title: How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions.
abstract: Maintaining patient safety in acute hospitals is a global health challenge. Traditionally, patient safety measures have been concentrated on critical care and surgical patients. In this review the medical literature was reviewed over the last ten years on aspects of patient safety specifically related to patients with dementia. Patients with dementia do badly in hospital with frequent adverse events resulting in the geriatric syndromes of falls, delirium and loss of function with increased length of stay and increased mortality. Contributory factors include inadequate assessment and treatment, inappropriate intervention, discrimination, low staff levels and lack of staff training. Unfortunately there is no one simple solution to this problem, but what is needed is a multifactorial, multilevel approach at the seven levels of care - patient, task, staff, team, environment, organisation and institution. Improving safety and quality of care for patients with dementia in acute hospitals will benefit all patients and is an urgent priority for the NHS.
authors.affiliation: Department of Medicine for the Elderly, Cumberland Infirmary, Carlisle, UK. jim.george@ncuh.nhs.uk
authors.forename: Jim
authors.initials: J
authors.lastname: George
authors.forename: Susannah
authors.initials: S
authors.lastname: Long
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
mesh_terms: D003704:Dementia / Q000453:epidemiology / Q000628:therapy*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D061214:Patient Safety / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011567:Psychiatric Department, Hospital; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom
keywords: delirium; dementia; falls; frailty; hospitals; safety