A cross-sectional study across 423 Portuguese residential care homes, carried out by researchers at the Universities of Coimbra and Aveiro within the SINDIA project through a survey of technical directors and published in Acta Médica Portuguesa, leaves two numbers worth reading together:
- on average, roughly one third of residents have a formal dementia diagnosis;
- roughly one fifth have suspected cognitive decline with no diagnosis on record.
The same work points to territorial inequity in access to diagnosis and in institutional responses, and reports two figures about life inside these institutions that are hard to forget: 75% of people with dementia in care homes never go outside, and 28% never receive visitors.
The figures are the study's own and refer to the surveyed universe, not to a representative sample of every care home in the country. The reading that matters here is not epidemiological — it is operational.
What the second number actually means
A fifth of residents sit in a grey zone: the team notices something has changed, but there is no assessment, no code, nothing written in the file. And what is not in the file never reaches whoever prepares the activity.
In practice that means three things:
- Whoever runs the session works with incomplete information about a substantial share of the people they work with.
- The adaptation they would make knowing the diagnosis — pace, verbal support, length, choice of content — is not made, or is improvised on the spot.
- When a session goes badly, the recorded explanation tends to be about the person («would not engage», «did not like it») rather than about the preparation.
This article is not about diagnosing. Diagnosis is a clinical act, it is not what we do, and it is not something technology should try to do. It is about running activities in a setting where the diagnosis frequently does not exist.
Three practical consequences
1. Prepare from observed functioning, not from the label
The label says little even when it exists — differences between conditions change a great deal of what works in a session, as we wrote in types of dementia: what changes in a session. When it does not exist, the alternative is not guessing: it is describing what you observe.
Four questions answerable without any formal assessment, which change a session more than any diagnostic code:
- Does the person follow a one-step instruction? A two-step one?
- Roughly how long do they hold attention before disengaging?
- Do they recognise people and places? Which ones?
- What agitates them — noise, darkness, being touched, being rushed?
This is what should be written down before the first session, and read before the second.
2. Start shorter than seems necessary
With uncertainty about cognitive status, the expensive mistake is starting long. A short first session that goes well gives enough information to extend the next one; a long session that goes badly shuts the door on that person for weeks — sometimes for good, because it is recorded as «does not tolerate it».
Length and frequency are not a universal number, and we go through the variables in session length and frequency.
3. Record what happened, not the impression of the day
This is where the grey zone resolves itself, over time. A consistent session record — what was used, for how long, how the person reacted, what interrupted it — is one of the few bodies of material a team accumulates about how someone functions outside the consultation.
It is not a diagnosis and replaces none. But when the attending physician asks «how long has it been like this», a dated sequence of observations is worth far more than the memory of whoever is on shift that day. That is why the session record exists and what it is for — nothing more.
About the 75% who never go outside
This is the number technology does not fix, and it is better said here than left for someone else to say for us.
A session on a headset can give someone fifteen minutes on a beach or in the street where they lived — and we know, from what teams tell us, that for a bedbound person that is not nothing — but it is not going outside. The right answer to 75% of people never leaving is organised outings, adapted transport, and opening the institution to the community. If equipment is used as a substitute for that, it makes the problem more comfortable to ignore, which is worse than not having it.
Technology's honest place is the remainder: the days when going out is impossible, the winter, the person who no longer has the mobility to leave, and the 28% who never get visitors — for whom what we have seen work best is not a scenario at all, but a video call with family.
Three questions for the next meeting
- How many of your residents have a recorded diagnosis, and for how many is there suspicion with no assessment?
- For those, is there any written functional description — instructions, attention, recognition, agitation triggers?
- When someone stops taking part in an activity they used to do, is that recorded as a dated event, or does it disappear quietly?
None of the three needs a budget. All three change daily practice more than the next purchase.
The RVer platform's base product is a Class I medical device registered with Infarmed. Sessions are run by the institution's own professionals, complement existing care and do not replace assessment, diagnosis or clinical follow-up.