This article highlights the vulnerability of people with dementia in the acute hospital setting, where they are more likely to experience clinical incidents such as falls, contract infections and be prescribed neuroleptic drugs. This patient group has a significantly longer length of hospital stay and higher mortality rate following discharge compared with those without dementia. As many as one third are discharged to institutionalised care. The article explores the knowledge gap concerning the complexity of caring for a person with dementia and highlights factors that can lead to staff detaching themselves from engaging in meaningful communication with patients. It also discusses the syndrome of ‘cascade iatrogenesis’ in relation to patients' physical and cognitive decline. More emphasis needs to be placed on addressing these issues to ensure the safety and welfare of people with dementia in hospitals. A case study from the author's clinical practice is used to illustrate the issues.

Lesley Butcher - Lecturer in Adult Nursing, Cardiff University, School of Healthcare Sciences, Cardiff