Background: The aim of the present study was to investigate the relation between cognitive performances and dependency state according to the AGGIR model, the national standardized instrument determining the attribution of the "Prestation Spécifique Dépendance" (PSD) in France.
Method: The sample of the study comprised 1,052 subjects aged 73 and over seen at the 8-year follow-up of the Paquid cohort. The "Autonomie Gérontologie Groupes Iso-Ressources" (AG-GIR) model relies on the assessment of eight measures of disability and two additional measures of intellectual coherence and orientation. The model results in a classification of six Iso-Resources Groups (GIR), only the subjects from GIR 1, 2 or 3 being potential beneficiaries of the PSD.
Results: The percentage of completely independent subjects (GIR 6) was 85% and only 6.1% were dependent according to the level of the attribution of the PSD (GIR 1 to 3). Among these subjects, 57.8% had been diagnosed as cases of dementia. Conversely, less than half of the cases of dementia were not potential beneficiaries of the PSD. Cognitive performances assessed by the Mini Mental State Examination (MMSE), were associated to a risk of dependency with an odds ratio of 1.4 for the subjects who lost one point on the MMSE (95% CI: 1.3-1.5, p < 0.001). Even when dementia was not diagnosed, low cognitive performances and dyspnea were the main factors of the dependency classification according to the AGGIR model.
Conclusions: This study confirms the relationship between cognitive performances and dependency assessed by the AGGIR model. However the model seems to lack sensitivity for taking into account functional impairment associated with dementia. Consideration of Instrumental Activities of Daily Living in the classification procedure could improve the satisfaction of the needs of these subjects.