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Background: Providing care for frail older persons is complex and demanding, and the transfer of older persons with cognitive impairment to the emergency department is associated with a high risk of them developing complications. Aim: To survey the most ill and frail older persons with cognitive impairment who were transferred from nursing homes to the emergency department, considering reasons for referral, symptoms and actions taken at the hospital. Method: A retrospective descriptive survey, conducting a review of 588 referral notes and medical records, analysed and presented with descriptive statistics and visualised with typical case narratives. Findings: The persons who were transferred to the emergency department were frail with complex symptomology. When reviewing the medical records in the light of criteria for avoidable hospitalisation, 75% of the patients could have been examined and treated at the nursing homes or in primary care. Conclusion: Frail older persons with cognitive impairment, who are in need of end‐of‐life care, should be prevented from unnecessary hospitalisation. The majority of these transfers to the emergency department can be avoided if there is better planning beforehand, more specially trained nurses in elderly care in the municipalities, and more physicians making house calls. • Published by arrangement with John Wiley & Sons.

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