[Dementia patients and levels of care: do symptoms of the illness affect the grading?].

OBJECTIVE: As the levels of care within long-term nursing care regulations are defined according to limitations in performing fundamental activities of daily living, the extent to which medically diagnosed cognitive, emotional and behavioral dementia symptoms are taken into account in the grading, should be investigated.
METHOD: 390 patients with mild to moderate dementia from the Mid-Franconia region, were included into the IDA ("Initiative Demenzversorgung in Allgemeinmedizin") study by specially trained general practitioners. The GPs had diagnosed dementia and noted the accompanying signs at baseline. In an interview with the caregiver, the Barthel Index was used to measure the level of help required with fundamental daily tasks. Predictors for grading were set down using logistic regression analysis.
RESULTS: Where one accompanying sign is present, about half the patients had not been assigned a grade. Besides the Barthel Index, the presence of agitation and agnosia and the absence of depression are the only independent predictors for grading. All other symptoms, impairment of the executive function, loss of orientation, aphasia, anxiety, sleeplessness, aggressiveness and tendency to wander, have no significant predictive value.
CONCLUSION: In the future development of nursing care insurance, the need for nursing care should be redefined using symptoms associated with dementia, particularly sleeplessness, aggressiveness and the tendency to wander as inclusion criteria. This is a prerequisite of improving the care available to dementia patients in the long term and also of expanding relief measures for family caregiver.