Disability Certification Without Functional Assessment: Uneven Documentation Across Diagnostic Groups in Romania

Background/Objectives: Disability certification in Romania rests mainly on medical diagnosis. We examined whether documented standardized functional assessment in certification dossiers differs across diagnostic groups. Methods: We analyzed 460 anonymized adult dossiers collected in January 2023, ten from each of 46 disability assessment commissions in 41 of Romania’s 42 first-level administrative units. Because the commissions selected the files and at least half had to include a psychological evaluation, we compared diagnostic groups rather than estimating national rates and repeated the main comparison accounting for clustering. Results: Most files concerned older adults with neurocognitive or mental disorders; dementias accounted for 40.2% of primary diagnoses. An activity scale (ADL, IADL or Barthel Index) was documented in 69.0% of non-dementia neurological dossiers, 34.4% of dementia dossiers and 10.8% of other mental-disorder dossiers; the gradient persisted after accounting for clustering. Cognitive and global instruments were documented more often than activity scales. Conclusions: Functional evidence was scarcest in neurocognitive and mental disorders, in which diagnosis predicts functioning least well. The national criteria list activity scales for neurological conditions but only cognitive and global instruments for neurocognitive and mental disorders; adding activity scales for these groups, then ICF-based assessment such as WHODAS 2.0, would address the gap.