Delayed discharge in alcohol-related dementia: consequences and possibilities for improvement.

Abstract

Individuals with alcohol-related dementia (ARD) are over-represented among ‘difficult to discharge’ patients. ARD is associated with prolonged hospital stay and high rates of discharge at own risk. Risk factors for delayed discharge in patients with ARD include: a lack of appropriate medical and social support; multiple and complex needs; psychiatric symptoms; challenging behaviours; and an unmet need for appropriate residential care. Integration into present services is problematic and aged care is not an acceptable option for these patients. The present paper identifies three key possibilities to reduce the burden of prolonged hospitalisation of patients with ARD. These are: improved availability of specialised, multidisciplinary care pathways for patients with ARD, many of which could be developed out of existing services; the development of flexible supported-accommodation options, including harm minimisation, for the subset of patients who are not able to live independently; and improved practice in the emergency department (ED) to ensure timely administration of parenteral thiamine to all patients at risk of developing ARD.