Introduction: The identification of geriatric syndromes in people with dementia is important. The aim of the study was to assess the prevalence of geriatric syndromes among dementia outpatients. Methods: A cross-sectional study was conducted enrolling outpatients with dementia aged ≥60 years old. Dementia was diagnosed by neuropsychiatrists following DSM-5 criteria. The geriatric syndromes assessed included nutritional status (Mini Nutritional Assessment Scale-Short Form), polypharmacy, comorbidities, alcohol use, depression (quality of life in Alzheimer disease), functional status (Barthel Index, Instrumental Activities of Daily Living); lower body strength (30 s stand chair test), and frailty (Timed Up and Go test ≥14 s). Results: A total of 87 participants was recruited in the study (mean age: 76.8 ± 1.2 years; female: 65.5%). The median number of geriatric syndromes per participant was 5 (IQR = 2); all participants had two or more geriatric syndromes. The most common geriatric syndromes were loss of independence (96.6% impairment in >1 IADL task score and 74.7% dependency in physical function at based on Barthel Index), reduced lower body strength (86.2%), malnutrition and risk of malnutrition (78.2%), and frailty (67.8%). Current and history of smoking, drinking alcohol, using memantine therapy, malnourishment and risk of malnourishment were significantly associated with increasing severity of dementia. Conclusion: The presence and coincidence of geriatric syndromes is common among outpatients with dementia. These findings have important clinical implications in terms of the assessment and service delivery for older adults in Vietnam. We are exploring ways to enhance our services to provide comprehensive, multidisciplinary approaches to screening, recognition, and treatment of geriatric syndromes in older adults with dementia.

Dementia is a widely prevalent condition in an aging society, affecting more than 50 million people in the world, and projected to triple by 2050 to more than 152 million people. Notably, the highest prevalence of dementia will be concentrated in low- and middle-income nations, where approximately two-thirds of dementia cases will occur [1]. In Vietnam, an estimated 660,000 Vietnamese adults are living with dementia [2]. Previous studies indicate the prevalence of dementia among older persons in the community was 9.4% [3] and in the hospital was 24.3% [4]. In the older population, dementia is the leading cause of disability and dependency [5] and results in a growing healthcare burden for both families and society [5‒8].

In addition, many geriatric syndromes can be present concomitantly with dementia, such as frailty, falls, mental health disorders, polypharmacy, malnutrition, and sleep disorders [9]. In the older people living with dementia, the prevalence of geriatric syndromes such as frailty, falls, mental health disorders, polypharmacy, malnutrition, and sleep disorders is high [10]. Geriatric syndromes have an additional detrimental effect on quality of life, functional status, and life expectancy. However, geriatric syndromes are often overlooked in clinical practice in older people in general and in patients with dementia in particular.

The identification of geriatric syndromes in people with dementia is important as targeted multifactorial interventions can be implemented to minimize the consequences of the occurrence of these syndromes. In Vietnam, however, there is still a lack of data on geriatric syndromes in older patients with dementia. Therefore, the aim of this study was to determine the prevalence of geriatric syndromes in older patients with dementia who were being seen as outpatients at the National Geriatric Hospital, Vietnam.

Design, Setting, and Sampling

In a cross-sectional study, we enrolled patients with dementia at the National Geriatric Hospital, Hanoi, Vietnam, from July to December 2021. The inclusion criteria were (1) patients aged 60 years old and older, (2) attending the outpatient department at National Geriatric Hospital, and (3) diagnosis of dementia according to DSM-5 criteria [10]. Patients who suffered from (1) acute and malignant diseases (advanced cancers, end-stage chronic diseases, acute myocardial infarction, acute stroke), (2) had diagnosis of schizophrenia, severe depression, psychiatric or bipolar disorder, (3) alcoholism or substance dependence, currently, or within the past 2 years, and (4) severe loss of vision, hearing or communicative ability were excluded. We used the consecutive sampling to enroll participants.

Data Collection Process

The patient, with the help of their carer, was interviewed using a structured questionnaire by trained researchers and their medical records were also reviewed.

Data Collection

Sociodemographic data collected included sex (male, female), age, body mass index, occupation (business, housewife, farmer, worker, pensioner, others), marital status (married, widow, or widower), living situation (family, career, alone), educational level (undergraduate high school, graduate high school, graduate university), living area (urban area, rural area), currently smoking (yes/no), and currently consuming alcohol (yes/no).

  • Dementia was diagnosed by neuropsychiatrists following DSM-5 criteria. The type of dementia was recorded as Alzheimer’s disease, vascular dementia, mixed dementia, and others. The severity of dementia was recorded as mild, moderate, and severe dementia (based on Mini Mental State Examination [MMSE] score: 21–25 for mild, 11–20 for moderate, and 0–10 for severe dementia [11]). Medication use and non-pharmacological therapy data were collected. Data were collected on medications used for dementia treatment including cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine. Receipt of any non-pharmacological therapies including cognitive (e.g., activity scheduling, mindfulness practices, skills training, cognitive restructuring…), physical (e.g., aerobic exercises, resistance exercises, stretching exercises…), and other (e.g., music and dance, animal assisted, multisensory) therapies were recorded.

Geriatric Syndromes Assessment

The nutritional status was assessed by Mini Nutritional Assessment Scale-Short Form (MNA-SF) [12]. The patients were divided into 3 groups according to their MNA-SF scores (malnourishment: 0–7 points, risk of malnutrition: 8–11 points, normal: 12–14 points). Definition for polypharmacy was five or more regular medications daily. Comorbidity (≥2 diseases) was determined by outpatient physician and extracted from the medical records. Symptoms of depression were assessed by the Patient Health Questionnaire-9 (PHQ-9) [13]. The total score is 27, with ≥5 points defined as having depression symptoms. To assess physical function, the Barthel Index with 5 categories was used (independent: 100 points, slight dependency: 91–99 points, moderate dependency: 61–90 points, severe dependency: 21–60 points, and total dependency: 0–20 points) [14]. The Instrumental Activities of Daily Living (IADL) scale was used to assess dependence for activities of daily living (8 points: total independent, 0–7 points: dependent) [15]. Timed Up and Go (TUG) was measured as the time required for the participants to rise from a straight-backed chair at once, walk at a comfortable pace for 3 m, turn around and walk back to the chair, and sit down. The participants were instructed to start the TUG maneuver immediately after hearing the “start” command. The participants were allowed to use walking aids during TUG test. Frailty was determined as present based on TUG [16]. TUG time ≥14 s was used as the cut-off value for frailty. Lower body strength was assessed by 30-s chair stand [17]. The cut-off value was based on the age-group (60–69 years old; 70–79 years old; ≥80 years old) and sex (with male: 60–69 years old≥ 10 times, 70–79 years old ≥10 times, and ≥80 years old ≥9 times and female: 60–69 years old ≥10 times, 70–79 years old ≥9 times, and ≥80 years old ≥8 times). The Falls Efficacy Scale-International (FES-I) >16 was used as the cut-off value for fear of falling. Fall was defined as whether the participant fell in the previous year [18].

The Fall Risk Index-21 questionnaire was used for screening risk of fall among participants (cut off: >10 point was defined as risk of fall [19]). Written informed consent was obtained from all patient’s legal guardian or healthcare proxy for participation in this study.

Data Analysis

Data entry and coding were undertaken using REDCap software and data analysis was done with SPSS software version 22. χ2 test was used to measure relationships between dementia stage and other characteristics. Descriptive statistics were used to examine characteristics: frequency, percent, mean. Statistical significance was defined as any p value <0.05.

Table 1 shows the baseline characteristics of the study participants according to their severity of dementia. Current and history of smoking, drinking alcohol, using memantine therapy were significantly associated with severe stage dementia.

Table 1.

Baseline characteristics of study participants (n = 87)

Baseline characteristicsDementia stageTotal, n (%)p value
mild (n = 31)moderate (n = 38)severe (n = 18)
Age 
 60–69 years old 4 (12.9) 8 (21.1) 5 (27.8) 18 (20.7) 0.08 
 70–79 years old 18 (58.1) 10 (26.3) 6 (33.3) 36 (41.4)  
 ≥80 years old 9 (29.0) 20 (52.6) 7 (38.9) 33 (37.9)  
Gender 
 Male 5 (16.1) 16 (42.1) 9 (50.0) 30 (34.5) 0.02 
 Female 26 (83.9) 22 (57.9) 9 (50.0) 57 (65.5)  
BMI 
 Underweight 1 (3.2) 7 (18.4) 0 (0.0) 8 (9.2) 0.01 
 Normal weight 12 (38.7) 21 (55.3) 12 (66.7) 45 (51.7)  
 Overweight 18 (58.1) 10 (26.3) 6 (33.3) 34 (39.1)  
Smoking (current and history) 
 Yes 2 (6.5) 11 (28.9) 6 (33.3) 19 (21.8) 0.03 
Drinking alcohol (current and history) 
 Yes 1 (3.2) 7 (18.4) 5 (27.8) 13 (14.9) 0.049 
Education level 
 Not graduated from high school 18 (58.1) 23 (60.5) 11 (61.1) 52 (59.8) 0.97 
 Graduated high school and higher 13 (41.9) 15 (39.5) 7 (38.9) 35 (40.2)  
Living area 
 Urban 25 (80.6) 28 (73.7) 14 (77.8) 67 (77.0) 0.8 
 Rural 6 (19.4) 10 (26.3) 4 (22.2) 20 (23.0)  
Medication use 
 Cholinesterase inhibitor 5 (16.1) 18 (47.4) 7 (38.9) 30 (34.5) 0.02 
 Memantine 0 (0.0) 0 (0.0) 2 (11.1) 2 (2.3) 0.02 
Non-pharmacological therapy received 
 Cognitive 0 (0) 2 (5.3) 0 (0) 0 (0) 0.27 
 Physical 0 (0) 2 (5.3) 0 (0) 0 (0) 0.27 
 Other 0 (0) 1 (2.6) 0 (0) 0 (0) 0.52 
Type of dementia 
 Vascular 5 (16.1) 7 (18.4) 1 (5.6) 13 (14.9) 0.83 
 Mixed 6 (19.4) 8 (21.1) 4 (22.2) 18 (20.7)  
 Alzheimer 15 (48.4) 20 (52.6) 11 (61.1) 46 (52.9)  
 Other 5 (16.1) 3 (7.9) 2 (11.1) 10 (11.5)  
Baseline characteristicsDementia stageTotal, n (%)p value
mild (n = 31)moderate (n = 38)severe (n = 18)
Age 
 60–69 years old 4 (12.9) 8 (21.1) 5 (27.8) 18 (20.7) 0.08 
 70–79 years old 18 (58.1) 10 (26.3) 6 (33.3) 36 (41.4)  
 ≥80 years old 9 (29.0) 20 (52.6) 7 (38.9) 33 (37.9)  
Gender 
 Male 5 (16.1) 16 (42.1) 9 (50.0) 30 (34.5) 0.02 
 Female 26 (83.9) 22 (57.9) 9 (50.0) 57 (65.5)  
BMI 
 Underweight 1 (3.2) 7 (18.4) 0 (0.0) 8 (9.2) 0.01 
 Normal weight 12 (38.7) 21 (55.3) 12 (66.7) 45 (51.7)  
 Overweight 18 (58.1) 10 (26.3) 6 (33.3) 34 (39.1)  
Smoking (current and history) 
 Yes 2 (6.5) 11 (28.9) 6 (33.3) 19 (21.8) 0.03 
Drinking alcohol (current and history) 
 Yes 1 (3.2) 7 (18.4) 5 (27.8) 13 (14.9) 0.049 
Education level 
 Not graduated from high school 18 (58.1) 23 (60.5) 11 (61.1) 52 (59.8) 0.97 
 Graduated high school and higher 13 (41.9) 15 (39.5) 7 (38.9) 35 (40.2)  
Living area 
 Urban 25 (80.6) 28 (73.7) 14 (77.8) 67 (77.0) 0.8 
 Rural 6 (19.4) 10 (26.3) 4 (22.2) 20 (23.0)  
Medication use 
 Cholinesterase inhibitor 5 (16.1) 18 (47.4) 7 (38.9) 30 (34.5) 0.02 
 Memantine 0 (0.0) 0 (0.0) 2 (11.1) 2 (2.3) 0.02 
Non-pharmacological therapy received 
 Cognitive 0 (0) 2 (5.3) 0 (0) 0 (0) 0.27 
 Physical 0 (0) 2 (5.3) 0 (0) 0 (0) 0.27 
 Other 0 (0) 1 (2.6) 0 (0) 0 (0) 0.52 
Type of dementia 
 Vascular 5 (16.1) 7 (18.4) 1 (5.6) 13 (14.9) 0.83 
 Mixed 6 (19.4) 8 (21.1) 4 (22.2) 18 (20.7)  
 Alzheimer 15 (48.4) 20 (52.6) 11 (61.1) 46 (52.9)  
 Other 5 (16.1) 3 (7.9) 2 (11.1) 10 (11.5)  

The results found that malnourishment and risk of malnourishment was significantly associated with dementia stage. All patients in moderate and severe dementia were dependent in ADL (Table 2).

Table 2.

Geriatric syndromes of participants (n = 87)

Geriatric characteristicsDementia stageTotal, n (%)p value
mildmoderatesevere
Physical function (Barthel) 
 Independent 13 (41.9) 8 (21.1) 1 (5.6) 22 (25.3) 0.13 
 Slight dependency 4 (12.9) 5 (13.2) 2 (11.1) 11 (12.6)  
 Moderate dependency 7 (22.6) 13 (34.2) 5 (27.8) 25 (28.7)  
 Severe dependency 7 (22.6) 10 (26.3) 8 (44.4) 25 (28.7)  
 Total dependency 0 (0.0) 2 (5.3) 2 (11.1) 4 (4.6)  
IADL 
 Dependent 28 (90.3) 38 (100.0) 18 (100.0) 84 (96.6) 0.06 
 Total dependence 2 (6.5) 7 (18.4) 4 (22.2) 13 (14.9) 0.23 
Symptom of depression 
 Yes 13 (41.9) 17 (44.7) 5 (27.8) 35 (40.2) 0.47 
Malnutritional status 
 Malnourishment and risk of malnourishment 19 (61.3) 32 (84.2) 17 (94.4) 68 (78.2) 0.01 
 Polypharmacy 10 (32.3) 11 (28.9) 6 (33.3) 27 (31.0) 0.93 
 Comorbidities 9 (29.0) 15 (48.4) 7 (22.6) 31 (35.6) 0.63 
 Frailty syndrome (TUG ≥14 s) 24 (77.4) 21 (55.3) 14 (77.8) 59 (67.8) 0.09 
 Reduced lower body strength 26 (83.9) 33 (86.8) 16 (88.9) 75 (86.2) 0.88 
 Risk of fall (yes) 25 (65.8) 11 (61.1) 59 (67.8) 23 (74.2) 0.6 
 Fear of fall (yes) 26 (83.9) 28 (73.7) 14 (77.8) 68 (78.2) 0.59 
 Fall in last 12 months (yes) 11 (35.5) 11 (28.9) 4 (22.2) 26 (29.9) 0.61 
Geriatrics syndrome, n 
 ≤2 0 (0.0) 4 (10.5) 2 (11.1) 6 (6.9) 0.18 
 3 5 (16.1) 5 (13.2) 0 (0.0) 10 (11.5)  
 ≥4 26 (83.9) 29 (76.3) 16 (88.9) 71 (81.6)  
Geriatric characteristicsDementia stageTotal, n (%)p value
mildmoderatesevere
Physical function (Barthel) 
 Independent 13 (41.9) 8 (21.1) 1 (5.6) 22 (25.3) 0.13 
 Slight dependency 4 (12.9) 5 (13.2) 2 (11.1) 11 (12.6)  
 Moderate dependency 7 (22.6) 13 (34.2) 5 (27.8) 25 (28.7)  
 Severe dependency 7 (22.6) 10 (26.3) 8 (44.4) 25 (28.7)  
 Total dependency 0 (0.0) 2 (5.3) 2 (11.1) 4 (4.6)  
IADL 
 Dependent 28 (90.3) 38 (100.0) 18 (100.0) 84 (96.6) 0.06 
 Total dependence 2 (6.5) 7 (18.4) 4 (22.2) 13 (14.9) 0.23 
Symptom of depression 
 Yes 13 (41.9) 17 (44.7) 5 (27.8) 35 (40.2) 0.47 
Malnutritional status 
 Malnourishment and risk of malnourishment 19 (61.3) 32 (84.2) 17 (94.4) 68 (78.2) 0.01 
 Polypharmacy 10 (32.3) 11 (28.9) 6 (33.3) 27 (31.0) 0.93 
 Comorbidities 9 (29.0) 15 (48.4) 7 (22.6) 31 (35.6) 0.63 
 Frailty syndrome (TUG ≥14 s) 24 (77.4) 21 (55.3) 14 (77.8) 59 (67.8) 0.09 
 Reduced lower body strength 26 (83.9) 33 (86.8) 16 (88.9) 75 (86.2) 0.88 
 Risk of fall (yes) 25 (65.8) 11 (61.1) 59 (67.8) 23 (74.2) 0.6 
 Fear of fall (yes) 26 (83.9) 28 (73.7) 14 (77.8) 68 (78.2) 0.59 
 Fall in last 12 months (yes) 11 (35.5) 11 (28.9) 4 (22.2) 26 (29.9) 0.61 
Geriatrics syndrome, n 
 ≤2 0 (0.0) 4 (10.5) 2 (11.1) 6 (6.9) 0.18 
 3 5 (16.1) 5 (13.2) 0 (0.0) 10 (11.5)  
 ≥4 26 (83.9) 29 (76.3) 16 (88.9) 71 (81.6)  
Median (IQR)Median (IQR)Median (IQR)Median (IQR)
Geriatrics syndrome, n 5 (1.0) 5 (2.3) 5 (3.0) 5 (2.0)  
Timed Up and Go test 18 (11.0) 15 (19.0) 24.5 (23.3) 18 (17.0)  
30 s stand chair test 6 (4.0) 5 (7.3) 4 (5.5) 5 (5.0)  
Median (IQR)Median (IQR)Median (IQR)Median (IQR)
Geriatrics syndrome, n 5 (1.0) 5 (2.3) 5 (3.0) 5 (2.0)  
Timed Up and Go test 18 (11.0) 15 (19.0) 24.5 (23.3) 18 (17.0)  
30 s stand chair test 6 (4.0) 5 (7.3) 4 (5.5) 5 (5.0)  

At the National Geriatric Hospital in Vietnam, we are developing a multicomponent intervention model of care for patients with dementia. To guide the development of this model of care, we sought to obtain a greater understanding of the geriatric syndromes prevalent in patients with dementia. Our study revealed that the geriatric syndromes were highly prevalent among older adults with a median number of 5 GSs per patient (IQR = 2); all participants had two or more geriatric syndromes. The most common geriatric syndromes were loss of independence (96.6% impairment in >1 IADL task score and 74.7% dependency in physical function based on Barthel score), reduced lower body strength (86.2%), fear of fall (78.2%), risk of fall (74.2%), malnutrition and risk of malnutrition (78.2%), and frailty (67.8%). The prevalence of risk of malnutrition and malnourishment had a consistent increase with the severity of dementia.

Our findings support evidence from previous studies that the presence and coincidence of geriatric syndromes were highly prevalent among older adults with dementia [20‒24]. A previous study in Brazil in patients with dementia showed that only 3.9% of the participants were independent regarding Instrumental Activities of Daily Living, 42.3% had a risk of falls, and 27% were at risk of malnutrition and malnutrition [21, 22]. Four out of 5 participants had more than 4 geriatric syndromes concurrently in our study. Geriatric syndromes are associated with reduced life expectancy, quality of life, increased length of hospital stay [25, 26]. A study on geriatric outpatient clinics revealed that frailty, polypharmacy, dysphagia, malnutrition, sarcopenia, fear of falling, excessive daytime sleepiness were significantly higher in patients with dementia. The co-existence of more than five geriatric syndromes in the same patient was 62.1% in people with dementia [27]. In Vietnam, the management of dementia patients predominantly falls under the purview of neurologists. However, the significant prevalence of geriatric syndromes among these patients indicates a pressing need for comprehensive geriatric assessments, which could be facilitated by an interdisciplinary geriatric healthcare team. Previous research highlighted that geriatric syndromes, often exacerbated by cognitive decline and increased dependency in daily activities, share common etiological factors and are interrelated, contributing to higher morbidity and mortality rates in dementia patients [27]. The integration of geriatricians into the care process is essential as they possess specialized training and confidence in managing such complexities. Furthermore, the establishment of collaborative frameworks between neurologists and geriatricians could enhance the overall management of dementia, ensuring that the multifaceted needs of these patients are adequately addressed. Thus, fostering interdisciplinary cooperation is crucial for improving dementia care outcomes in Vietnam.

The risk of fall and fear of falling in this study was higher than previous studies [28]. People with cognitive impairment had higher incidence of falls than older people with normal cognition because of reduced executive function, slow processing speed, motor impairment, attentional deficits, depressive symptoms, and psychotropic medication [29]. Falls among the older adults are one of the most frequent reasons for morbidity and mortality. There is currently insufficient evidence to endorse any intervention to reduce falls for people living with dementia in any setting [30]. However, fall prevention interventions should target balance and mobility impairments were recommended in a systematic review and meta-analysis [29].

Loss of independence is the central aspect of dementia and becomes more evident as the disease progresses. In our study, the prevalence of functional dependency was reported by approximately almost half in the severe dementia group and one-fifth of moderate and mild dementia group, respectively. Our results showed that all patients with moderate and severe dementia were dependent on at least one IADL; 11% of patients with severe dementia were totally dependent as per Barthel score. Evidence from previous research showed that impairment in both cognitive and motor performance were related to functional impairment in persons with dementia [31, 32]. Our data also showed that motor disorders such as gait disturbances (TUG test) and reduced lower body strength (30 s stand chair test) were very common, especially in the group of patients with severe dementia. Functional impairment in people with dementia is due to multiple factors. In addition to pharmacological treatments, the results from this study showed that the number of patients receiving cognitive, physical, and social interventions was limited. Multidomain interventions have been shown to be effective in delaying progression of functional impairment or disability in dementia patients [33]. Therefore, it is important to develop multidisciplinary models of care for older adults with dementia with the goals of maximizing their cognition and function levels.

Malnutrition is common among dementia patients. Our study is consistent with previous findings showing that patients with dementia are at risk of malnutrition [27, 34, 35]. The previous literature demonstrated an association between poorer nutritional status and worse clinical features of dementia, such as severity of the dementia and functional impairments, and neuropsychiatric symptoms [34, 36]. Nutritional care may serve as an important component of primary care in people with dementia [37].

To the best of our knowledge, this is the first study to evaluate the prevalence of geriatric syndromes in older people with dementia in Vietnam. The limitations of the study are that it had a cross-sectional study design and so does not tell us about the incidence of geriatric syndromes. Participants in this study were recruited from a tertiary care center and the sample size was small and so may not be representative of older people with dementia. Our findings have important implications for the development of clinical services required for the care of older adults with dementia in the hospital settings in Vietnam. We are currently developing comprehensive, multidisciplinary approaches to screening, recognition, and treatment of people with dementia in the hospital settings.

The presence and coincidence of geriatric syndromes are common among outpatients with dementia. These findings have important clinical implications in terms of the assessment and service delivery for older adults in Vietnam. We are exploring ways to enhance our services to provide comprehensive, multidisciplinary approaches to screening, recognition, and treatment of geriatric syndromes in older adults with dementia.

Ethical approval has been performed in accordance with the Declaration of Helsinki and have been approved from the Hanoi Medical university (IRB00003121) on December 31, 2020. Written informed consent was obtained from all patient’s legal guardian or healthcare proxy for participation in this study.

Authors have no potential conflict of interest to disclose.

This study was not supported by any sponsor or funder.

All authors (L.V.T., T.T.H.N., T.X.N., T.N.G., H.T.T.N., A.L.N., V.N., J.T., H.T.T.N., A.T.N., and H.T.T.V.) were involved in designing the study, developing the protocol, and reviewing the manuscript. L.V.T. and T.X.N. were major contributors in writing the manuscript. All authors read and approved the final version of this manuscript.

The data that support the findings of this study are not publicly available due to their containing information that could compromise the privacy of research participants but are available from the corresponding author Luc V.T. upon reasonable request.

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