COGNITIVE IMPAIRMENT - A CHALLENGE FOR COMMUNITY CARE - A COMPARISON OF THE DOMICILIARY SERVICE RECEIPT OF COGNITIVELY IMPAIRED AND EQUALLYDEPENDENT PHYSICALLY IMPAIRED ELDERLY WOMEN

Objectives: to compare the domiciliary service receipt of cognitively impaired and equally dependent physically impaired elderly women prior to the passing of the UK Community Care Act. Methods: secondary analy sis of a population survey conducted in 1986 in the city of Cambridge. The analysis used data on 1585 women aged 75 and over Living in the c ommunity, The effect of type of impairment on the receipt of domicilia ry services (meals-on-wheels, home help and community nursing) is meas ured using a multivariate model which allows for adjustment for depend ency level and other potential confounding factors. Results: the odds of an elderly woman getting help from any of the domiciliary services whilst not being significantly affected by cognitive impairment (odds ratio 0.7, 95% CI 0.5-1.2) are increased by physical impairment (odds ratio 1.8, 95% CI 1.2-2.5). Similar results were found for the home he lp service, The differences were exaggerated in the case of the commun ity nursing service, whilst receipt of meals-on-wheels was similar for women of with all types of impairment. Conclusions: in the late 1980s , cognitively impaired elderly women received less help from the domic iliary services than equally dependent physically frail women who live d in similar household circumstances. The development of specialist se rvices appropriate to the needs of cognitively impaired elderly people presents a challenge to community care policy, especially since this group are at high risk of institutionalization.