dependency and personal characteristics of patients with Alzheimer's disease in both countries. Regarding the interplay of health-related variables on the severity level of care dependency, a difference was found between countries.

The care dependency scale for measuring basic human needs: an international comparison.

AIM: To report a study conducted to compare the utility of the care dependency scale across four countries. BACKGROUND: The care dependency scale provides a framework for assessing the needs of institutionalized patients for nursing care. Henderson's components of nursing care have been used to specify the variable aspects of the concept of care dependency and to develop the care dependency scale items. DESIGN: The study used a cross-cultural survey design. METHOD: Patients were recruited from four different countries: Japan, The Netherlands, Poland and Turkey. In each of the participating countries, basic human needs were assessed by nurses using a translated version of the original Dutch care dependency scale. Psychometric properties in terms of reliability and validity of the care dependency scale have been assessed using Cronbach's alpha, Guttman's lambda-2, inter-item correlation and principal components analysis. Data were collected in 2008 and 2009. RESULTS: High internal consistency values were demonstrated. Principal component analysis confirmed the one-factor model reported in earlier studies. CONCLUSION: Outcomes confirm Henderson's idea that human needs are fundamental appearing in every patient-nurse relationship, independent of the patient's age, the type of care setting and/or cultural background. The psychometric characteristics of the care dependency scale make this instrument very useful for comparative research across countries.

Health and nursing problems of elderly patients related to bio-psycho-social need deficiencies and functional assessment.

Elderly population is characterized by larger need for social welfare and medical treatment than other age groups. Along with aging, there is a number of emerging health, nursing, caring, psychological and social problems. Complexity of these problems results from overlapping and advancing involutional changes, multi-illness, decreased functional efficiency and other factors. The aim of the study was the assessment of health problems in geriatric patients as well as bio-psycho-social need deficiencies in a view of selected parameters of functional efficiency. The research group consisted of the Chair and Clinic of Geriatrics, 186 women and 114 men, 300 persons in total. The research was carried out using a diagnostic poll method with the application of the Activities of Daily Living (ADL) questionnaire of assessment of daily efficiency on the basis of the Katz Scale; the Care Dependency Scale (CDS) questionnaire used to measure the level of the care dependency and human needs, Norton's bed sores risk assessment scale, the Nursing Care Category (NCC) questionnaire applied to assess the need for nursing care. In most patients the results unveiled manifestations of three or more illnesses. Functional efficiency was at low and average level. Half of the subjects were endangered by risk of bed sores as well as showed high need fulfillment deficiency. The highest level of the deficiency was observed in patients in the eldest age group as well as suffering from multi-illness. Material status, education, place of residence or gender showed no significant influence on the level of need fulfillment.

Independence of elderly patients with arterial hypertension in fulfilling their needs, in the aspect of functional assessment and quality of life (QoL).

Functional efficiency is the ability to be independent in fulfilling the basic needs of everyday life. Independence in meeting these needs is important to maintain a good quality of life (QoL). Chronic diseases affecting elderly people may, to some extent, limit fulfilling numerous needs, however, the acquired ability to live with a disease enables such patients to cope well with their needs. The aim of the study was to evaluate in the examined patients the independence in meeting their bio-psycho-social needs in relation to functional efficiency and QoL. The study group was recruited among hospitalized patients in the Department and Clinic of Geriatrics, 91 women and 59 men, for a total of 150 people. The mean age of the study group was 73.4 years. The research was carried out using a diagnostic poll method with the application of The Functional Assessment of Chronic Illness Therapy questionnaire (FACIT-F version 4); Activities of Daily Living questionnaire (ADL) of assessment of daily efficiency on the basis of the Katz Scale; Care Dependency Scale questionnaire (CDS) used to measure the level of the care dependency and human needs. The results of CDS for the study group were running at high level and were dependent on the marital status and age. No impact of gender, place of residence, education, material situation and disease duration was revealed. Similarly, FACIT-F scores were higher for married patients than for widowed ones, and they were age-dependent. Most of CDS scores were at a high level, which means that the investigated patients were, to a limited extent, care-dependent in meeting their needs. In the majority of subjects, the level of daily activities was high, which proves an independent functioning. Results of CDS were dependent on FACIT-F scores in the study group.

Care Dependency Scale--psychometric testing of the Polish version.

The importance of this study lies in the availability of psychometrically sound assessment instruments, which are of critical importance for the study of patient's care dependency and the provision of care to these patients. The aim of this study was to identify the psychometric properties of the Care Dependency Scale (CDS) by analyzing data gathered in Poland. The Polish research instrument was a translation of the original Dutch CDS. Psychometric evaluations were carried out based on a convenience sample of 216 older patients. A high alpha coefficient of 0.98 was obtained. Subsequent inter-rater and test-retest reliability revealed Kappa values between 0.82-0.97 and 0.64-0.86, respectively. Factor analysis (principal component analysis) confirmed the one-factor model reported in earlier studies. The analysis of the scale showed that the instrument is promising to be used in elderly care in Poland. The Polish version of the CDS permits comparison with results from earlier studies using this instrument.

Socio-demographic factors related to functional limitations and care dependency among older Egyptians.

AIM: This paper is a report of a study determining the relationship of socio-demographic factors to functional limitations and care dependency among older care recipients and non-care recipients in Egypt. BACKGROUND: The population is ageing in Egypt and age-related functional limitations are increasing. Age and gender influence this phenomenon, but its relationship to socio-economic status has not yet been demonstrated for Egypt. Functional limitations are an antecedent to care dependency, which also may be associated with these socio-demographic factors. METHOD: A cross-sectional study with a two-group comparative design was conducted in Greater Cairo. The sample was composed of 267 non-care recipients and 344 care recipients. Path analysis was used to determine the relationship between variables. Age, gender and acceptance of care were covariates in the multiple regressions. Analyses were conducted separately for care recipients and non-care recipients. RESULTS: Among non-care recipients, lower socio-economic status was related to more functional limitations and higher care dependency. This relationship was not found among care recipients. CONCLUSION: Older persons from low income groups are more likely to become care dependent but are less able to pay for required care. Currently, untrained volunteer groups of religious organizations try to support these older people in the poorer strata of Egyptian society. Training in the basics of care might help to make their work more effective.

Prevalence of frailty on clinical wards: description and implications.

This paper describes the prevalence and frailty level of patients aged > or = 75 years upon admission to various clinical wards. The data collection took place on five clinical wards of different clinical specialisms: Geriatric Centre, traumatology, pulmonology/rheumatology, internal medicine and surgical medicine. The Groningen Frailty Indicator was used to assess the frailty of newly admitted patients. The presence of number and kind of the various frailty indicators was different for the clinical wards, because of clinical diagnose, age and gender. On the Geriatric Centre, almost all patients were indicated as frail. On the other wards, 50-80% of the patients were indicated as frail with most frailty indicators on the scale 'psychosocial'. The study show a high prevalence of frail elderly on some wards and gives an indication of the various needs for other disciplines within the framework of the care for frail elderly people.

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt.

AIM: The aim of this study was to determine the validity and reliability of the modified Arabic Care Dependency Scale for self-assessment of older persons in Egypt and to compare these self-assessments to proxy assessments by care givers and family members. BACKGROUND: The Care Dependency Scale is an internationally used instrument to measure care dependency. The Arabic version may improve data collection on this phenomenon in the Middle East where the population is ageing. DESIGN: A cross-sectional study with a sample of 611 older persons living in Greater Cairo. Participants belonged to three groups: nursing home residents, home care recipients and non-care recipients; 459 participants were also rated by proxies and 171 repeated their self-assessment after two weeks. METHODS: The correlation between sum scores of the Care Dependency Scale and the Activities of Daily Living scale was calculated to establish criterion validity. Construct validity was determined by comparing care recipients and non-care recipients with regard to their Care Dependency Scale sum scores and by exploratory factor analysis. Intraclass coefficients were used to assess test-retest reliability of self-ratings for each item. Mean differences between self and proxy assessment were calculated. RESULTS: The Care Dependency Scale had a strong correlation to the Activities of Daily Living scale and is able to distinguish between care recipients and non-care recipients. Factor analysis revealed one factor for basic needs and one factor for psychosocial needs. ICC values were >0.7 for most items related to the factor for basic needs among care recipients. Proxy assessment yielded higher care dependency than self assessment. CONCLUSION: Care Dependency Scale items for basic needs are suitable to assess care dependency among Egyptian care recipients. RELEVANCE TO CLINICAL PRACTICE: Assessment of care dependency is useful to obtain data for appropriate resource allocation among care recipients.

Cultural adequecy of the care dependency scale for older persons in Egypt: a Delphi study.

PURPOSE: The aim of this study is to determine the cultural adequateness of the Arabic version of the Care Dependency Scale (CDS), an internationally used instrument to measure care needs by either self-reports or external assessment. METHOD: A Delphi study in two rounds about the Arabic version was performed with 37 panelists in Cairo. Acceptance of CDS items was rated on a 4-point Likert-type scale. RESULTS: Agreement among panelists in the second round was found for 11 CDS items, but 2 items had decreased acceptance after rephrasing and 2 were rejected. DISCUSSION: Rejected items seem to reflect a heterogeneous perception in the target population. Despite some limitations, the CDS is a promising instrument to detect care needs among older Egyptians.

The meaning of care dependency as shared by care givers and care recipients: a concept analysis.

AIM: This paper is a report of a concept analysis to identify a meaning of care dependency that can be shared by both care givers and care recipients. BACKGROUND: Care dependency can be perceived from the care recipient's and the care giver's perspective. To allow for comparisons, both sides should share the same understanding of the concept. The current research about care dependency has focused on external assessment by nurses and suffers from a tendency to use the concept with different meanings. As a consequence, research on dependency may capture different phenomena. METHOD: Walker and Avant's method for concept analysis served as the guideline for this study. The Medline, CINAHL and Cochrane databases were searched for the period 1996-2006 using the terms dependence, dependency, care dependence and care dependency. RESULTS: Care dependency can be defined as a subjective, secondary need for support in the domain of care to compensate a self-care deficit. Functional limitations are a necessary antecedent and unmet needs are a possible consequence of care dependency. The conceptual difference between care dependency, functional limitations and unmet needs may be meaningless for study participants. They may better understand these differences if they are asked about all three phenomena in the same investigation. CONCLUSION: Care givers and care recipients can agree on the suggested attributes of care dependency but may judge them in different ways. Self-assessed care dependency has the potential to challenge preconceptions of care givers about care dependency.

Family participation in care plan meetings: promoting a collaborative organizational culture in nursing homes.

In this study, the author evaluated a project in The Netherlands that aimed to promote family members' participation in care plan meetings at a psychogeriatric nursing home. The small-scale pilot project, which was conducted in four wards of the nursing home, was designed to involve families in health care decisions by allowing family members to participate in care plan meetings. Both qualitative (participant observation and interview) and quantitative (observation matrix and index analysis) approaches were used to evaluate the project. Findings showed family members were involved in approximately half of the interactions, and many of the questions family members asked were not about the illness, but about its effects. This study indicates there is a need for family members to participate in the multidisciplinary care plan meeting.

Diagnostic accuracy of the care dependency scale.

AIM: This paper reports an investigation of the diagnostic accuracy of the Care Dependency Scale (CDS). BACKGROUND: Assessment tools can be described in terms of diagnostic accuracy, or the ability to correctly classify subjects into clinically relevant subgroups. Diagnostic accuracy can be determined by several techniques as sensitivity, specificity, receiver operating curve analysis and likelihood ratios. METHOD: A cross-sectional design was used with data from 237 patients from two studies. Data were collected using a questionnaire consisting of the CDS and the Barthel Index (BI). The CDS is a relatively new instrument and should be validated by comparison against an established gold standard, in this case the BI. Measures to quantify the validity of diagnostic tests, such as sensitivity, specificity, positive and negative predictive values, prevalence and likelihood ratios were calculated. In addition, the receiver operating characteristics (ROC) curve analysis was used to report the test accuracy of the CDS and to determine an appropriate cut-off point for care dependency detection. FINDINGS: The prevalence in the sample study was very high (84%). The area under the ROC curve for the CDS was 0.81, which indicates moderate diagnostic accuracy. Patients with a CDS sumscore

Cross-cultural psychometric testing of the Care Dependency Scale with data.

BACKGROUND: The importance of the present study lies in addressing whether it is justified to compare the care dependency status of older patients from different settings and cultures using the same instrument. AIM: The aim of this international study was to compare the psychometric properties of the Care Dependency Scale (CDS) by analysing data gathered in Finland, Spain and the United Kingdom (UK). METHOD: The Finnish, Spanish and UK research instruments were translations of the original Dutch CDS. Psychometric evaluations of this were carried out for each country separately as well as for the three countries combined, based on a convenience sample of 378 older patients. RESULTS: High alpha coefficients between 0.94 and 0.97 were obtained. Subsequent test-retest and interrater reliability revealed moderate to almost perfect kappa values. CONCLUSION: One of the main outcomes of the international comparison was that the findings between the three countries showed more similarities than differences in psychometric assessment, indicating that the CDS can be used for care dependency assessment in different countries.