The relationship between frailty, functional dependence, and healthcare needs among community‐dwelling people with moderate to severe dementia

Abstract

This paper examines the healthcare needs of community‐dwelling older people living in Porto, Portugal, diagnosed with moderate or severe dementia, linked to functional dependency, cognitive decline, limitations in the activities of daily life, and frailty levels. A sample of 83 participants was recruited. Data were collected between 2013 and 2017. A sociodemographic questionnaire, the Clinical Dementia Rating (CDR), the Barthel Index (BI), the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, and the Edmonton Frail Scale (EFS) were used. A set of 26 healthcare needs was defined to support the assessment. The Pearson chi‐square or Fisher's exact test (as appropriate) was used to examine the association of the needs (unmet and met) with the levels of dementia and frailty. Participants were diagnosed previously with moderate or severe dementia and benefited from a structured home‐care program. There was a high number rated as “severe dementia,” “fully dependent,” “severely or fully dependent in the activities of daily living (ADL),” and “severe frailty.” There were statistically significant differences among needs identified in people with moderate or severe dementia and moderate or severe frailty. The most prevalent healthcare needs in the sample were food preparation, medication/taking pills, looking after their home, toilet use, sensory problems, communication/interaction, bladder, bowels, eating and drinking, memory, sleeping, and falls prevention. In particular, the study identifies a set of needs that are present simultaneously in both frailty and dementia stages. This study underlines that despite well‐structured home‐care programs for people with dementia, unmet health needs remain. Timely healthcare needs assessment may help professionals to avoid fragmented care and to tailor quality‐integrated interventions, including the emotional and psychological balance of the caregiver.

Care for frail older adults in the community: an integrative review

“…Regarding the measurement of frailty, five articles used the Clinical Frailty Scale 11,15,[22][23][24] , four used the Frailty Phenotype 14,23,25,26 , three used the Tilburg Frailty Indicator [27][28][29] , two used the Comprehensive Frailty Assessment Instrument 10.30 , five defined frailty without an instrument or objective measurement 4.14. [31][32][33] , one article used Prisma-7 6 and one the Edmonton Frailty Scale 34 . Of these, in two articles 14,23 there was the combination of more than one instrument.…”

“…The articles reviewed highlight the focus on the independence of the frail older person, person-centered care and personalized assistance on topics important to the daily life of each individual to maintain their autonomy, despite their disabilities 15,18,24,38 . The integration of services to minimize fragmentation in the provision of services, improve communication, socialization and mobility are necessary 15,18,24,34 . Emotional aspects to produce comfort and well-being; the adoption of psychosocial and spiritual approaches; and the assessment of care needs and comprehensive geriatric assessments are also essential 34 .…”

“…The integration of services to minimize fragmentation in the provision of services, improve communication, socialization and mobility are necessary 15,18,24,34 . Emotional aspects to produce comfort and well-being; the adoption of psychosocial and spiritual approaches; and the assessment of care needs and comprehensive geriatric assessments are also essential 34 .…”

“…Examine the health needs of older residents in the community living in Porto, Portugal, diagnosed with moderate or severe dementia, associated with functional dependence, cognitive decline, limitations in activities of daily living and levels of frailty34 .…”

Are There Inequalities in the Receipt of Help Among People With Dementia or Cognitive Impairment? Results From the English Longitudinal Study of Ageing

“…People with impaired cognitive function (ranging from poor performance in memory and orientation tasks to the neurodegenerative disorder dementia) often have greater needs for assistance in daily activities compared to older people without cognitive di culties (1)(2)(3). Unmet needs are frequently observed among people with dementia, with over 90% having at least one unmet need (4)(5)(6)(7)(8)(9). Unmet needs are also common among people with memory problems not amounting to dementia (10).…”