One in six UK hospital beds is currently occupied by a person with dementia, at a cost to the taxpayer of £2.8 billion annually, with this number set to increase to one in four by 2040, according to a new report by UCL researchers.
The study is the most comprehensive review of dementia hospitalisations ever undertaken in the UK.
The researchers outline how delayed discharges, lack of NHS staff communication and hospital environments unsuitable for dementia patients are keeping people in hospital unnecessarily, eroding dignity and exacerbating frailty. Those with dementia are five times more likely to remain in hospital despite being medically fit to leave, with delayed discharges alone costing £328 million annually to the taxpayer.
The landmark report, released today by UCL with support from the Geller Commission, Dementia UK and the Alzheimer’s Society, and backed by an umbrella review article published in Alzheimer’s and Dementia , draws on evidence from 77 unique papers and 1.48 million participants to identify the human, social and financial costs of unnecessary hospitalisations:
Hospitalisations have a staggering impact on the condition of those with dementia, with the report showing 45.8% develop delirium whilst in hospital, while 90% of families say hospitals are frightening and cause confusion. Challenges of providing care in these settings mean that staff may frequently disempower, infantalise and stigmatise patients, particularly regarding personal hygiene and nutrition.
Hospital admissions were “ terrifying ” for one participant’s parent with dementia, with staff “ only taking care of medical needs, nothing else, with no regard for creating a safe space and familiarity for her.” The report details an experience in which a person with dementia was told off by a nurse when attempting to visit the toilet, leading them to wet the bed.
Conversations with the report’s lived experience contributors reveal that the situation is often no better in so-called “dementia-friendly wards”. A participant was “ shocked that the ward said they were dementia-friendly, because it wasn’t in the slightest – the nurses just left his food and didn’t assist him with eating it”.
The report’s lead author Professor Andrew Sommerlad (UCL Psychiatry) said: "Despite public and political perception, these dementia-related failings in the UK health and care system are not intractable. The research clearly shows how important community-centric approaches are to reducing hospitalisations and minimising long stays, yet the NHS is not implementing them.
"With one in three people over 90 expected to have dementia, it has never been more important to redirect resources to evidence-based care and improve communication to ensure families, hospital staff and carers are working as one joined-up team.”
The affordable fixes being ignored
The report finds many interventions often thought to be effective, particularly case management programmes and exercise, do not reduce hospitalisation in people with dementia. While these are important for other aspects of care, they are not solutions for reducing dementia-related hospitalisation rates.
Backed by evidence from lived experience and academic research, the report sets out clear, affordable interventions that could prevent hospitalisations for dementia patients and reduce the length of stays – if the NHS redirects funding to evidence-based and community-centric approaches:
Laurence Geller, the Chairman of the Geller Commission, commented: “For too long, the crisis facing people with dementia in our hospitals has been hiding in plain sight – acknowledged but never resolved, despite the millions of people across the country who have first-hand experiences of the inadequacies of current care provisions. I founded the Geller Commission and in turn, was pleased to support this important research, because I believe that what gets measured gets fixed. Until now, we have lacked a complete picture of the true human and financial cost of these failures. This report provides that evidence, and with it, the basis for change. Ignorance is no longer an excuse for inaction.”
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Alzheimer s & Dementia
The effect of psychosocial and healthcare interventions on reducing hospitalization in people with dementia: an umbrella review