Dementia Care Pathway Research Articles

Memory clinic survey in New Zealand: a second look.

To investigate the changes in publicly funded memory clinics in New Zealand's since the last survey in 2008. We conducted an online survey of the 20 District Health Boards (DHBs) and gathered information on the recently discontinued or established memory clinics. We found dedicated memory clinics in the seven DHBs that have the largest older persons populations in New Zealand. Those DHBs that had discontinued their memory clinics did so because they opted for a more integrated approach using their primary care based dementia care pathway. Increased waiting times, low staffing ratios, variance in cognitive screening tests and patient demographics were reported. There is significant variability in the structure of memory clinics in New Zealand. These clinics could benefit from collaboration and bench-marking of their services.

Health Professional Perspectives on Rehabilitation for People With Dementia.

Multidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from key advocates. Clinician views regarding the relevance of rehabilitation in dementia care are not well known. This qualitative study explored the perspectives of health professionals regarding barriers to provision of multidisciplinary rehabilitation programs for people with dementia. Sixteen health professionals from a variety of settings and professional backgrounds were purposively sampled using maximum variation sampling. Semi-structured interviews were conducted to explore attitudes toward the care of people with dementia and beliefs about the feasibility and value of multidisciplinary rehabilitation in this population. Thematic analysis was used to identify themes. Participating clinicians acknowledged problems with existing dementia care pathways in Australia but rarely conceptualized rehabilitation as relevant to this pathway. Analyses yielded two main and related themes: (i) difficulty defining worthwhile outcomes of a rehabilitation program for people with dementia and (ii) perceived barriers to participation in this population. Clinicians felt that achievable outcomes for people with dementia were not sufficiently worthwhile for investment. Broader acceptance of multidisciplinary rehabilitation as relevant to dementia care will require a reframing of practice that both educates emerging health professionals regarding the outcomes that may be achievable for people with dementia and persuades staff to appreciate that the investment is worthwhile.

Learning from the development of two Integrated Care Pathways for dementia

Introduction: There is an increasing emphasis on the use of Integrated Care Pathways for dementia in the hospital environment. Despite this, the Irish National Audit of Dementia Care in Acute Hospitals De Siun et al. 2014 found that 94% of acute hospitals did not have a dementia care pathway in operation. The Health Service Executive HSE and Genio provided funding to three hospitals in Ireland to develop an ICP for dementia care. An independent evaluation was conducted to uncover the strengths and challenges of the ICPs developed, as well as to collate learning from the sites to further develop ICPs for those living with dementia. Methods: Mixed methods were used to evaluate two of the ICPs developed to date. This included analysis of service provider and service user data, as well as audit and Hospital Inpatient Enquiry HIPE data. Ethical approval was secured from the Faculty of Health Sciences Research Ethics Committees in Trinity College Dublin and relevant hospital Ethics Committees. Results: The complexity involved in developing and rolling out an ICP for dementia was highlighted. Findings demonstrated a number of facilitators and challenges in the development of ICPs. Facilitators included: project leadership; organisational support; dedicated project personnel; project responsiveness; and dovetailing with other clinical, educational or organisational developments. Challenges identified included: competing initiatives and acuity of care demands; absence of standardisation; deficits in communication; and pressure on resources. Discussion and conclusions: The person with dementia and their individualised needs should be central to any innovations in integrated dementia care. A dementia-friendly orientation needs to be embedded in the strategic objectives and operational planning of an organisation in order for meaningful impact to be achieved. Innovation in the development of ICPs needs well-defined governance and visionary leadership. Dedicated resources are required by such leaders to support dementia care development. Findings demonstrated that a consortium approach is beneficial for projects to design, test and implement innovations to develop integrated dementia care. ICP development and dementia-friendly environmental design are protracted and require extensive planning to include process mapping of the care journey, evidence review and multi stakeholder consultation. Therefore, such projects should make consideration of sufficient lead-in time to devise related interventions. Such planning activities should be viewed as sub-components of the overall intervention. In cases where dementia-specific roles are shown to have positively influence project impact, commitment and resources are required to maintain these roles in order to maximise and further develop gains.

Learning from the development of Integrated Care Projects in Dementia

Introduction: Due to demographical shifts and potential high demand for care, increased attention and leadership around dementia care within acute hospital services is anticipated. This is of particular concern due to potential barriers to timely patient flow associated with this cohort of vulnerable service users. This paper aims to report on scope and nature of service delivery reform needed to achieve integration in dementia care within the acute hospital sector. Methods: Three acute hospital sites are included in the analysis, with data collected pre-implementation of the ICP. An audit of hospital organisation/environment and case notes was conducted. Ethical approval was secured from the Faculty of Health Sciences Research Ethics Committees in Trinity College Dublin and relevant hospital Ethics Committees. Results: There was a high level of commitment and enthusiasm amongst service providers for dementia care and the development of an ICP. Data revealed the high demand for dementia-sensitive care and a number of gaps in service provision including absence of formalised dementia care pathways, inconsistent inreach/outreach arrangements between hospital and community, lack of standardisation in documentation and assessment and absence of formal system to alert personnel of dementia diagnosis. Gaps at an environmental and ward level such as reduced staffing levels were noted. The physical limitation of hospital as a suitable care environment for PwD was also highlighted. Areas for improvement to be addressed included colour schemes to allow PwD to find their way around the ward and clear marking of key areas. Pressure on resources and the need for active management of patients were highlighted as potential barriers to dementia care. A number of obstacles to optimal and timely patient flow were detected. The need for a central record was one of the most important aspects of early learning. Difficulties within the journey of care were highlighted including, for example, difficulties in assessment, delays in resolving capacity issues, high level of movement of patients within the hospital, and insufficiency in suitable community care provision. Discussion: Findings highlight the significant and wide reaching reforms needed in all aspects of service delivery so the hospital care environment may be optimised to meet the needs of PwD. Such reform necessitates a coherent dementia strategy within hospitals so the environment, care processes and staff are appropriately responsive to the needs of PwD. Considerable investment of time and resources is needed to fully understand the systems and processes that underpin the quality of integration in dementia care. The implementation of the proposed ICP is a lengthy and onerous process and there is significant change yet to be implemented within the three sites. These findings will inform the respective development and implementation process. Conclusion: The findings outlined here provide an important comparison for assessment post-implementation of the ICP across all sites. There is significant early learning from the data, both on a national and international level, in relation to the development and implementation of ICPs in an acute hospital setting, with critical barriers to same highlighted.

A novel integrated care pathway for people with dementia presenting to acute hospitals

Introduction: Almost 30% of older people admitted to acute hospitals in Ireland have dementia, but only 1/3 of these have a known diagnosis in the community. Thus hospital staff are often treating patients with dementia without knowing it. Acute hospitalisation is a pivotal time for a person with dementia, associated with longer length of stay, poor assessment by hospital staff of the dementia, and often discharge to long-term care post hospitalisation. No hospital in Ireland had a functioning dementia care pathway in 2014. Practice change implemented: Introduction of a novel dementia pathway in an acute hospital as follows: all older people (≥70 years) screened for cognitive vulnerability (delirium, dementia, or delirium on dementia) on admission to hospital; patients with known dementia following a novel dementia pathway throughout their hospital stay, including daily delirium screening and a dementia care bundle, and an in-reach community dementia service to allow seamless post-discharge support; enhanced communication with community at time of discharge; patients with suspected dementia following a novel diagnostic pathway with streamlined access to diagnostic clinics and post-diagnostic support in the community. Aim and theory of change: A dementia pathway would improve the detection of cognitive vulnerability and the prevention/detection of delirium and would also standardise and improve integrated care. Targeted population: People with dementia or possible dementia presenting to an acute hospital; stakeholders: hospital staff (especially nurses), patients, carers, hospital management; community based healthcare workers and managers Timeline: Preparation (literature review, process mapping of patient journey through hospital and into community; staff and stakeholder engagement; development of pathway with wide consultation and input): 1 year; piloting and modification of pathway on a single ward: 6 months; roll-out to other wards: 6 months. Highlights: (innovation, Impact and outcomes) The pathway development process was robust and was a partnership with multiple hospital stakeholders, including patients and carers, and the community with a consrtium of 45 people across the hospital and community working together. The pathway incorporated national delirium screening algorithms and for the Emergency Department, a combined dementia/delirium care bundle was developed to meet their need for a simple, easy-to-administer bundle that could be used even when the diagnosis of dementia and/or delirium was not yet clear. Existing community based services were used, but enhanced communication and a novel in-reach community dementia service led to integrated discharge planning and post discharge support. The impact and outcomes are being evaluated by an external agency currently. Comments on sustainability: This pathway functions ideally with a dementia nurse specialist at its core, but can be used without this post in place. It bundles together core nursing activities, with some small areas of new practice (daily delirium screening, enhanced information gathering via a patient “passport”) which have been sustained in the participating wards thus far. Comments on transferability: This pathway was designed to be transferrable to other acute hospitals and community areas in Ireland with minor adaptations only.

A Systematic Review of the Economic Evidence for Home Support Interventions in Dementia.

Recent evidence signals the need for effective forms of home support to people with dementia and their carers. The cost-effectiveness evidence of different approaches to support is scant. To appraise economic evidence on the cost-effectiveness of home support interventions for dementia to inform future evaluation. A systematic literature review of full and partial economic evaluations was performed using the British National Health Service Economic Evaluation Database supplemented by additional references. Study characteristics and findings, including incremental cost-effectiveness ratios, when available, were summarized narratively. Study quality was appraised using the National Health Service Economic Evaluation Database critical appraisal criteria and independent ratings, agreed by two reviewers. Studies were located on a permutation matrix describing their mix of incremental costs/effects to aid decision making. Of the 151 articles retrieved, 14 studies met the inclusion criteria: 8 concerning support to people with dementia and 6 to carers. Five studies were incremental cost-utility analyses, seven were cost-effectiveness analyses, and two were cost consequences analyses. Five studies expressed incremental cost-effectiveness ratios as cost per quality-adjusted life-year (£6,696-£207,942 per quality-adjusted life-year). In four studies, interventions were dominant over usual care. Two interventions were more costly but more beneficial and were favorable against current acceptability thresholds. Occupational therapy, home-based exercise, and a carers' coping intervention emerged as cost-effective approaches for which there was better evidence. These interventions used environmental modifications, behavior management, physical activity, and emotional support as active components. More robust evidence is needed to judge the value of these and other interventions across the dementia care pathway.

Technology-based tools and services for people with dementia and carers: Mapping technology onto the dementia care pathway.

The extent to which technology may be able to support people with dementia and their carers along the care pathway and in different care settings is of interest to policy makers and governments. In this paper we provide an overview of the role of technology in dementia care, treatment and support by mapping existing technologies - by function, target user and disease progression. Technologies identified are classified into seven functions: memory support, treatment, safety and security, training, care delivery, social interaction and other. Different groups of potential users are distinguished: people with mild cognitive impairment and early stages of dementia, people with moderate to severe dementia and unpaid carers and health- and social care professionals. We also identified the care settings, in which the technologies are used (or for which the technologies are developed): at home in the community and in institutional care settings. The evidence has been drawn from a rapid review of the literature, expert interviews and web and social media searches. The largest number of technologies identified aim to enhance the safety and security of people with dementia living in the community. These devices are often passive monitors, such as smoke detectors. Other safety interventions, such as panic buttons, require active intervention. The second largest number of interventions aims to enhance people's memory and includes global positioning systems devices and voice prompts. These technologies mostly target people in the early stages of dementia. A third group focusing on treatment and care delivery emerged from the literature. These interventions focus on technology-aided reminiscence or therapeutic aspects of care for people with dementia and their carers. While the review found a range of technologies available for people with dementia and carers there is very little evidence of widespread practical application. Instead, it appears that stakeholders frequently rely on everyday technologies re-purposed to meet their needs.

ALZCARE: an information system for screening, management and tracking of demented patients.

The ALZCARE project aims at assisting people at risk or already suffering of dementia, their family and health professionals in the dementia care pathway by providing an integrated ICT-enabled information System. The system consists of a mobile platform for screening people at risk, a Clinical Information System and a satellite-based patient tracking system. The system is currently on the evaluation phase focusing on addressing the needs of citizens of the cross-border areas of Greece and Albania.

DEVELOPING A DEMENTIA CARE PATHWAY IN ACUTE CARE HOSPITALS: A REVIEW OF THE LITERATURE

DEVELOPING A DEMENTIA CARE PATHWAY IN ACUTE CARE HOSPITALS: A REVIEW OF THE LITERATURE

Care pathways for dementia: current perspectives.

Uncertainty appears to typify the experience of living with dementia. With an uncertain illness trajectory and unpredictable levels of deterioration and stability in symptoms, people with a diagnosis of dementia may live with uncertainty and anxiety and find it hard to make plans or decisions for their future. People with memory problems and caregivers seeking a diagnosis of dementia may also potentially find themselves navigating a labyrinth-like maze of services, practitioners, assessments, and memory tests, with limited understanding of test scores and little information about what support is available. In this context of uncertainty, the apparent clarity and certainty of a “dementia care pathway” may be attractive. However, the term “dementia care pathway” has multiple and overlapping meanings, which can potentially give rise to further confusion if these are ill-defined or a false consensus is presumed. This review distinguishes four meanings: 1) a mechanism for the management and containment of uncertainty and confusion, useful for the professional as well as the person with dementia; 2) a manual for sequencing care activities; 3) a guide to consumers, indicating eligibility for care activities, or a guide to self-management for dementia dyads, indicating the appropriateness of care activities; and 4) a manual for “walking with” the person. Examples of these approaches are presented from UK dementia services with illustrations of existing care pathways and associated time points, specifically focusing on: 1) early symptom identification and first service encounters, 2) assessment process, 3) diagnostic disclosure, 4) postdiagnostic support, and 5) appropriate interventions. We review the evidence around these themes, as well as discuss service pathways and referral routes used by some services in England and internationally. We conclude that the attraction of the term “care pathway” is seductive, but caution is needed in taking shared understandings for granted.

The design and implementation of a computer supported assessment of Dementia - ACEmobile

Introduction: There is increasing need to be able to reliably diagnose Alzheimer’s Disease (AD) in the NHS. With an aging population, the number of patients expected to have dementia is predicted to double by 2030 (www.dementia2010.org). Despite developments in NHS memory clinic services, currently, 50% of patients with dementia may never receive a formal diagnosis and many do not receive a diagnosis until they are in the moderate/severe stages. There is a need to develop measures to assess dementia that are valid, sensitive, reliable and, importantly, fit for use in routine care. The demand on the NHS dementia care pathway, with high numbers of referrals and limited clinician time, means assessments need to be quick, easy to administer and cost effective. The Addenbrooke’s Cognitive Examination Revised (ACE-R), recently updated to the ACE-III, is one of the most widely used bedside cognitive assessments in the UK, with demonstrated efficacy in the diagnosis of AD. It is commonly used the routine NHS assessment of cognitive impairment associated with the onset of dementia (Larner 2007). Estimates suggest that over 150 clinical and research centres in the UK and internationally routinely use the ACE-R (Mioshi et al, 2006). The traditional paper-based version takes 10-15 mins to complete and is subject to administrator and scoring errors, and is time-consuming to analyse. To support the clinical use of the tool, a computerised version of ACE-III was developed – ACEmobile. Method: In developing ACEmobile a range of steps were necessary including design, usability testing, acceptability feedback, implementation considerations, NHS data governance, validation testing and software security. These were all undertaken with continual consideration of best clinical practice and optimal patient benefit. ACEmobile was designed by clinicians for clinicians. Results: ACEmobile is a tablet based software package developed to support the administration of the Addenbrooke's Cognitive Examination III (ACE-III) in the assessment of dementia. The tool is designed to guide the dementia clinician through the administration, to autoscore the patient's responses and to generate a report to be added into the clinical notes. The development of International Digital Health and Care Congress, The King’s Fund, London, September 10-12 2014. International Journal of Integrated Care – Volume 14, 01 November – URN:NBN:NL:UI:10-1-116506– http://www.ijic.org/ ACEmobile has been led by a small team of clinicians with a vision to support local, national and international dementia assessment, at no cost to the clinical users. ACEmobile provides a tool for collecting anonymised assessment data on an international scale, supporting research and being supported by research. Conclusion: ACEmobile is free to download and use around the world and represents a joint venture between the NHS (Plymouth Hospitals NHS Trust) and an academic institution (Plymouth University).

Dementia Service User Involvement in the FPOP Dementia Workstream papers on the Early Stages Dementia Care Pathway

This article will describe an innovative approach to involving people with dementia in contributing to and shaping the FPOP Dementia Workstream’s series of papers to inform best practice across the early/moderate dementia care pathways.

Dementia Care in Eight European Countries: Developing a Mapping System to Explore Systems

There is a knowledge gap with regard to the structure of the care and service system available to persons with dementia. This is very much a concern for nurses who are the main providers in the care of dementia. The study, a part of the "RightTimePlaceCare" project, describes the development and content of a mapping system aimed at exploring the content of care and service for persons with dementia and their informal caregiver throughout the disease trajectory. The usefulness of the mapping system is illustrated in describing the availability of care and service at the diagnostic stage, and at the institutional and palliative stages. A descriptive cross-country design concerning eight European countries differing in demographic composition and terms of long-term care provided is employed. A modified consensus strategy was used to develop the mapping system and define the terminology. Thereafter, each country's mapping system was completed by its research group collecting country-specific information and using expert groups either as consultants or for completing the system. The consensus procedure worked satisfactorily with regard to content and definitions, whereas assessing the availability and utilization of care and service was problematic. Some 50 types care and service activities were identified and defined and were categorized as follows: (a) screening, diagnostic procedures, and treatment of dementia; (b) outpatient care facilities; (c) care at home; (d) institutional care; (e) palliative care; (f) informal caregiving and supportive actions; and (g) civic activities. Care at home included the broadest range of activities; palliative care, informal caregiving, and supportive actions were the smallest range. The dementia care systems were found to be comprehensive and to emphasize home care. Activities aimed at transferring knowledge to informal caregivers, though highly important for home care, seemed less extensive. The mapping system appears useful from a nurse manager's standpoint for exploring the dementia care pathway. Comparisons between countries appear useful for developing the care system and for sharing information of how to perfect it. Further testing and development are needed regarding information on the availability and utilization of care and service activities. The mapping system can be useful in clarifying the dementia care system for those concerned, in helping nurse researchers and managers review and initiate evaluation and communicate with policy makers, as well as to ensure that providers use appropriate parts of the system. It can also be useful in national and international comparative studies.

Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems?

BackgroundThe Ministry of Health, Labour, and Welfare of the Japanese national government announced a “Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)” in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies. MethodsAn international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy. The study consisted of a bibliographical survey, a field survey, and an online case vignette survey in several countries. ResultsThe Japanese health- and social-care system had multiple access points in the dementia care pathway, as did Australia, France, South Korea, and the Netherlands. Contrary to Japan, a simplified access point was observed in Denmark, England, and Sweden. The Orange Plan aimed to establish specific health-care services, social-care services, and the coordination of agencies for persons with dementia. However, fragmentation remains in the dementia care pathway. ConclusionThe national government should examine fundamental revisions in health, social-care services, and advocacy in joint initiatives with Alzheimer's Association Japan to improve the national dementia strategy.

The effect of funding status on duration of stay for inpatients with dementia

PurposeThis study is a follow‐up to a previously published paper, by Ball et al. in 2004. The purpose of the study was to examine the factors that influenced the discharge outcomes and duration of stay over the three years since the introduction of the National Framework for Continuing Health Care (CHC) provision in October 2007.Design/methodology/approachThis study examined consecutive dementia patients (n=175) admitted to an organic elderly mental health assessment ward over a three‐year period between January 2008 and December 2010. The majority of patients in the study had vascular dementia (34 per cent) or Alzheimer's disease (31 per cent) with an average score of 11.5 in the Mini‐Mental State Examination. The assessment tools used in this study were good indicators as part of the dementia care pathway to predict the rehabilitation outcome.FindingsThe mean duration of stay of patients was 8.4 weeks but this was extended to 18.3 weeks for the 15 per cent of patients subject to CHC funding. Patients who require CHC funding can expect to stay in hospital for more than ten weeks before a placement is made. Duration of stay was longer for those patients with behavioural and psychological complications, but the strongest independent predictor of duration of stay was CHC funding which accounted for 23 per cent of the duration of stay in hospital, independently of any clinical parameters in the patient.Originality/valueThis study provides evidence of the effect of current funding procedures in the discharge of inpatients with dementia from an assessment ward.

Educating and Training the Workforce to Work with People with Dementia: Two Projects from the United Kingdom

Educating and training the dementia workforce is a global challenge, given the expected increasing number of people living with dementia across the world as the population ages. Two projects from the UK (one regionally and one locality based) investigated courses available to the workforce and mapped the content of identified courses against a locally developed dementia care pathway. The locality project included a survey of what percentage of staff time was spent with people living with dementia, and what percentage of staff caseloads were devoted to people living with dementia. There was a great variation in the extent of education and training available, with some stages of the dementia care pathway poorly addressed. An educational strategy for the dementia workforce in the UK might include four categories of education and training: basic dementia awareness, intermediate level, advanced level, and dementia awareness for managers. Staff requiring education and training might be divided into three groups: those employed to work specifically with people living with dementia and their families; those working with people who have other conditions but some of whom will have a coincidental dementia; those working with other conditions but in settings where a high proportion of their patients have a comorbid dementia. To improve workforce skills in dementia care will require actions across the whole of education and training for professionals and untrained workers who provide services to this group.

A systematic review of religion and dementia care pathways in black and minority ethnic populations

Objective: To investigate how religion influences care pathways for black and minority ethnic individuals with dementia. We conducted a systematic search of the literature to explore how religion affects later presentation to care services, absence of care-seeking and dissatisfaction with care. Exclusion and Inclusion criteria were applied to the research literature. Qualitative and quantitative papers were included. Included studies were assessed independently by four authors according to quality criteria. Two US studies adhered to the final screening stage. Findings from these papers postulated that religion influences care in two polarised ways: (1) Religion hinders access to the traditional health care pathway. (2) Religion assists in positive coping. Collaboration between religious institutions and health care providers is required to improve care referral, provide information dissemination and relieve care-giver burden. UK research in this area is necessary.

Evaluating a service against the Good Practice Standards for Dementia and People who have Learning Disabilities

The increasing population of older people with a learning disability (LD) has led to a growth in the rates of dementia in this population. This paper presents an evaluation of the provision and quality of dementia care currently provided in one locality where health and social care providers are co-terminus.A self-assessment checklist containing 15 best practice standards for care of people with LD and dementia was published by the British Psychological Society and the Royal College of Psychiatrists (Dodd et al., 2009).Each standard can be rated using a traffic light system of green, amber or red depending how well the local service meets the best practice standard. Interviews were held with 15 staff from LD and older adult’s services to examine how well the currently provided LD dementia care met with the standards set out in the checklist. Two standards were rated green, eleven were rated amber and two were rated red. A number of recommendations are made on the basis of these findings and are detailed in the report. The most important of these for changing the care provided are:The development of a multi-agency dementia strategy and care pathway for people with LD.The need for baseline dementia assessments for people with DS at 30 years of age.An investigation into the potential errors in Social Services’ database.

Duration of stay and outcome for inpatients on an assessment ward for elderly patients with cognitive impairment

The move away from the provision of long‐stay beds by the NHS inevitably meant a change in function for wards for elderly patients with cognitive impairment to a more acute way of working. Literature is scarce on the role or effectiveness of the new assessment wards that have replaced them and the factors affecting outcome and the duration of stay. Evidence suggests that those patients with higher dependency levels and behavioural problems stay in hospital longer, as do those awaiting a nursing home placement.This paper reports a prospective study of a consecutive group of 101 patients who died on or were discharged from an acute assessment ward for elderly patients with cognitive impairment. Clinical characteristics were recorded according to an in‐patient dementia care pathway, which included Mini‐MOUSEPAD, Crichton activities of daily living, Mini‐Mental State Examination and the Burvill physical health score evaluations. Outcome measures were duration of stay, destination on discharge or death on the ward.Most patients had cerebrovascular disease (48%) or Alzheimer's disease (32.9%), and their average Mini‐Mental State Examination score was 14.9. The mean duration of stay was 7.9 weeks. Self‐funding status and lack of behavioural and psychological complications were associated with a reduced duration of stay. 22.2% of patients were successfully rehabilitated to their own homes, but 20% died. Discharge home was most strongly predicted by having a spouse at home, and the need for nursing home rather than residential care was related to the severity of cognitive impairment. This study concludes that patients can expect to stay in hospital for 8 weeks but two areas of concern are highlighted. Firstly, the importance of the funding of community rehabilitation for patients with memory disorders and, secondly, the importance of a spouse at home to look after the patient.