Poor care in hospital is delaying discharge of patients with dementia, charity saysBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4907 (Published 18 November 2009) Cite this as: BMJ 2009;339:b4907
People with dementia are staying far longer in hospital than people being treated for the same illnesses or injuries who don’t have dementia, says a new report.
The Alzheimer’s Society, which published the report, also found that nearly half (47%) of carers said that being in hospital had a negative effect on the physical health of the person with dementia. More than half (54%) said that being in hospital had also made the person’s dementia worse. A third of those who are admitted to hospital are unable to return home afterwards and enter a care home instead.
The charity blames the longer stays on a lack of person centred care in hospitals, poor communication with patients, and problems in keeping patients safe and in the discharge process, including access to additional services such as physiotherapy.
It is calling for hospitals to reduce the average length of stay for a person with dementia by at least a week. The £80m (€90m; $134m) this would save, it says, should be invested in training of nurses and community services staff to ensure that people with dementia are admitted to hospital only when they really need it.
For the report the society questioned 1300 carers of people with dementia and 1100 nurses in England, Wales, and Northern Ireland.
The most common reasons cited for admission to hospital were falls, broken or fractured hips or hip replacements, urine infection, chest infection, and stroke.
The charity found that the average stay for someone having surgery for a broken or fractured hip was six days. But more than half (57%) of people with dementia in hospital for the same reason stayed two weeks or more; a third stayed for one month or more.
For a urine infection the average hospital stay for someone with dementia was 10 days longer than that for someone who did not have dementia.
The survey of nurses found that 80% said they do not receive any or enough training in dementia, even though nearly all of them work at some time with patients with dementia. Most (89%) said they found working with people with dementia very or quite challenging.
The report recommends that hospitals have a senior clinician to lead on quality improvement in dementia care and to define the care pathway. Hospitals also need to commission specialist liaison teams in older people’s mental health to facilitate the management and care in hospitals of people with dementia.
Neil Hunt, chief executive of the Alzheimer’s Society, said, “It is shocking that people with dementia are occupying up to a quarter of hospital beds yet there are scandalous variations in quality of dementia care in hospitals.
“At least £80m a year—and probably hundreds of millions—could be saved if people with dementia are enabled to leave hospital one week earlier. Hospitals must commit to reducing the length of stay if we are to stop people with dementia deteriorating in hospital and lessen the chance of people being discharged to a care home.”
Jo Webber, deputy policy director at the NHS Confederation, which represents more than 95% of NHS organisations, said, “Dementia is a life changing and sometimes harrowing experience for sufferers and their relatives. As the number of people with dementia is likely to double over the next 20 years, this report highlights how vital it is to improve services so that they are all as good as the best.”
Cite this as: BMJ 2009;339:b4907
Counting the Cost: Caring for People with Dementia on Hospital Wards is at www.alzheimers.org.uk/countingthecost.