UCL Dementia


Towards 'Dementia-Friendly' Hospitals

Shocking statistics on the experience of dementia patients in hospitals are catalysing major changes in practice. 

Hospitals can be intimidating places at the best of times. For patients with dementia, they can be highly distressing. Having documented the enormous difficulties dementia patients experience in hospitals, Dr Liz Sampson's research is feeding into a training programme across north London to raise awareness among acute care staff at all levels - from porters to chief executives - of the needs of dementia patients. 

The impact of emergency admission to hospital was graphically illustrated in a prospective study of more than 600 acute admissions of people aged over 70. Some 42 per cent were suffering from dementia, though only half had previously been diagnosed. Perhaps most striking, they suffered markedly higher mortality - 24 per cent of patients with cognitive impairment died during admission, five times the proportion of those without impairment. 

Their long-term survival was also much worse. Median survival was 2.7 years for those without dementia but just 1.1 years for those with dementia. 

Additional studies on a cohort of 230 patients with dementia, followed through their hospital stay, have provided more detail on the difficulties such patients face. Behavioural disturbances are extremely common, but this was strongly associated with undiagnosed pain - patients struggling to communicate that they are in pain often become agitated. 

The key issue is that hospital systems are simply not geared to the special needs of dementia patients. To help remedy this, Dr Sampson has developed a training package designed to help acute care staff provide better support for patients with dementia. Working with 'dementia champions' across UCL Partners - which provides services to six million people - Dr Sampson has helped to train more than 1000 members of staff. Having real data to draw upon, she suggests, has a profound impact - one chief executive was visibly shocked to discover that 75 per cent of dementia patients showed some form of aggressive or agitated behaviour during admission. 

As well as evaluating the training programme, Dr Sampson is also investigating other ways in which health systems may need to adapt to accommodate dementia patients. The standard way of assessing pain levels, for example, using a series of faces showing varying levels of distress, is impossible for many patients to use, owing to their cognitive impairments. With the numbers of dementia patients certain to rise sharply, there is an urgent need to ensure hospital facilities offer a more suitable service to this highly vulnerable group of patients.