One in five community-dwelling older adults has mild neurocognitive disorders

Mild neurocognitive disorders (NCDs) are present in one in five community-dwelling older adults in Hong Kong, while 70 percent of older adults living in residential care homes have dementia, researchers from the Chinese University of Hong Kong (CUHK) have reported.

With an average life expectancy of 87.6 years, Hong Kong has one of the longest-living populations in the world. As mood disorders and NCDs constitute two of the most common conditions in geriatric patients, an updated analysis of their prevalence in Hong Kong’s elderly population is necessary to facilitate future healthcare planning. [Int J Environ Res Public Health 2019;16:128; Lancet Reg Health West Pac 2023:41:100909; Int J Nurs Stud 2023:140:104413]

In the Hong Kong Mental Morbidity Survey for Older People, the researchers provided free mental and cognitive health assessment to older adults living in the community (n=4,368) or residential care homes (n=503) between 2019 and 2023. [www.hkmmsop.org/home_en.html]

Results showed that mood disorders were common among community-dwelling older adults, with 8.6 percent having depression and/or anxiety and 2.4 percent having intention of self-harm in the past week.

NCDs, which encompass a range of conditions (eg, Alzheimer’s disease, Lewy body disease, Parkinson’s disease, frontotemporal lobar degeneration, vascular disease, traumatic brain injury, Huntington’s disease), are classified according to the specific cause or nature of cognitive decline. [Focus (Am Psychiatr Publ) 2017;15:4-12]

“One-fifth of the community-dwelling older adults had mild NCDs,” reported Professor Linda Lam of the Department of Psychiatry, CUHK. “Early recognition of mild NCDs allows provision of effective early interventions that may alter the trajectory of cognitive decline.”

Major NCD (ie, dementia) was present in 7 percent of community-dwelling older adults, and the prevalence increased with age, reaching 30–50 percent in those aged ≥85 years. In contrast, approximately 70 percent of older adults living in residential care homes had dementia.

Both mild and major NCDs involve impairments in cognitive abilities such as memory, problem-solving, language, and perception, which interfere with daily life. While patients with mild NCDs may have preserved functional abilities, those with dementia may require assistance in everyday activities. As such, the caregiver burden markedly increases with the severity of NCDs. Family caregivers of dementia patients spent an average of 141.3 hours per month on caregiving, and one-fourth of informal caregivers had to take absence from work. [Clin Geriatr Med 2014;30:421-442; BMC Health Serv Res 2020;20:121]

“Despite feeling needed, caregivers of NCD patients in Hong Kong generally expressed low appreciation of their own efforts, and less than half of them received community services,” highlighted Lam.

“Our findings also revealed that older adults who had good physical function or participated in leisure activities tended to have better cognitive and mental health. Therefore, it is important to improve chronic disease management from the primary care level and encourage a broad range of active leisure activities,” pointed out Lam. “More resources should be directed toward supporting caregivers and prioritizing their emotional well-being.”