- Email: [email protected]
Minimal clinically important change of functional decline in community dwelling older persons: Prospective cohort study
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9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
Results.– The average FI-score was 0.27. A higher FI-score was associated with higher age and more severe ID. FI-scores of people with ID were much higher than in the general 50+ population (average FI-score 0.13). Key conclusions.– Comparison with the results of previous studies among non-disabled populations shows that our population has a higher mean FI score; on average, frailty starts at a much younger age. Future research is needed to confirm whether frail older people with ID have a higher risk of adverse health outcomes and to establish how early frailty can be prevented. Data on adverse health outcomes will be presented at the congress. http://dx.doi.org/10.1016/j.eurger.2013.07.256 P195
The association of cerebral small vessel disease and frailty in patients with vascular cognitive impairment J.E. de Wit a,b,c , H.L. Koek a,b,c , L.G. Exalto a,b,c , M.A. Binnenwijzend a,b,c , N.D. Prins a,b,c , F. Barkhof a,b,c , G.J. Biessels a,b,c , W.M. van der Flier a,b,c a Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, Netherlands b Department of Geriatrics, University Medical Center, Utrecht, The Netherlands c Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands Introduction.– The association between cerebral small vessel disease (CSVD) and frailty is unclear. Therefore, we studied the association between white matter hyperintensities (WMHs) or lacunar infarcts, and frailty, operationalized according to Fried, in patients with vascular cognitive impairment (VCI), a population with CSVD. Methods.– We included 165 patients with VCI (mean age 65 ± 7.5 years, mean MMSE 24) from the ongoing, memory clinic based Amsterdam Dementia Cohort. Patients had syndromal diagnoses of dementia (47%), mild cognitive impairment (21%) or subjective cognitive complaints (24%). WMHs, using the Fazekas scale (0–3), and presence of lacunar infarcts (17%) were rated visually on 3Tesla MRI FLAIR- and T2-images. Frailty was assessed using the Fried criteria: weight loss, exhaustion and physical activity (questionnaire), gait speed (4.5-m walk test) and handgrip strength (handgrip dynamometer). Frailty was defined as > 3 positive criteria and pre-frailty as 1-2. Logistic and multiple linear regression models were used. Results.– Frailty was present in 1% of all patients, pre-frailty in 47%. No associations were found between WMHs (OR = 1.1, 95%CI 0.81–1.58) or lacunar infarcts (OR = 1.1, 95%CI 0.49–2.50) and prefrailty. No associations were found between WMHs or lacunar infarcts and individual frailty criteria. When analysis was restricted to patients 65 years, WMHs were negatively associated with handgrip strength (beta = -0.21, 95%CI -0.42- -0.01), but this association lost significance after adjustment for age and gender. Conclusion.– In this VCI population with low occurrence of frailty, CSVD was not associated with pre-frailty. Apparently, in this population other factors than CSVD are more important for the occurrence of frailty. http://dx.doi.org/10.1016/j.eurger.2013.07.257 P196
Modification and external validation in primary care of the Identification of Seniors At Increased Risk of Functional Decline Questionnaire: A prospective cohort study
J.J. Suijker , B.M. Buurman , M. van Rijn , M.T. van Dalen , G. ter Riet , N. van Geloven , R.J. de Haan , E.P. Moll van Charante , S.E. de Rooij Academic Medical Center, University of Amsterdam, Departments of General Practice, Internal Medicine and Geriatrics, Clinical Research Unit, Amsterdam, Netherlands Introduction.– Our objective was to modify and validate in primary healthcare the Identification of Seniors At Risk (ISAR) screening questionnaire to identify older persons at increased risk of functional decline and determine ISAR’s value above identification by age. Methods.– In prospective cohort studies of community-dwelling persons aged 70 years and over the original ISAR was modified using logistic regression and external validated. Functional decline at 12 months was defined as an increase of at least one point on the modified Katz-Activities of Daily Living (ADL) index compared to baseline, or death. Results.– In the developmental cohort, 248/790 respondents (31.4%) experienced functional decline. This resulted in the ISAR-Primary Care (ISAR-PC) containing three items independently associated with functional decline: instrumental activities of daily living (OR 2.04; 95% CI 1.42–2.91), impaired memory (OR 2.02; 95% CI 1.27–3.26), and age (OR 1.06 per year; 95% CI 1.03–1.09). The AUC of the ROC of the ISAR-PC was 0.72 (95% CI 0.70–0.79) after shrinkage, and 40.7% of the participants were identified as being at increased risk of functional decline. Regarding validation in 2573 respondents, ISAR-PC’s AUC was 0.68 (95% CI 0.65–0.70). Selection by age ≥ 75 years yielded an AUC of 0.60 (95% CI 0.55–0.65) in the developmental cohort and 0.59 (95% CI 0.56–0.62) in the validation cohort and identified 60.2% of the participants as being at increased risk of functional decline. Conclusion.– The ISAR-PC has moderate predictive value. Application of the ISAR-PC is more efficient than selection based on age alone in identifying persons at increased risk of functional decline. http://dx.doi.org/10.1016/j.eurger.2013.07.258 P197
Minimal clinically important change of functional decline in community dwelling older persons: Prospective cohort study J.J. Suijker , M. van Rijn , E.P. Moll van Charante , S.E. de Rooij , B.M. Buurman Academic Medical Center, University of Amsterdam, Departments of General Practice, Internal Medicine and Geriatrics, Amsterdam, The Netherlands Introduction.– Decline in (instrumental) activities of daily living ((I)ADL) is frequently used in research and clinical practice, but which changes are clinically relevant is still unknown. Minimal clinically important change (MCIC) can provide valuable information for researchers, healthcare providers and policymakers. Our objective was to estimate the MCIC of ((I)ADL) decline in community dwelling older persons. Methods.– Data from a prospective cohort study were used. Every six months, ADL functioning was measured using the Katz-ADL index. IADL decline was measured using the IADL scale of Lawton and Brody. Mean change scores (MCS), minimal detectable change (MDC) and optimal cut-off point of the receiver operating characteristics (ROC) curve were used to assess the MCIC for a six month period. As an external criterion, three scales for self-perceived (I) ADL-decline and limitations were used. Results.– In total, 2753 participants aged 70 years and over were included. MCS ranged from 0.66 to 0.88 for ADL decline and was 0.55 for IADL decline. MDC ranged from 0.01 to 0.02 for ADL decline and was 0.02 for IADL decline. The optimal cut-off was 0.5 points
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
for both ADL and IADL decline. The AUC ranged from 0.70 to 0.73 for ADL and was 0.68 for IADL decline. Conclusion.– Comparing the Katz-ADL index with three variants containing different ADL items reveals no substantial difference in MCIC for ADL decline. In community dwelling older persons an increase of minimal 0.5 points in I(ADL) decline can be considered clinically important. http://dx.doi.org/10.1016/j.eurger.2013.07.259 P198
The impact of post-herpetic neuralgia: A prospective multicentre study on pain and health related quality of life J.M. Castro-Lopes a,b,c,d , J. Menezes a , L. Mendonc¸a c , A. Costa-Pereira a,c,d , L. Azevedo a,c,d a Faculty of Medicine of the University of Porto, Porto, Portugal b Institute for Molecular and Cellular Biology, Portugal c National Observatory for Pain, Portugal d CINTESIS – Centre for Research in Health Technologies and Information Systems, University of Porto, Portugal Introduction.– Post-herpetic neuralgia (PHN) is the most common complication of Herpes Zoster (HZ), being frequently severe and incapacitating. Methods.– A nationwide prospective study was conducted, specifically addressing pain characteristics, its management and quality of life of HZ/PHN patients followed at Portuguese Chronic Pain Clinics. Results.– Only four of the 91 patients enrolled were under 50 years of age (overall mean 72; SD 13.8). Most patients had permanent and severe pain during the acute phase of HZ, and shingles where most frequently localized in the thoraco-abdominal region. Pain characteristics reported by PHN patients were highly suggestive of a neuropathic component, with tactile dynamic allodynia and sensations of burning and pins and needles as common features. Other common and frequent associated symptoms were fatigue and negative humour. All patients used prescription or non-prescription drugs somewhere along the evolution of HZ or PHN. At the study interview, 76 (84%) were still using drugs for HZ or PHN treatment, most frequently anticonvulsants, analgesics (mainly opioids) and antidepressants. Antiviral drugs and topic analgesics/anaesthetics were seldom reported. Health related quality of life assessed by EQ-5D indicated low levels of “extreme problems” and a moderate level of “some problems” reported for the five EQ-5D dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The most affected dimension was pain/discomfort. Conclusions.– When comparing the current health status with the pre-HZ health status, assessed by the five dimensions of EQ-5D, EQ5D VAS and EQ-5D derived utilities, an important reduction in all aspects of health related quality of life was observed.
c Department of Internal Medicine and Geriatrics, Academic Medical Center, Amsterdam, Netherlands d Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands e Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands f CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, Netherlands g Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands h Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands i Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
Background.– In 2008, the Dutch Ministry of Health, Welfare and Sport commissioned the National Care for the Elderly Programme (http://www.nationaalprogrammaouderenzorg.nl/home/). While numerous research projects in geriatric health care were to be conducted under this national agenda, the Programme committee advocated the development of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) which would be integrated into all funded research projects. In this context, we describe TOPICS-MDS data sharing initiative. Construction.– A working group drafted TOPICS prototype, which was subsequently approved by a multidisciplinary panel. Using instruments validated for older populations, information was collected on demographics, morbidity, quality of life, functional limitations, mental health, social functioning, and health service utilization. From informal caregivers, information was collected on demographics, hours of informal care, perceived burden, and quality of life. Utility.– TOPICS-MDS is a public data repository which contains essential data to better understand health challenges experienced by older persons and informal caregivers. Such findings are relevant for countries where increasing health-related expenditure has necessitated the evaluation of contemporary health care delivery. Discussion.– Although open sharing of data can be difficult to achieve in practice, proactively addressing issues of data protection, conflicting data analysis requests and funding limitations during TOPICS-MDS developmental phase has fostered a data sharing culture. TOPICS-MDS has been successfully incorporated into 40 research projects, thus supporting the feasibility of constructing a large (> 30,000 observations), standardized dataset pooled from various study protocols. This unique implementation strategy can improve efficiency, permit individual patient data meta-analyses, and may also increase generalizability. http://dx.doi.org/10.1016/j.eurger.2013.07.261
http://dx.doi.org/10.1016/j.eurger.2013.07.260
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The institutionalized elder – cognitive and daily life activities profile
The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): A large-scale data sharing initiative J.E. Lutomski a,b , M.A.E. Baars a , B.M. Buurman c , W.P.J. den Elzen d , A.P.D. Jansen e , G.I.J.M. Kempen f , P.F.M. Krabbe g , B. Steunenberg h , E.W. Steyerberg i , M.G.M. Olde Rikkert a , R.J.F. Melis a a Department of Geriatrics, Radboud University, Nijmegen, Netherlands b National Perinatal Epidemiology Centre, Cork, Ireland
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S.D.P.S. Joana , C.G.S. Rosa , F. Bruno ICS-UCP, ACES-PV, Portugal Introduction.– Population aging, associated with chronic degenerative diseases have revealed to be a public health problem. These changes, more specifically cognitive deficit, are a prevalent problem in the elder that tend to aggravate with institutionalization. Associated with higher life expectancy, the institutionalization tends to be for long term. In this context, a study was performed to explore the cognitive capacity of the elder, and association with ability to perform daily living activities (DLA). Objective.– Determine the cognitive profile of the institutionalized elder and understand its relation with dependency levels and functional capacity.
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
Results.– The average FI-score was 0.27. A higher FI-score was associated with higher age and more severe ID. FI-scores of people with ID were much higher than in the general 50+ population (average FI-score 0.13). Key conclusions.– Comparison with the results of previous studies among non-disabled populations shows that our population has a higher mean FI score; on average, frailty starts at a much younger age. Future research is needed to confirm whether frail older people with ID have a higher risk of adverse health outcomes and to establish how early frailty can be prevented. Data on adverse health outcomes will be presented at the congress. http://dx.doi.org/10.1016/j.eurger.2013.07.256 P195
The association of cerebral small vessel disease and frailty in patients with vascular cognitive impairment J.E. de Wit a,b,c , H.L. Koek a,b,c , L.G. Exalto a,b,c , M.A. Binnenwijzend a,b,c , N.D. Prins a,b,c , F. Barkhof a,b,c , G.J. Biessels a,b,c , W.M. van der Flier a,b,c a Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, Netherlands b Department of Geriatrics, University Medical Center, Utrecht, The Netherlands c Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands Introduction.– The association between cerebral small vessel disease (CSVD) and frailty is unclear. Therefore, we studied the association between white matter hyperintensities (WMHs) or lacunar infarcts, and frailty, operationalized according to Fried, in patients with vascular cognitive impairment (VCI), a population with CSVD. Methods.– We included 165 patients with VCI (mean age 65 ± 7.5 years, mean MMSE 24) from the ongoing, memory clinic based Amsterdam Dementia Cohort. Patients had syndromal diagnoses of dementia (47%), mild cognitive impairment (21%) or subjective cognitive complaints (24%). WMHs, using the Fazekas scale (0–3), and presence of lacunar infarcts (17%) were rated visually on 3Tesla MRI FLAIR- and T2-images. Frailty was assessed using the Fried criteria: weight loss, exhaustion and physical activity (questionnaire), gait speed (4.5-m walk test) and handgrip strength (handgrip dynamometer). Frailty was defined as > 3 positive criteria and pre-frailty as 1-2. Logistic and multiple linear regression models were used. Results.– Frailty was present in 1% of all patients, pre-frailty in 47%. No associations were found between WMHs (OR = 1.1, 95%CI 0.81–1.58) or lacunar infarcts (OR = 1.1, 95%CI 0.49–2.50) and prefrailty. No associations were found between WMHs or lacunar infarcts and individual frailty criteria. When analysis was restricted to patients 65 years, WMHs were negatively associated with handgrip strength (beta = -0.21, 95%CI -0.42- -0.01), but this association lost significance after adjustment for age and gender. Conclusion.– In this VCI population with low occurrence of frailty, CSVD was not associated with pre-frailty. Apparently, in this population other factors than CSVD are more important for the occurrence of frailty. http://dx.doi.org/10.1016/j.eurger.2013.07.257 P196
Modification and external validation in primary care of the Identification of Seniors At Increased Risk of Functional Decline Questionnaire: A prospective cohort study
J.J. Suijker , B.M. Buurman , M. van Rijn , M.T. van Dalen , G. ter Riet , N. van Geloven , R.J. de Haan , E.P. Moll van Charante , S.E. de Rooij Academic Medical Center, University of Amsterdam, Departments of General Practice, Internal Medicine and Geriatrics, Clinical Research Unit, Amsterdam, Netherlands Introduction.– Our objective was to modify and validate in primary healthcare the Identification of Seniors At Risk (ISAR) screening questionnaire to identify older persons at increased risk of functional decline and determine ISAR’s value above identification by age. Methods.– In prospective cohort studies of community-dwelling persons aged 70 years and over the original ISAR was modified using logistic regression and external validated. Functional decline at 12 months was defined as an increase of at least one point on the modified Katz-Activities of Daily Living (ADL) index compared to baseline, or death. Results.– In the developmental cohort, 248/790 respondents (31.4%) experienced functional decline. This resulted in the ISAR-Primary Care (ISAR-PC) containing three items independently associated with functional decline: instrumental activities of daily living (OR 2.04; 95% CI 1.42–2.91), impaired memory (OR 2.02; 95% CI 1.27–3.26), and age (OR 1.06 per year; 95% CI 1.03–1.09). The AUC of the ROC of the ISAR-PC was 0.72 (95% CI 0.70–0.79) after shrinkage, and 40.7% of the participants were identified as being at increased risk of functional decline. Regarding validation in 2573 respondents, ISAR-PC’s AUC was 0.68 (95% CI 0.65–0.70). Selection by age ≥ 75 years yielded an AUC of 0.60 (95% CI 0.55–0.65) in the developmental cohort and 0.59 (95% CI 0.56–0.62) in the validation cohort and identified 60.2% of the participants as being at increased risk of functional decline. Conclusion.– The ISAR-PC has moderate predictive value. Application of the ISAR-PC is more efficient than selection based on age alone in identifying persons at increased risk of functional decline. http://dx.doi.org/10.1016/j.eurger.2013.07.258 P197
Minimal clinically important change of functional decline in community dwelling older persons: Prospective cohort study J.J. Suijker , M. van Rijn , E.P. Moll van Charante , S.E. de Rooij , B.M. Buurman Academic Medical Center, University of Amsterdam, Departments of General Practice, Internal Medicine and Geriatrics, Amsterdam, The Netherlands Introduction.– Decline in (instrumental) activities of daily living ((I)ADL) is frequently used in research and clinical practice, but which changes are clinically relevant is still unknown. Minimal clinically important change (MCIC) can provide valuable information for researchers, healthcare providers and policymakers. Our objective was to estimate the MCIC of ((I)ADL) decline in community dwelling older persons. Methods.– Data from a prospective cohort study were used. Every six months, ADL functioning was measured using the Katz-ADL index. IADL decline was measured using the IADL scale of Lawton and Brody. Mean change scores (MCS), minimal detectable change (MDC) and optimal cut-off point of the receiver operating characteristics (ROC) curve were used to assess the MCIC for a six month period. As an external criterion, three scales for self-perceived (I) ADL-decline and limitations were used. Results.– In total, 2753 participants aged 70 years and over were included. MCS ranged from 0.66 to 0.88 for ADL decline and was 0.55 for IADL decline. MDC ranged from 0.01 to 0.02 for ADL decline and was 0.02 for IADL decline. The optimal cut-off was 0.5 points
9th Congress of the EUGMS / European Geriatric Medicine 4 (2013) S20–S80
for both ADL and IADL decline. The AUC ranged from 0.70 to 0.73 for ADL and was 0.68 for IADL decline. Conclusion.– Comparing the Katz-ADL index with three variants containing different ADL items reveals no substantial difference in MCIC for ADL decline. In community dwelling older persons an increase of minimal 0.5 points in I(ADL) decline can be considered clinically important. http://dx.doi.org/10.1016/j.eurger.2013.07.259 P198
The impact of post-herpetic neuralgia: A prospective multicentre study on pain and health related quality of life J.M. Castro-Lopes a,b,c,d , J. Menezes a , L. Mendonc¸a c , A. Costa-Pereira a,c,d , L. Azevedo a,c,d a Faculty of Medicine of the University of Porto, Porto, Portugal b Institute for Molecular and Cellular Biology, Portugal c National Observatory for Pain, Portugal d CINTESIS – Centre for Research in Health Technologies and Information Systems, University of Porto, Portugal Introduction.– Post-herpetic neuralgia (PHN) is the most common complication of Herpes Zoster (HZ), being frequently severe and incapacitating. Methods.– A nationwide prospective study was conducted, specifically addressing pain characteristics, its management and quality of life of HZ/PHN patients followed at Portuguese Chronic Pain Clinics. Results.– Only four of the 91 patients enrolled were under 50 years of age (overall mean 72; SD 13.8). Most patients had permanent and severe pain during the acute phase of HZ, and shingles where most frequently localized in the thoraco-abdominal region. Pain characteristics reported by PHN patients were highly suggestive of a neuropathic component, with tactile dynamic allodynia and sensations of burning and pins and needles as common features. Other common and frequent associated symptoms were fatigue and negative humour. All patients used prescription or non-prescription drugs somewhere along the evolution of HZ or PHN. At the study interview, 76 (84%) were still using drugs for HZ or PHN treatment, most frequently anticonvulsants, analgesics (mainly opioids) and antidepressants. Antiviral drugs and topic analgesics/anaesthetics were seldom reported. Health related quality of life assessed by EQ-5D indicated low levels of “extreme problems” and a moderate level of “some problems” reported for the five EQ-5D dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). The most affected dimension was pain/discomfort. Conclusions.– When comparing the current health status with the pre-HZ health status, assessed by the five dimensions of EQ-5D, EQ5D VAS and EQ-5D derived utilities, an important reduction in all aspects of health related quality of life was observed.
c Department of Internal Medicine and Geriatrics, Academic Medical Center, Amsterdam, Netherlands d Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands e Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands f CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, Maastricht, Netherlands g Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands h Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands i Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
Background.– In 2008, the Dutch Ministry of Health, Welfare and Sport commissioned the National Care for the Elderly Programme (http://www.nationaalprogrammaouderenzorg.nl/home/). While numerous research projects in geriatric health care were to be conducted under this national agenda, the Programme committee advocated the development of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) which would be integrated into all funded research projects. In this context, we describe TOPICS-MDS data sharing initiative. Construction.– A working group drafted TOPICS prototype, which was subsequently approved by a multidisciplinary panel. Using instruments validated for older populations, information was collected on demographics, morbidity, quality of life, functional limitations, mental health, social functioning, and health service utilization. From informal caregivers, information was collected on demographics, hours of informal care, perceived burden, and quality of life. Utility.– TOPICS-MDS is a public data repository which contains essential data to better understand health challenges experienced by older persons and informal caregivers. Such findings are relevant for countries where increasing health-related expenditure has necessitated the evaluation of contemporary health care delivery. Discussion.– Although open sharing of data can be difficult to achieve in practice, proactively addressing issues of data protection, conflicting data analysis requests and funding limitations during TOPICS-MDS developmental phase has fostered a data sharing culture. TOPICS-MDS has been successfully incorporated into 40 research projects, thus supporting the feasibility of constructing a large (> 30,000 observations), standardized dataset pooled from various study protocols. This unique implementation strategy can improve efficiency, permit individual patient data meta-analyses, and may also increase generalizability. http://dx.doi.org/10.1016/j.eurger.2013.07.261
http://dx.doi.org/10.1016/j.eurger.2013.07.260
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The institutionalized elder – cognitive and daily life activities profile
The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): A large-scale data sharing initiative J.E. Lutomski a,b , M.A.E. Baars a , B.M. Buurman c , W.P.J. den Elzen d , A.P.D. Jansen e , G.I.J.M. Kempen f , P.F.M. Krabbe g , B. Steunenberg h , E.W. Steyerberg i , M.G.M. Olde Rikkert a , R.J.F. Melis a a Department of Geriatrics, Radboud University, Nijmegen, Netherlands b National Perinatal Epidemiology Centre, Cork, Ireland
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S.D.P.S. Joana , C.G.S. Rosa , F. Bruno ICS-UCP, ACES-PV, Portugal Introduction.– Population aging, associated with chronic degenerative diseases have revealed to be a public health problem. These changes, more specifically cognitive deficit, are a prevalent problem in the elder that tend to aggravate with institutionalization. Associated with higher life expectancy, the institutionalization tends to be for long term. In this context, a study was performed to explore the cognitive capacity of the elder, and association with ability to perform daily living activities (DLA). Objective.– Determine the cognitive profile of the institutionalized elder and understand its relation with dependency levels and functional capacity.