Previously designed interventions to reduce hospitalisations in people with dementia have not been found to be effective. Understanding these would help to plan services for future increasing numbers of people with dementia. In this systematic review, we aimed to examine the rates of all general hospitalisations of people with dementia, whether these differ from those without dementia, and to identify socio-demographic and clinical predictors of admission. Admissions are costlier for people with dementia than those without, and pressures on hospitals to reduce admission length could also mean that people with dementia are prematurely discharged from hospital into long-term care. Avoidable admissions are more frequent for people with dementia and readmission is common. Hospital admissions can be harmful and distressing for people with dementia who are less likely to receive adequate pain relief, more likely to receive potentially harmful medication, have a higher risk of delirium than those without dementia, and commonly decline functionally during admission. The number of older people is expected to rise throughout the century, with the number of people with dementia rising in parallel. Future interventions to reduce unnecessary hospitalisations should target potentially modifiable factors, such as polypharmacy and functional ability, in high-risk populations. People with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. There was strong evidence that dementia severity alone is not associated. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. Hospitalisation rates in people with dementia were between 0.37 and 1.26/person-year in high-quality studies. The pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. We included 34 studies of 277,432 people with dementia: 17 from the USA, 15 from Europe, and 2 from Asia. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia. Three authors graded evidence strength using Cochrane’s GRADE approach, including assessing for evidence of publication bias using Begg’s test. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. We searched MEDLINE, Embase, and PsycINFO from inception to. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia and to identify socio-demographic and clinical predictors of hospitalisation. However, no intervention has yet reduced admissions of community-dwelling people with dementia. Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority.
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