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Jackson, Thomas A. and Gladman, John R.F. and Harwood, Rowan H. and MacLullich, Alasdair M.J. and Sampson, Elizabeth L. and Sheehan, Bart and Davis, Daniel H.J. (2017) Challenges and opportunities in understanding dementia and delirium in the acute hospital. PLOS Medicine, 14 (3). e1002247/1-e1002247/9. ISSN 1549-1676

Abstract

What is the problem?

Dementia in general hospitals

Dementia is very common in patients admitted to acute hospitals, affecting one in four patients, with 6% of people living with dementia being inpatients in acute hospitals at any given time [1,2]. Dementia is often unrecognised by doctors and other hospital staff and frequently complicated by delirium. Deficiencies in care have been highlighted by national audit and numerous reports [3].

“Intellectual failure” is recognised as one of the “geriatric giants.” Both delirium and dementia are disorders of cognitive function, are associated with adverse health outcomes, and are intricately linked [4]. Understanding how to assess, manage, and follow up older people with cognitive impairment in hospitals is vital to improving their care.

This essay discusses the clinical manifestation and complications of delirium and dementia in acute hospitals. Diagnosis of both conditions can be uncertain, and treatments are limited, but effective actions and management may improve outcomes. We also highlight areas for future research and suggest policy interventions to improve hospital care.

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