Professor Emma Vardy is a Consultant Geriatrician and Clinical Frailty Lead at the Northern Care Alliance NHS FT. She is an honorary clinical chair with the Manchester Academic Health Science Centre at the University of Manchester. She is the North West NIHR RRDN ageing specialty lead and has specialist interests in dementia and delirium.
In January 2026 the Alzheimer’s Society published a joint report with Health Service Journal (HSJ) Information. This showed that significant numbers of patients who are fit to be discharged from hospital, but for whom the discharge is delayed, have a probable diagnosis of dementia. Nearly a quarter of people where discharge is delayed for a week and almost a third of people where discharge is delayed for three weeks or more are likely to have dementia. The report demonstrated that there is a widespread variation between Integrated Care Boards (ICBs). There is no indication in the report of the reason for these variations. It also does not show the clinical reason for admission, though all are non-elective, or if hospital avoidance pathways were not available. The Daily Mail reported that discharge delays for people with dementia costs the NHS £328million a year and wastes 584,080 bed days a year (with reference to 2024/2025).
Sadly, the results of the report are not surprising and it highlights the importance of community services, social care provision and alternatives to hospital admission. The language used in these newsworthy stories about people with dementia being in hospital ‘longer than they need to be’, alongside the emphasis on financial cost implies, however unintentionally, that people with dementia, and their families, are responsible for unnecessary hospital use and ‘wasted’ resources.
We know as healthcare professionals working with older people that staying in hospital longer than necessary increases the person’s risk of complications, especially delirium or falls, and can be particularly damaging for a person with dementia. I have previously blogged about my personal experience of my dad’s dementia journey and the challenges and benefits of post-diagnostic support. Three years later, I’m actively working against standardised pathways and systems that would rather my dad be taken to hospital at risk of becoming one of many described in the charity report and newspaper headline.
Thanks to an excellent care home who know my dad well, and to paramedics involving our family in these decisions, we luckily prevented a hospital trip which would have in all likelihood resulted in my dad, who now has severe dementia, lying on a trolley in a corridor, frightened and confused, and becoming further deconditioned. You will know the story all too well. Interestingly, what my mum thought was an advance care plan was actually a DNACPR order. Following an eConsult request, everything was properly and quickly put in place.
Soon after helping avoid a hospital transfer for my dad, I spoke to the relative of a patient with dementia cared for by the Hospital at Home Team that I work with, begging me not to let her mum once again be transferred to hospital to endure a long wait on a trolley in the Emergency Department in a corridor, with little to eat and drink. Listening to people with dementia, and their families and next of kin, is key. Availability of the outcome of that conversation to the health and social care professionals involved in the care of a person with dementia can be achieved by documenting advance care planning (ACP) conversations. ACP is proven to reduce ambulance callouts and conveyance to hospital, reduce days in hospital, reduce cost of hospital treatment in the last year of life and achieve preferred place of death, which unsurprisingly is not usually hospital. There is also evidence that earlier discussion of ACP in people with adults living with long term conditions is less distressing, though there are additional complications and considerations in dementia due to the nature of the illness.
When ACP is initiated for a person with more advanced dementia this means that there are additional challenges as this relies on healthcare professionals and family carers. How do we ensure that we don’t ‘miss the boat’ such that the person with dementia ends up as another statistic, stuck in a hospital bed they never wanted to be in in the first place? In my experience this is better delivered as a proactive evolving conversation, rather than delayed until a crisis occurs. The availability of Electronic Palliative Care Recording systems (EPaCCS) in many areas is such a helpful adjunct to achieving this.
On a happier note, I return to a previous blog I wrote for Dementia Action Week 2022 on the therapeutic power of music for people with dementia and the work of Playlist for Life. Since then, a recent academic paper has shown that musical interventions are associated with a 50% reduction in the risk of delirium in certain clinical settings. Now that my dad is on the NHS CHC ‘fast-track’ pathway and is in the final chapter of his life, I was reminded how much he enjoyed music. With a CD player and a Don Williams album chosen - a musical memory from my childhood - a man who is so often distressed these days is calmed by music he still recognises. He refers to the music as “marvellous” and now four decades after first hearing a Don Williams album, I might just agree with him.
