Under-recognition of dementia in long-term care homes in Hong Kong

Objective: To examine the extent to which dementia in nursing homes is recognized by staff. Methods: About 189 residents with very mild to moderate dementia (Clinical Dementia Rating, CDR >= 0.5) and Mini-Mental State Examination (MMSE) 10-24 were recruited from 12 nursing homes in Hong Kong. A senior staff in each home provided information on whether the participant was known to have dementia, and if so, the exact diagnosis. Logistic regression was conducted to predict identification by age, gender, whether for-profit or non-profit home, length of stay, MMSE, CDR, activities of daily living, and use of cholinesterase inhibitors and antipsychotic medications. Results: It was observed that 42.3% of the sample had mild dementia and 14.8% had moderate dementia. Although identification rates increased with increasing severity of cognitive impairment, only 30.0% of those with mild dementia and 64.3% of those with moderate dementia were known to have dementia by the homes. Identification rates did not differ between for-profit homes and non-profit homes which had regular MMSE screening. Logistic regression analysis showed that only MMSE (OR = 0.85, 95% CI = 0.76-0.95, p = 0.005) and CDR 2 (as compared with CDR = 0.5; OR = 4.78, 95% CI = 1.23-18.65, p = 0.024) were significantly associated with dementia recognition. No other factors were related to dementia recognition. Conclusions: Despite a high prevalence of dementia in long-term care facilities, recognition of dementia as a medical condition in residents by staff was suboptimal, and MMSE screening in some homes did not seem to increase awareness significantly.