Key factors for the assessment of mobility in advanced dementia: A consensus approach

Abstract

Introduction Loss of mobility is common in advanced dementia and has important negative consequences related to fall risk, loss of independence, and lack of participation in meaningful activities. The causes of decline are multifactorial, including disease-specific changes in motor function, behavior, and cognition. To optimize clinical management of mobility, there is a need to better characterize capacity for safe and independent mobility. This study aimed to identify key factors that impact on mobility in dementia. Methods Expert input was gathered using a modified Delphi consensus approach. The primary criterion for participation was specialist knowledge in mobility or dementia, either as a clinician or a researcher. Participants rated elements of mobility for importance and feasibility of assessment in advanced dementia and prioritized items for inclusion in a mobility staging tool. Descriptive statistics and qualitative content analysis were used to summarize responses. Results Thirty-six experts completed the first survey with an 80% retention rate over three rounds. One-third of 61 items reached consensus for being both important and feasible to assess, representing five categories of elements. Items reaching agreement for a staging tool included walking, parkinsonism, gait, impulsivity, fall history, agitation, transfers, and posture control. Discussion This study highlights the need for a multidimensional, dementia-specific approach to mobility assessment. Results have implications for development of assessment methods and management guidelines to support the clinical care of mobility impairment in people with dementia.

Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks

“…In such incidences, people with dementia living with others are more likely to have a caregiver who is able to provide an overview of their needs and abilities on their behalf [ 59 , 60 ].…”

Differences in Assistive Technology Installed for People With Dementia Living at Home Who Have Wandering and Safety Risks

“…This may re ect limitations in the skills and knowledge of staff conducting the assessment of need (19,48). People living alone are less likely to be diagnosed with dementia, and clinicians often struggle to identify their needs (47,48). Additionally, people with more severe impairment often have less documented assessment than people with milder cognitive impairment (4).…”

“…In such incidences, people with dementia living with others are more likely to have a caregiver who is able to provide an overview of their needs and abilities on their behalf (47,48).…”

“…Factors which may not be considered during the AT needs assessment include the impact of caregiver needs, the caregiver's view of the person with dementia's needs or the support received from informal caregivers. This may re ect limitations in the skills and knowledge of staff conducting the assessment of need (19,48). People living alone are less likely to be diagnosed with dementia, and clinicians often struggle to identify their needs (47,48).…”

Mobility in Older Community-Dwelling Persons: A Narrative Review

“…Further questions remain on the specific relationship between single gait parameters and cognitive variables. At present, research is investigating the involved brain regions related to mobility (Rosso et al, 2013a;Holtzer et al, 2014;Demnitz et al, 2017;Van Ooteghem et al, 2019).…”