Missing the diagnosis: senile dementia in patients admitted to nursing homes

Objective - To establish dementia diagnoses in patients recently admitted to a nursing home by a geriatrician, and to compare the agreement with diagnoses recorded in the nursing home's medical records and with short screening instruments. Design - Descriptive study. Geriatric work-up of the individual patient, information obtained from the medical records of nursing homes, structured interviews with nurses and a short cognitive test. Setting - Nursing homes in Bergen, Norway, with 123 long-term care patients. Main outcome measures - Dementia diagnosis according to the International Classification of Diseases (ICD-10), Clinical Dementia Rating and the Short Portable Mental Status Questionnaire. Results - Fifty-nine percent of the patients were diagnosed as demented according to the ICD-10. One-third of cases were not formerly diagnosed according to nursing home medical records. Clinical Dementia Rating and the Short Portable Mental Status Questionnaire detected "dementia/non-dementia'' cases correctly in 93% and 94%, respectively. Conclusion - Geriatric work-up indicates under-diagnosing of dementia among recently admitted nursing home patients. This may have serious consequences for the treatment. Dementia diagnostics in primary health care must be improved. The knowledge of the attending nurses should be better incorporated in the medical work-up of nursing home patients.