For a person with dementia, a hospital can be one of the most confusing places imaginable.
Unfamiliar faces, constant noise, disrupted routines and strange rooms can turn an ordinary medical admission into a frightening experience that lasts much longer than expected.
A major review led by University College London has now examined the scale of this problem across the UK. Supported by the Geller Commission, Dementia UK and Alzheimer’s Society, the work draws on 77 unique papers covering around 1.48 million participants.
The supporting umbrella review was published in Alzheimer’s & Dementia. Researchers describe it as the most comprehensive review yet of hospital use among people living with dementia in the UK.
Dementia affects memory, reasoning, communication and the ability to carry out everyday tasks. As the condition progresses, many people need increasing help from relatives, community services and healthcare professionals.
Going into hospital can disrupt that support system. A person who normally functions reasonably well in familiar surroundings may become much more confused when routines, caregivers and surroundings suddenly change.
The review found that people with dementia were 42% more likely to be admitted to acute hospital care. They also faced up to a 35% higher risk of being readmitted after leaving hospital.
The difference became even more striking once patients were inside the hospital. People with dementia could stay seven times longer than comparable patients and were five times more likely to remain after they were medically fit for discharge.
Being medically fit does not always mean a person can simply walk out of the hospital. Someone with dementia may need a home-care package, a residential care place, rehabilitation, transport, equipment or a family plan before returning safely to the community.
If different parts of the health and social care system do not communicate well, these arrangements can take time. The report estimated that delayed discharges involving dementia cost taxpayers around £328 million every year.
But the financial cost tells only part of the story. Long hospital stays can expose people with dementia to loss of mobility, disrupted sleep, poor nutrition and worsening confusion.
One especially serious problem is delirium. Unlike dementia, which usually develops gradually, delirium is a sudden and severe change in attention and awareness that can appear over hours or days.
People with dementia are particularly vulnerable to it. The review found that 45.8% developed delirium during hospitalization, a finding that highlights how quickly an already vulnerable person’s mental state can worsen during an acute illness.
Families frequently described hospital care as frightening. About 90% said hospitals caused fear and confusion for their relatives with dementia.
Some accounts in the report described failures involving basic human needs. Patients were sometimes left without enough help to eat, use the toilet or maintain personal hygiene, while relatives felt that medical problems were treated without enough attention to the person’s dementia.
Even labels such as “dementia-friendly” did not always guarantee suitable care. Families reported situations in which food was delivered but patients who could not manage independently were not helped to eat it.
Hospital staff are also under pressure. The report found that 87% of workers considered dementia care challenging because they lacked adequate resources, showing that the problem extends beyond individual staff members to the way services are organized.
Outside hospital, relatives often fill the gaps. Some families provide more than 100 hours of unpaid care each week, an extraordinary workload that can damage careers, income, sleep and mental health.
The researchers therefore looked at ways to prevent avoidable admissions and shorten unnecessary stays. Interestingly, not every widely used approach appeared to achieve that particular goal.
Case management programs and exercise, for example, did not clearly reduce hospitalizations in the evidence reviewed. That does not make them useless, because they may improve other aspects of health and support, but the researchers argue that hospitalization policies should be guided by evidence about what actually reduces admissions.
One approach with stronger promise is coordinated care from several professions. Instead of treating dementia, physical illness, medication and social needs as separate problems, a joined-up team can address them together.
Pharmacists may have an especially valuable role because medication problems can send vulnerable older adults back to hospital or delay their discharge. Evidence cited by the report suggested that including clinical pharmacists in these teams could produce substantial savings, potentially returning £38 for each £1 invested.
Planning before a crisis may be equally important. Advance care planning allows people with dementia and their families to discuss future treatment preferences, including when care at home might be preferred over hospitalization.
The evidence reviewed suggested that advance planning could cut hospital admissions by up to 55% in some settings. It can also give families clearer guidance when they face difficult decisions during a medical emergency.
There are limitations to the review. Because it combines many earlier studies, the quality and methods of those studies vary, and some results may reflect particular hospitals, services or groups of patients rather than every person living with dementia.
Some findings also describe associations rather than proving that hospitalization itself caused every negative outcome. People with dementia who are admitted to hospital may already be frailer or more medically unwell than those who remain at home.
Even so, the size and breadth of the evidence make the overall pattern difficult to dismiss. People with dementia are entering hospitals more often, staying longer and facing significant risks while families and staff struggle to support them.
The review suggests that solving this problem will require more than creating specially labeled wards. Stronger community care, better communication, medication support and earlier planning may prevent some hospital stays altogether and help patients leave sooner when admission cannot be avoided.
For people with dementia, that could mean more time in familiar surroundings and less time in an environment that may increase distress and confusion. For families, healthcare workers and the NHS, it could also mean a system that uses hospital care when it is truly needed rather than because safer alternatives were not ready.
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Source: University College London.
