At any one time 1 in 4 hospital beds are occupied by people living with dementia. People with dementia often experience longer hospital stays, delays in leaving hospital and reduced independent living.
Hospital admission can trigger distress, confusion and delirium for someone with dementia. This can contribute to a decline in functioning and a reduced ability to return home to independent living. Over recent years there have been a range of initiatives on improving the experience and outcomes of hospital care for people with dementia, such as the National Dementia Action Alliance and Dementia Friendly Hospitals Charter.
Our guidance on dementia and transition between inpatient hospital settings and community or care home settings for adults with social care needs supports these initiatives by stating which aspects of care should be expected to ensure quality dementia care in hospital. This includes appropriate admission to hospital, comprehensive assessments, personal history taking and co-ordinated discharge.
One of the key aspirations of Challenge on Dementia 2020 is to create dementia-friendly hospitals. All acute trusts in England were asked to make a public commitment to becoming dementia friendly. By February 2018, 164 acute and non-acute trusts made that commitment with 88 submitting action plans and joining the National Dementia Action Alliance.
Emergency admissions to hospital
Our dementia guideline says that before admitting a person living with dementia to hospital, the value of keeping them in a familiar environment as well as any advance care and support plans should be taken into account. For people living with severe dementia we recommend that an assessment should be carried out that balances the person’s current medical needs with the additional harms they may face in hospital, such as a longer length of stay and increased mortality.
These recommendations were made to reduce the likelihood that a person with dementia is admitted to hospital. However, data reported by Public Health England shows that the number of emergency admissions to hospital for people with dementia for admissions which are short stay (1 night or less) have increased, from 95,000 in 2014/15 to 115,000 in 2017/18.
Variation in admission rates from the national figure are seen at CCG level. In areas where the admissions are above or below the national rate, further investigation may be necessary to understand the factors contributing to these rates. This may include the provision of primary or community care services and how dementia care is managed and reviewed.
We recommend that staff working in care and support services should receive training in person-centred and outcome-focused care for people living with dementia. The Royal College of Psychiatrists' national audit of dementia reported that of hospitals reporting, 89% of staff had received some form of dementia training from the hospital they currently work at in 2018/19, compared with 83% in 2017, showing encouraging levels of staff training.
The number of short stay emergency admissions for people with dementia increased by 20% between 2014/15 and 2017/18
Comprehensive assessment
Our guideline on dementia recommends various assessments that should take place for people living with dementia. This includes assessments in cognition, delirium, pain, continence and nutritional needs. Providing a comprehensive assessment in hospital can improve the rates of people with dementia returning home after admission and reduce the risk of dying during the hospital stay.
The Royal College of Psychiatrists' National Audit of Dementia Care in General Hospitals measures comprehensive assessments. In 2018/19, it found that overall physical health assessments were administered and documented more often than mental health assessments.
Proportion of people who had each type of assessment during their hospital stay
Personal details and preferences
Personal details recorded in hospital about people with dementia helps staff to understand and anticipate their needs and preferences and involve them in decisions about their care. Our dementia guideline says health and social care practitioners should encourage and enable people living with dementia to give their own views and opinions about their care, and to consider using a structured tool to assess their likes and dislikes, routines and personal history.
In 2018/19, the national audit of dementia care in general hospitals reported that 97% of hospitals said they had a formal system in place for collecting personal information about people with dementia. However, when case notes were reviewed for the audit, less than two thirds contained personal information on the person’s dementia. This may be because personal information is often held in other documents that stay with the person with dementia rather than being in hospital case notes.
The proportion of hospitals with a system to collect information about people with dementia has increased and remained stable
Discharge from hospital
The needs of people with dementia should be considered before they can be safely discharged from hospital. For example, they may need to arrange help in their home with washing and preparing meals or require adaptations such as a stair-lift. Other people may need to move into a care home.
Our guideline and quality standard on transition between inpatient hospital settings and community or care home settings state that adults with social care needs who are in hospital should have a named discharge coordinator to ensure a safe and planned discharge from hospital. The national audit of dementia reported that, in 2018/19, 92% of hospitals had a named person in place to co-ordinate discharge plans for people with dementia. Having a named discharge coordinator helps to ensure a safe and planned discharge from hospital.
A safe, well designed living space is a key part of providing the best care for people living with dementia. Good design and the use of assistive technology can help people to be as independent as possible for as long as possible, and has been shown to reduce hospital stays and care home admissions. It can also help to compensate for impaired memory, learning and reasoning skills and can reduce stress.
My wish to stay on the ward 24/7 with my husband was respected, and valued. The ward culture encouraged young healthcare assistants to engage with the people with dementia in a respectful and caring manner. On admission we completed, with the staff, our preferences for place of discharge, which was to return home once medically fit. On discharge, my wishes were supported by the ward.