Cork Study finds diagnosis of dementia is poor among elderly

A study of about 600 elderly patients admitted to six Cork hospitals found 25% had dementia of whom almost two thirds had not been previously diagnosed, with obvious implications for care.

The study authors warned that the absence of a diagnosis could lead doctors to wrongly believe patients had the capacity to understand the complex risks and benefits associated with proposed treatments. It could also lead to incorrect prescribing and result in a loss of opportunity for planning future care of a person with dementia.

“The reason we conducted this study was to support the need to change practice”, said consultant geriatrician Dr Suzanne Timmons, lead author of “Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition”.

“We need to ensure staff working in acute hospitals and emergency departments have the necessary skills and training to support people with dementia. We also need changes to the hospital environment to make it more user friendly, and we need greater access to dementia nurse specialists,” said Dr Timmons.

The research, conducted in six weeks among patients aged 70 and older recruited between May 2012 and February 2013, involved Cork University Hospital, the South Infirmary Victoria Hospital, the Mercy University Hospital, Mallow and Bantry general hospitals and the Bon Secours private hospital.

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Dementia prevalence was higher in public hospitals than private, and higher in rural than urban (37.1% versus 26.9%). It was also higher among patients admitted with acute medical illness as opposed to surgical (26.2% versus 11.0%). Dementia was common in orthopaedic (26.9%), and geriatric admissions (51.1%).

UCC lecturer Dr Timmons said the lower prevalence in private hospitals was linked to their having more elective admissions and less “oldest old” while the rural/ urban contrast was explained by the age profile of patients admitted to rural hospitals.

“There are higher numbers of over 70s and wherever you have older patients, you have higher rates of dementia. Also GPs may choose to send the patients to smaller hospitals where there is less likelihood of spending time on a trolley,” she said.

The report found of 606 patients, 149 (24.9%) had dementia, of which over half the instances were mild.

It also found patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status. Delirium was common (57%) on admission.

Patients with dementia were more commonly admitted with urinary or respiratory infections (24.2%) than those without dementia (10.3%). Pneumonia accounted for 23.6% of acute medical dementia admissions.

Bantry general hospital

Since only 35.6% of people with dementia were previously diagnosed, the authors said it emphasised the necessity for cognitive assessment in older people on presentation to hospital.

This was backed by Colette Kelleher, CEO of The Alzheimer’s Society of Ireland who described as alarming the low dementia diagnosis rate. She said they were calling for the immediate provision of key aspects of the National Dementia Strategy which relate to acute hospital settings.

The study, published in the Oxford journals, can be found at http://ageing.oxfordjournals.org/content/early/2015/09/28/ageing.afv131.abstract