Underdiagnosis of dementia in residents of residential aged care services: A scoping review

Objective

Dementia is a leading cause of disability, dependence and death worldwide. Timely diagnosis and management of dementia are essential in the community and residential aged care services (RACS) or nursing homes. Underdiagnosis of dementia in RACS may negatively impact the quality of care, resulting in adverse health outcomes. Hence the objective is to review estimates of the prevalence of dementia underdiagnosis, potential associated factors, consequences and evidence of interventions targeting to reduce this underdiagnosis.

Methods

Guided by Arksey and O'Malley's scoping review framework, this scoping review was conducted as per the PRISMA extension for Scoping Reviews (PRISMA-ScR). Databases were searched to 31 January 2024 for studies published in English since 2010 in Ovid®, including Scopus, MEDLINE, Embase, Emcare and PubMed Central, as well as CINHAL Ultimate, PsycINFO and ProQuest. After removing duplicates, 545 studies proceeded to title, abstract and full-text screening, resulting in four eligible studies. Two additional studies were identified through reference searching.

Results

A total of six studies were included. Most studies were conducted in the last 5 years. The prevalence of dementia underdiagnosis in RACS was 14%–70%. Different scales were applied to identify dementia. Findings from two studies suggested dementia underdiagnosis is more common among those with less severe disease. No studies investigated health outcomes or explored interventions to reduce dementia underdiagnosis.

Conclusions

Estimates of underdiagnosis in RACS are high and variable. More research is required to clarify factors associated with dementia underdiagnosis in RACS, its consequences and potential interventions to reduce its risk.