Admitted More Often, Waiting Longer to Leave: Dementia in Hospital

In the health systems with the best data, people living with dementia are admitted to hospital more often than people of the same age without dementia, stay longer once they are there, and are far more likely to remain in a hospital bed after their acute treatment has ended because the care they need next is not ready^[1][2].

A hospital stay is hard for anyone, and harder for someone living with dementia. A ward is noisy, unfamiliar and busy; routines change; the faces change with every shift. Families often explain the person’s needs again and again, then wait for a care package or care-home place before the person can leave. This article brings together research and official statistics from North America, Europe and Asia on how often people with dementia go into hospital, how long they stay, how often discharge is delayed and how often they return.

People with dementia are admitted more often, even allowing for other illness

The strongest summary comes from a 2019 systematic review and meta-analysis of 34 studies covering 277,432 people with dementia: 17 from the US, 15 from Europe and 2 from Asia. In studies that adjusted for age, sex and physical comorbidity, people with dementia living in the community had 1.42 times the risk of hospital admission of people without dementia. In the high-quality studies, admission rates ranged from 0.37 to 1.26 per person per year^[1]. The review found strong evidence that older age is linked to admission, moderately strong evidence for multimorbidity, polypharmacy (taking many medicines) and lower day-to-day functioning, and strong evidence that the severity of dementia on its own is not linked^[1].

Individual cohorts show the same pattern. In a long-running US study of 3,019 people aged 65 and over enrolled in an integrated health care system (the Adult Changes in Thought study), followed from 1994 to 2007, 86% of the 494 people who developed dementia were admitted at least once, against 59% of those who stayed free of it. Their unadjusted admission rate was 419 per 1,000 person-years against 200; after adjustment for age, sex and other factors the ratio was 1.41^[3]. The Alzheimer’s Association, summarising US data in its 2026 report, says people living with dementia have twice as many hospital stays per year as other older people^[4].

National hospital data from Canada, published by the Canadian Institute for Health Information (CIHI), give the clearest whole-country picture. In 2015–2016 about 90,000 seniors with dementia (CIHI’s term for people aged 65 and over), or 1 in 5, were admitted to hospital; 38% of them more than once, making about 145,000 admissions. The admission rate was 33 per 100 seniors with dementia against 20 per 100 without, 65% higher, though CIHI notes that the gap narrowed and then reversed in the oldest age groups^[2]. Rates varied from 29 per 100 seniors with dementia in Ontario to 41 per 100 in New Brunswick and Quebec^[2].

In England, a study using linked records for 10,137 people aged 65 and over diagnosed with dementia in South London between 2008 and 2016 found that 50.6% were admitted to a general hospital in the year after diagnosis. The annual admission rate was 1.26 per person, of which 0.90 were emergency admissions, and the emergency rate rose throughout the study period. Compared with people of the same age in the area without diagnosed dementia, the age-standardised emergency admission ratio was 2.06^[5]. Not every trend runs the same way: in Lombardy, Italy, a region of 10 million people, the rate of hospital admissions of people aged 65 and over with dementia, calculated against the resident population, fell from 100.6 per 10,000 in 2002 to 65.1 per 10,000 in 2020^[6]. These studies use different populations and measures, so their figures should not be set side by side as a single trend.

Most admissions are for the same illnesses as other older people, and some may be avoidable

Most admissions of people with dementia are not for dementia itself. In Canada, seniors with dementia admitted for medical reasons went into hospital for much the same reasons as other seniors; dementia was responsible for 12% of these admissions, and the most common reasons were pneumonia (7.3% of admissions), chronic obstructive pulmonary disease (5.1%), urinary tract infections (5.1%) and heart failure (4.8%)^[2]. In Lombardy, respiratory disease grew from 10.4% of admissions of people with dementia in 2002 to 26.8% in 2020, and has been the leading cause since 2017^[6]. In a national Japanese dataset of people aged 65 and over discharged from 987 acute hospitals, 14.7% had dementia overall, but the share varied from 3.0% among people treated for prostate cancer to 69.4% among those treated for aspiration pneumonia^[7].

The US study above found that incident dementia was linked to more admissions for “ambulatory care-sensitive conditions”, illnesses for which proactive outpatient care might prevent a hospital stay^[3]. The English study found that many of the factors linked to admission were social and psychological, such as depressed mood and problems with daily living or living conditions^[5]. Emergency admissions, avoidable admissions and delirium are covered in our companion study on emergency admissions and delirium.

Once admitted, people with dementia stay longer and come to more harm

A 2019 systematic review found 60 studies comparing hospital stays of people with and without dementia in general hospitals; 52 of them found that people with dementia stayed longer. The size of the gap varied widely between and within countries and by the reason for admission: in studies not restricted to one condition, it ranged from 2 days shorter to 22 days longer after matching or adjustment^[8]. In German health insurance claims from 2004 to 2015, covering 7,139 people with dementia and 21,417 matched people without, the first hospital stay of people with dementia was 4.3 days longer. Delirium, a sudden state of confusion, was strongly tied to longer stays, adding 9.6 days to the first stay of people with dementia^[9].

In Canada, the median stay of seniors with dementia was 1.3 to 2 times that of seniors without. Among people aged 65 to 69 it was 8 days against 4; among those aged 80 and over, 8 days against 6^[2]. In Ireland, a study published in 2015 estimated 246,908 additional hospital days a year due to dementia, at an extra cost of over €199 million^[10].

Longer stays matter because hospital itself carries risk. CIHI found that 11.5% of seniors with dementia in Canada experienced hospital harm in 2015–2016, against 7.9% of seniors without^[2]. People with dementia who came through emergency departments were also more often admitted to a bed: 43% against 21%^[2]. A meta-analysis of studies following people after a hospital stay found that people with dementia had 1.74 times the risk of death and 2.16 times the risk of moving into long-term residential care compared with people without dementia^[11]. These are associations: the studies cannot separate the effect of the stay from the illness that caused it.

The longest waits are for the care that should come next

Some of the extra time in hospital is not treatment at all. Canada records “alternate level of care” (ALC) days, which CIHI defines as time when a patient occupies a hospital bed after the acute phase of their stay is complete. Seniors with dementia accounted for about half of all ALC days reported, and were 3 times more likely to have ALC days: 1 in 5 seniors with dementia had an ALC component to their stay, against 1 in 15 without^[2].

Canadian provincial studies show the same pattern over time. In British Columbia, a study of 276,299 people aged 70 and over with at least one urgent admission, in four years between 2001/02 and 2015/16, found that delayed discharge increased among people with dementia while it fell among people without. Dementia was the strongest predictor of delayed discharge, with 4.76 times the odds, and both dementia and waiting for a long-term care place predicted more days of delay^[12]. In Ontario, 62,622 people aged 65 and over living in the community with dementia, matched to people without dementia by age, sex and other illness, were 2.36 times as likely (relative risk) to have a hospital stay with a discharge delay between 2007 and 2014; after seven years, 49.0% had spent time in long-term care, against 6.8% without dementia^[13].

At its most extreme, a ward becomes a waiting room. A review of every ALC patient in two New Brunswick hospitals on one day in July 2009 found that ALC patients occupied 33% of beds; 63% of them had a diagnosis of dementia, the mean length of stay was 379.6 days, and 86% were waiting for a long-term care bed^[14]. That is one snapshot of two hospitals, not a national rate, but it shows where the gap lies: in the shortage of care that should follow hospital, not in the person. The role of residential care is covered in our study of dementia in care homes.

After discharge, readmission is higher in most studies, and the return home is where the gaps show

The evidence on readmission is less clear-cut. A 2017 systematic review of 12 studies found that 4 of 5 cohort studies showed higher readmission rates for people with dementia, with an average absolute increase above comparison groups of 3 to 13%, but 7 case-control studies found no link^[15]. A 2019 review of 19 studies found 30-day readmission rates for people with dementia ranging from 7% to 35%, higher than for people without dementia, and judged that many readmissions are potentially preventable^[16]. A meta-analysis found readmission results inconsistent across studies^[11].

In Japan, among 1,834,378 people aged 65 and over discharged from 987 acute hospitals between April 2014 and September 2015, 8.3% of people with dementia had an unplanned readmission within 30 days, against 4.1% without, an adjusted risk ratio of 1.46. The gap depended on the reason for the first stay: after hip fracture the adjusted risks were 11.5% and 7.9%, but after cholecystitis (gallbladder inflammation) they were almost the same, 12.8% and 12.4%^[7].

In the US, a study of 1,089,109 Medicare hospitalisations in 2016, 19.3% of them of patients with diagnosed dementia, found that 17.7% of patients with dementia were readmitted within 30 days against 13.1% without. After adjusting for other illness, frailty and where people went on discharge, the extra odds were small (adjusted odds ratio 1.02). Within 30 days, 5.7% of patients with dementia had died against 3.1% without (adjusted odds ratio 1.21)^[17]. The clearest signal concerned people discharged home: among patients with dementia, 18.9% of those discharged to the community were readmitted against 16.0% of those discharged to nursing facilities, and when readmitted, 20.7% of the former died during the readmission against 4.4%. The authors point to possible gaps in post-discharge services and support for carers^[17].

What the evidence asks of us

The figures point less to hospitals alone than to the joins between hospital, home and long-term care. They suggest several priorities for services, commissioners and governments.

• Know who is living with dementia when they arrive. The National Audit of Dementia’s sixth “Care in General Hospitals” report, published by the Royal College of Psychiatrists in December 2024, found that hospitals “continue to struggle to identify all people who are living with dementia when they are admitted as inpatients”, and recommended wider use of personal information documents that record a person’s preferences and needs^[18]. The audit also found wide variation between hospitals in assessments and in carers’ ratings of overall care and communication^[18].
• Weigh the harms of admission. NICE guideline NG97 asks clinicians considering admission for a person living with severe dementia to balance current medical needs against the additional harms of hospital, including disorientation, “a longer length of stay”, increased mortality and delirium, and to take into account advance care plans and “the value of keeping them in a familiar environment”^[19].
• Build the care that comes after hospital. Where people with dementia wait in hospital beds for long-term care or home support, as Canadian data show they do at far higher rates, the evidence points to community and residential care capacity as the remedy, not shorter treatment^[2][12]. In British Columbia, continuity of care with the same physician before an urgent admission was associated with less delayed discharge^[12].
• Support people and carers on the way home. The higher readmission and death rates among US patients with dementia discharged to the community suggest gaps in post-discharge services and carer support^[17].
• Fund better trials. When the 2019 meta-analysis was published, no intervention had yet been shown to reduce admissions of community-dwelling people with dementia^[1]. A 2026 umbrella review of 25 systematic reviews found high-certainty evidence that case management and exercise programmes did not reduce hospitalisation, low-certainty evidence that advance care planning reduced admissions, and moderate-certainty evidence that clinical pharmacists in multidisciplinary teams reduced medication-related readmissions^[20]. Its authors call for high-quality randomised trials^[20].

Place of death and palliative care are covered in our study of end-of-life care, and the wider evidence is gathered in the Dementia & Health research library.

Language: this piece uses person-first language ("people living with dementia", "people with dementia"), as most dementia organisations and people with lived experience prefer, and uses clinical terms such as "Alzheimer's disease" or "mild cognitive impairment" only where a study, dataset or diagnosis refers to that specific condition.

Why we're publishing this

Hospital is where many gaps in dementia care become visible: an infection not caught early at home, a ward that does not know the person has dementia, a discharge that waits weeks for a care place. People living with dementia, their families and the organisations that support them meet these gaps every day. We have gathered the international evidence in one place so that their case can rest on clear, cited figures, and so that the problem is located where the evidence puts it: in the design and capacity of services, not in the people who need them.

How to read this data

The figures here come from different kinds of evidence: systematic reviews and meta-analyses, national hospital databases (Canada, Japan, US Medicare), regional linked records (South London, Lombardy, British Columbia, Ontario), health insurance claims (Germany), a single cohort (the US Adult Changes in Thought study) and a national hospital audit (England and Wales). Most rely on recorded diagnoses, so people with undiagnosed dementia are counted as “without dementia”, which may narrow the gaps reported. Measures differ: relative risks, rate ratios, odds ratios and simple percentages are reported as each study gives them and are not interchangeable. Some of the data are old; CIHI’s Canadian figures refer to 2015–2016 and the New Brunswick snapshot to 2009. The evidence comes mainly from high-income countries; we found little from low- and middle-income countries. All of these studies describe associations, not proof that dementia alone causes an admission, a longer stay or a readmission. Australian national hospital figures were not accessible for this review and are not included.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

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