Cognitive impairment ranges from normal age-related changes to conditions that progress to dementia and represents an important global public health issue. Prevalence estimates vary widely by diagnostic criteria and setting. Prior literature shows higher rates of cognitive impairment among nursing home residents compared with community-dwelling older adults. In Palestine, epidemiological data comparing community and institutional settings have been limited. This study aimed to describe the prevalence of cognitive impairment and associated characteristics among older Palestinians attending primary healthcare centers and residing in charitable nursing homes in the West Bank.
This was a descriptive–analytical, cross-sectional study conducted from May to October 2024 among individuals aged 55 years and older in the West Bank. Participants were recruited from 10 charitable nursing homes (selected from an initial list of 14, with geographic exclusions and one refusal) and from primary healthcare centers across several governorates. The study collected sociodemographic, clinical, and lifestyle information and assessed cognitive function using the validated Arabic version of the Mini-Mental State Examination (A-MMSE, GTD-USJ).
Nursing homes included in the study provide basic accommodation, meals, and assistance with activities of daily living, with variable access to on-site medical or rehabilitative services; admissions to these facilities commonly reflect social isolation, lack of family support, functional or cognitive decline, chronic illness, or financial hardship. All relevant data and supporting information were reported with the manuscript.
A total of 441 participants were enrolled: 305 from primary healthcare centers and 136 from nursing homes. Median ages differed between settings: nursing home residents had a median age of 73.0 years, while primary healthcare attendees had a median age of 65.0 years.
The overall sample had a high prevalence of illiteracy in the nursing home cohort (41.9%) and a predominance of females (66.9%). Clinically, 58% of the population were obese or overweight. The most common reported conditions in the overall sample included hypertension (47.8%) and diabetes (30.9%). Among primary healthcare attendees, dyslipidemia (59%), diabetes (50.2%), and hypertension (67.9%) were frequently recorded. In the community cohort, 45.2% were male, 27.9% were current smokers, 16.1% were illiterate, and 27.5% had completed university education.
Statistical analysis identified significant associations between cognitive impairment and several factors in both cohorts. In the nursing home cohort, cognitive impairment was significantly associated with gender (p = 0.030), smoking status (p < 0.001), educational attainment (p < 0.001), and monolingualism (p < 0.001). Among primary healthcare attendees, cognitive impairment was significantly correlated with gender (p < 0.001), smoking status (p < 0.001), educational attainment (p < 0.001), and monolingualism (p = 0.003).
This study provides cross-sectional prevalence data for cognitive impairment among older adults in two care settings in the West Bank: nursing homes and primary healthcare centers. The findings align with international observations that institutionalized older adults tend to be older, more likely to be female, and have higher rates of illiteracy and comorbidity than community-dwelling peers. The observed associations with educational attainment, smoking, gender, and monolingualism are consistent with known risk and protective factors reported in other populations.
Because the A-MMSE was used as the cognitive screening instrument, the results reflect performance on that validated Arabic tool; differences in instruments or cut-off scores can alter prevalence estimates across studies. The study highlights modifiable risk factors that could be targeted in local prevention or management strategies.
The authors report that the study supplies the first baseline prevalence estimates for cognitive impairment among both nursing home residents and primary healthcare attendees in Palestine. Data were collected from multiple governorates and from charitable nursing homes representing typical residential care available in the region. The use of a validated Arabic cognitive screening tool (A-MMSE) and the collection of extensive sociodemographic and clinical variables strengthen the descriptive findings.
As a cross-sectional study, causal inferences about risk factors for cognitive impairment cannot be drawn. Details such as the exact prevalence percentages by cognitive impairment category (mild, moderate, etc.) beyond the reported associations were not provided in the abstract; readers should consult the full manuscript and supporting information for comprehensive tables and analyses. The nursing home population in Palestine may not be representative of institutionalized older adults in other regions because admissions are often driven by social and financial factors unique to the local context.
The study documents baseline prevalence data for cognitive impairment among older Palestinian adults in both community and nursing home settings and identifies significant associations with gender, smoking status, educational attainment, and monolingualism. The authors underscore the need for geriatric care standards tailored to local needs, investment in longitudinal cohort research to characterize trajectories of cognitive decline, improved management of modifiable risk factors, and implementation of evidence-based cognitive stimulation programs within nursing facilities.
(Data availability and supporting materials are reported as provided with the manuscript and its supporting information files.)