title: Fewer referrals to Swedish emergency departments among nursing home patients with dementia, comprehensive cognitive decline and multicomorbidity.
abstract: OBJECTIVE
  The objective was to describe the extent to which nursing home patients had cognitive impairments and were diagnosed with dementia. Furthermore, to describe and compare multicomorbidity, health status and drug use in the three subgroups; dementia diagnosis/not referred, dementia diagnosis/referred and no dementia diagnosis/not referred to an emergency department (ED) over a one-year period.
  
  
  METHODS
  A cross-sectional follow-up study was carried out in Sweden. RAI/MDS assessments were conducted on 719 patients in 24 nursing homes, of whom 209 were referred to EDs during a one-year period, accounting for 314 visits. This study involved an extensive examination of the population.
  
  
  RESULTS
  The 719 patients were reported to suffer from comprehensive cognitive impairments, which not accorded with the dementia diagnoses, they were significantly fewer. Cognitive decline or dementia diagnosis contributed to a significant decrease of referrals to EDs. Patients with dementia diagnosis/not referred had difficulties understanding others, as well as impaired vision and hearing. Patients with dementia diagnosis/referred usually understood messages. Low BMI, daily pain, multicomorbidity and high drug consumption occurred in all groups. Patients with no dementia diagnosis/not referred had significantly less multicomorbidity. Neuroleptica was significantly more prevalent among those with dementia diagnosis.
  
  
  CONCLUSIONS
  Dementia remains undetected. Patients with cognitive decline and dementia are probably as sick as or even worse than others but may, due to low priority be undertreated or referrals avoided with the objective to provide good care in the setting. Observational studies are needed to identify what is done and could be done in referral situations.
authors.affiliation: Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden. anamar@hig.se
authors.forename: A G
authors.initials: AG
authors.lastname: Mamhidir
authors.forename: A
authors.initials: A
authors.lastname: Wimo
authors.forename: A
authors.initials: A
authors.lastname: Kihlgren
mesh_terms: D000369:Aged, 80 and over; D003072:Cognition Disorders; D015897:Comorbidity; D032882:Comprehension; D003430:Cross-Sectional Studies; D003704:Dementia; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006311:Hearing Disorders; D006801:Humans; D009735:Nursing Homes; D012017:Referral and Consultation; D013548:Sweden; D014786:Vision Disorders