Characteristics of complex cases of community-dwelling older people with cognitive impairment: A classification and its relationships to clinical stages of dementia.

Abstract

Older people with severe and complex needs are a major challenge in the realm of community health. However, despite the importance of the issue there is a lack of knowledge regarding complex cases of community-dwelling older people with cognitive impairment (hereafter referred to as "complex cases").The first aim of this study was to develop a framework for the comprehensive assessment and analysis of the issues faced by complex cases. The second aim was to identify the relationships between these issues and the clinical stages of dementia using the Clinical Dementia Rating (CDR). A consecutive case series study was conducted using the records of 293 cases in municipal psychogeriatric services. Descriptions regarding the issues faced by complex cases were extracted from the case records and categorized. Next, trends according to CDR were analyzed. The association between each category and the CDR was then examined by multivariate analysis. The issues faced by complex cases were categorized into five categories: A, Mental Health Issues; B, Physical Health Issues; C, Family Issues; D, Issues of Neighborhood Communication; and E, Financial Issue. The higher the CDR score, the higher the frequency of categories C and E, the lower the frequency of category A, and the more categories each case faced. After adjusting for possible confounders, CDRs were associated with the categories of issues faced by complex cases. The analytical framework developed in the present study will help in the categorization of the complexity of complex cases and the development of intervention strategies. In addition, by incorporating the perspective of the clinical stage of dementia, more effective support can be provided. Geriatr Gerontol Int 2022; 22: 997-1004.