How well are the diagnosis and symptoms of dementia recorded in older patients admitted to hospital?

ABSTRACT

Introduction: In the United Kingdom dementia is generally diagnosed by mental health services. General hospitals are managed by separate healthcare trusts and the handover of clinical information between organisations is potentially unreliable. Around 40% of older people admitted to hospital have dementia. This group have a high prevalence of psychological symptoms and delirium. If the dementia diagnosis or symptoms are not recognised, patients may suffer unnecessarily with resulting negative outcomes. Methods: To understand areas of unmet need we have described the prevalence of dementia in over 75 year olds admitted to a general hospital, the accuracy of diagnostic recording, and the prevalence of recorded psychological symptoms and delirium. To achieve this we conducted a retrospective review of 116 patients admitted to hospital with known dementia. Psychiatric and medical notes were reviewed, identifying the accuracy dementia diagnosis recording by the hospital and all episodes of documented psychological symptoms and delirium. Results: The prevalence of documented dementia in the population was estimated at 15%; 74% of dementia diagnoses were recorded in the medical notes; 10% had documented psychological symptoms (depression 4%, anxiety 3%, hallucinations 3%, delusions 4%); and 11% had documented delirium. There were no associations between the specialty providing care and the recognition of dementia or the reporting of symptoms. Discussion: This work suggests an under reporting of dementia and symptoms associated with it in the general hospital. Improving this requires closer collaboration between metal health and hospital healthcare services and training for staff on how to access diagnostic information and recognise common psychological symptoms.