Prevalence of mild and major neurocognitive disorders in community and residential care homes in Hong Kong: considerations for multidimensional risk factor evaluation and intervention in primary care

Introduction: Given the rapid population ageing, the cognitive healthcare needs of older adults warrant attention. This study reports on the findings of the Hong Kong Mental Morbidity Survey for Older People (HKMMSOP), which evaluated the prevalence of neurocognitive disorders (NCD) and associated health factors that may inform primary care risk assessment and intervention. Methods: The HKMMSOP recruited 4871 participants aged 60 years or above through random sampling in Hong Kong during 2019 and 2023, including 4368 community-dwelling and 503 residential care home residents. Participants were assessed for cognitive function and mental status and completed health and lifestyle questionnaires. The prevalence of NCD and associated factors were evaluated with reference to the 2022 Hong Kong population. Results: The age-and gender-adjusted prevalences of mild and major NCD were 21.8% and 9.7%, respectively, among adults aged 60 years or above in Hong Kong. Approximately 70% of residents in long-term care (LTC) institutions had major NCD. Chronic diseases, sarcopenia risk, sensory impairments, and specific lifestyle habits were associated with cognitive function in logistic regression analyses adjusted for demographic confounders (P<0.05). Specialised medical services, including psychiatric care, were used by approximately 40% of community participants with major NCD. Conclusion: A range of NCD is prevalent in both community and LTC settings, with the highest rates observed among the oldest-old. To improve functional independence, community primary healthcare should prioritise early cardiovascular disease management, physical health maintenance, correction of sensory impairments, and promotion of intellectual and social engagement. For effective healthcare planning for frail older adults living in LTC institutions, the complex needs of nursing home residents with NCD should be addressed.