Dependency in old age: A comparison of mental and physical factors

Abstract

SUMMARYThe level of dependency of 412 patients aged 70 years or over living in hospitals, nursing homes or sheltered accommodation (N=312) or receiving care from the domiciliary nursing services (N= 100) and of 100 elderly people living in the community in Hobart, Tasmania, was assessed using a version of the CARE schedule. The respective roles of mental and physical factors were examined using other CARE items and after administering the Geriatric Mental Status schedule and the Wechsler Memory Scale. Rank-order correlations and log-linear analyses indicated that physical impairment affecting mobility and upper limb function and cognitive impairment due to dementia were about equally strongly related to the level of dependency; at least moderate degrees of both mental and physical impairment were present in 20% of patients. Vision was often hard to assess in demented patients but was associated with dependency in the non-demented. Dependency was significantly related to age and self-rated health but not to deafness and was related to mood disorder only in non-demented patients nursed at home. Apart from this, these patients showed similar relations between dependency and physical and mental impairments to those living in institutions. Central nervous system disease was associated with greater dependency than other medical diagnoses. Preventative programmes, and effective management and treatment of the individual, will depend on careful diagnosis of the causes of dependency.

Physical Performance Test and Activities of Daily Living Scales in the Assessment of Health Status in Elderly People

“…MMSE is known to be strongly related to function; the development of cognitive impairment is often due to progressive dementia, leading first to impairment of IADL and to impairment of BADL. Even the latter scale has a large cognitive component which can never be fully separated from the physical abilities of the individual 10,12 . Thus, it is not surprising that cognitive impairment is the best predictor of BADL and IADL dysfunction.…”

“…In our community -based study of elderly persons living in Italy, a performance-based measure was more IAGS-OCTOBER 1993-VOL. 41, NO. 10 closely associated with markers of health than selfreported ADL scales.…”

“…The relationship between disease and impairment, functional limitation, and disability is still unclear 7–10 . Many factors limit our knowledge; a major role is played by variability in disease severity, both within and between diseases, by multiple pathologies and their interactions, and by non‐medical factors.…”

Management of Demented Patients in Emergency Department

“…It should also be considered that there is a different prevalence of somatic diseases in different stages of Alzheimer's disease and other dementias. Those that are usually associated with mild to moderate dementia are the tumours, diabetes, gastrointestinal disease, while those associated with severe dementia are pneumonia and other infectious diseases, stroke, malnutrition, hip fractures, bed sores [ 5 ]. See Table 2 for a summarization.…”

The Diagnosis and Grading of Dementia in Population Surveys: Measuring Disability

“…In multivariate analyses IADL scores were predicted by MMSE score but also by age, visual impairment and dyspnoea, and by depression [33], Surveys of elderly general practice patients [34] and residents of institutions [35] showed that disability was most often due to musculoskeletal disease but that cogni tive impairment or dementia was next in importance.…”