Ward changes during hospital admissions are linked to longer stays for people living with dementia, a new study has found.
The research suggests each change of ward meant five extra days in hospital for older people – and a further 1.7 days for those with dementia. But there was no interaction between dementia and ward changes on mortality and new care home admission.
The research used data from nearly 20,000 patients aged 65 or over at Northern Care Alliance NHS Foundation Trust’s four hospitals in Greater Manchester between January 2023 and February 2024. It also involved experts from the National Institute for Health and Care Research Applied Research Collaboration Greater Manchester (NIHR ARC GM).
It’s not unusual for patients to move to different wards during hospital admissions, with some of the reasons for changes driven by bed availability, rather than clinical need. But it can result in a lack of continuity of care and poorer outcomes for patients, the researchers say.
Other studies have found that room or ward changes in older people increases their length of stay, risk of delirium and risk of falls – but the impact of ward changes on people with dementia hadn’t been explored previously.
In this study, 14 per cent (2,760) of the older patients had dementia. The data showed 35% had been on one ward, 50% on two and 15% had been on three or more wards. For those without dementia, 38% had been on one ward, 44% on two wards and 18% had been on three or more wards.
Clinical practice
Lead author of the Age and Ageing paper Dr Emma Elliott, postdoctoral researcher from the NIHR ARC GM, said the team’s work has important implications for clinical practice. She said: “We know that hospital stays can be particularly challenging for people living with dementia, and on a personal level I know the impact this can have on both patients and their families. Our study provides evidence that people with dementia are more negatively affected when they are moved between wards, with these moves associated with longer hospital stays. This reinforces the need to ensure such moves are only made when absolutely necessary.”
Senior author Professor Emma Vardy, a consultant geriatrician at NCA’s The Royal Oldham Hospital, is an international expert on delirium and dementia research and practice. She said: “We know from clinical experience that ward bed moves can be detrimental to older people, with increased risk of harms such as incident delirium, those with dementia are at particular risk and ward moves can cause particular distress and disorientation. The NHS England Discharge Frontrunner work led by Programme Director Lindsey Darley has shown that it is possible to reduce ward moves for people living with dementia.
“This research confirms that where possible ward moves should be limited for older people, particularly those with dementia, and provides evidence to support configuration of patient flow pathways to support continuity of care in the right place by staff with the right specialist skills from the outset.”
- Emma Elliott, Robyn Hamilton, Luke Munford, Connor Richardson, Lindsey Darley, Rebecca Thompson, Daniel Rowbotham, Emma Vardy: Do ward changes affect outcomes differently in people living with dementia? (Age and Ageing).