Community Health Needs Assessment and Tool, Term Paper Example

Alzheimer’s disease is not only one of the most common and debilitating ailments associated with individuals over the age of 65, but also its overall impact on society is projected to increase as the baby boomers start to retire in 2011. Indeed, according to statistics from the Alzheimer’s Association, Alzheimer’s is the sixth leading cause of death in the United States with over 5.2 million individuals currently suffering from the disease (Alzheimer’s Association, 2011). In addition, the burden of Alzheimer’s in the senior population is projected to increase: According to projections, the number of people aged 65 and older with Alzheimer’s disease is estimated to triple (16 million) by the year 2050 (Alzheimer’s Association, 2011).

Although general prevalence statistics may be relatively well known among those in the medical community, the devastating toll that Alzheimer’s imposes on family members living with Alzheimer’s patients is still being understood.  According to a recent report, there are nearly 15 million unpaid care givers in the United States that give care totaling roughly $202 billion annually to sufferers of Alzheimer’s (Alzheimer’s Association, 2011). The high standard of care needed for Alzheimer’s patients not only imposes monetary stress on family members, but also increases the overall stress level: The study found that 61% of caregivers cited high levels of stress as a by-product of care in a recent survey (Alzheimer’s Association, 2011).

With this background in mind, I chose to pick a survey instrument that would target the aggregate I chose: Family members living with an Alzheimer’s patient.  This aggregate population, which has not been extensively analyzed in the medical literature, plays a key role in the process for a number of reasons including their closeness to the patient and ability to detect when the onset of disease may have occurred. That is, survey instruments aimed at family members might provide more accurate and earlier warning than a survey given to a parent or relative who is already in the early stages of cognitive decline. Although there are several instruments aimed at this aggregate, I chose an existing survey instrument that has proven to be quite valuable in assessing the needs of the aggregate population: The Margaret Blenkner Research Center (MBRC) Caregiver Strain Instrument.

The MBRC Caregiver Strain Instrument was developed in 1994 at the Margaret Blenker Research Center, as a result of the emergent phenomenon of family members taking care of relatives and spouses with Alzheimer’s disease.  In particular, the developers of this survey tool were interested in developing a more comprehensive social care model that would include inputs not only from family/relatives, but also from community service providers that could help share the emotional and time burden that accompanies such care (Bass, McClendon, Deimling& Mukherjee, 1994).[1]The MBRC instrument was developed as a means to assess how caregivers were faring from a number of different aspects- psychological, health, and socially.

There are many different permutations of the MBRC instrument; however, I have chosen a permutation commonly used by nursing homes and psychologists for assessment purposes. Overall, this version of the MBRC instrument reflects this concern as the survey includes 19 questions that can be broken down into four different analytical categories (Please see appendix 1 for the survey instrument).  Questions one through four deal with how the family member feels in making care decisions for the individual with Alzheimer’s such as regarding the role of proper care and the need to do a “better job” in providing care. This analytical sub-category is known as “Caregiver Mastery Score.”

Questions five through nine deal with the overall relationship between the care giver and the individual with Alzheimer’s, particularly focusing on the existing relationship including feelings of manipulation and resent the caregiver may have based allocation of care.  This analytical sub-category is known as the “Relationship Strain Score.”  Questions 10 through 14 deal with the physical health situation of the individual who is taking care of the individual’s with Alzheimer’s; this category covers a wide range of physical symptoms including the caregiver’s current state of energy, as well as the physiological state and psychological state. This analytical sub-category is known as the “Health Strain Score.”  Finally, questions 15-19 deal with how the regular activities of the caregiver has been influenced by giving care for the individual with Alzheimer’s asking questions pertaining to participation in church/religious events, group events, and general activities.

While this survey instrument does a good job capturing of how different aspects of a caregiver’s life is affected, the one weakness (as far as this assignment is concerned) is the lack of demographic information it provides regarding the aggregate population.  In order to make up for this lacuna, I propose that the following questions be added to the beginning of the survey (this is just an attenuated sample; all questions given on the website would be used): 1) Sex of caregiver (male/female); 2) Age of caregiver ( ); 3) Location of caregiver’s residence (urban/rural); 4) Race of caregiver; 5) Occupation of caregiver (if any).

The advent of the MBRC tool has proven critical in not only assessing the needs of the aggregate community, but also in creating a more holistic approach to providing care for Alzheimer’s patients outside the traditional nursing home setting that may not be palatable to certain individuals.  Bass et al. (1996) develop this framework as they use results from the MBRC instrument to assess the current strain on the caregiver and also pull in different resources from community health providers in order to optimize care solutions for both the caregiver and the individual with Alzheimer’s (Bass, D.M., Noelker, L.S., &Rechlin, L.R., 1996). In this sense, the MBRC instrument serves a key assessment that can be used as the initial stepping off point in understanding what type of resources should be leveraged in order to provide adequate care for individuals with Alzheimer’s.  In addition, the Instrument has also played an instrumental role in helping determine what educational programs may be useful in the initial stages of Alzheimer’s disease.  Roberts et al. use the MBRC instrument in order to determine when education should be implemented for both caregivers and individuals with Alzheimer’s disease (Roberts &Silverio, 2009).

Overall, the MBRC Caregiver Strain Instrument is a valuable addition to better understand the burdens and challenges faced by individuals with Alzheimer’s and their caregivers.  In addition to providing a holistic assessment of how caregivers’ life is impacted in a number of key areas, the survey instrument has also been used to initiate programs in education and therapeutic activities for caregivers.

Citations

Alzheimer’s Association. (2011).  2011 Alzheimer’s disease facts and figures.  Accessed at: http://www.alz.org/alzheimers_disease_facts_and_figures.asp.

Bass, D. M., McClendon, M. J., Deimling, G. T., & Mukherjee, S. (1994). The influence of diagnosed mental impairment on family caregiver strain. Journals of Gerontology, 49, S146-S155.

Bass, D.M., Noelker, L.S., &Rechlin, L.R. (1996). The moderating influence of service use on negative caregiving consequences. Journal of Gerontology: Social Sciences ,51B, S121-S131.

Roberts, J.S. &Silverio, E. (2009).  Evaluation of an education and support program for early-stage Alzheimer’s disease.  Journal of Applied Gerontology, 28, 419-435.

Appendix 1

MBRC Caregiver Strain Instrument

Strongly agree = 3 Agree = 2 Disagree = 1 Strongly disagree = 0

National Chronic Care Consortium

During the past four weeks, because of helping the patient, I felt:

1. ____unsure whether he/she was getting proper care.
2. ____uncertain about how to best care for him/her.
3. ____that I should be doing more for him/her.
4. ____that I could do a better job of caring for him/her.
5. ____that he/she tried to manipulate me.
6. ____that my relationship with him/her was strained.
7. ____that he/she made requests over and above what he/she needed.
8. ____resentful toward him/her.
9. ____angry toward him/her.
10. ____my physical health was worse than before.
11. ____downhearted, blue, or sad more often.
12. ____more nervous or bothered by nerves than before.
13. ____I had less pep or energy.
14. ____bothered more by aches and pains.

Caregiver Mastery Score _________________ (Sum of items 1–4)

Relationship Strain Score _________________ (Sum of items 5–9)

Health Strain Score __________________ (Sum of items 10–14)

Page 19

Less often = 2 The same = 1 Strongly disagree = 0

During the past four weeks, because of helping the patient, I:

15. ____participated in church or religious activities.
16. ____visited with friends or family.
17. ____participated in group or organized activities.
18. ____engaged in volunteer activities.
19. ____went out to dinner, the theater, or a show.

Activity Restriction Score _________________ (Sum of items 15–19)

[1]Although the paper called for “two sources after the year 2000”, due to the age of the instrument, the seminal scholarship regarding MBRC was largely published before 2000.  I hope the instructor can make an exception in this case based on the evidence.