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

The 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 programs, and effective management and treatment of the individual, will depend on careful diagnosis of the causes of dependency