Introduction People with dementia admitted to acute hospitals often receive poor care, many of whom die in this setting. The BePaid study (Behaviour and Pain in Dementia) is funded jointly by Alzheimer's Society and the BUPA Foundation.

Aims and Methods A longitudinal cohort study in two London hospitals providing evidence about mortality rates, pain and carer satisfaction using the following tools: Pain Assessment in Advanced Dementia (PAINAD), medical notes review and carer questionnaire.

Results 230 patients were recruited, with a mortality rate of 13%. 70% of deaths were documented as expected, with 77% of those individuals being put on the Liverpool Care Pathway. Only 17% of patients that subsequently died were referred to the palliative care team during their admission and 27% died with a pressure sore (grades 1–4). 50% of patients were noted by clinicians to be in pain in the last 48 h of life. Mean pain score throughout admission for these that died was 2.69 on the PAINAD, in comparison to 1.49 for those who were discharged. Of those that died, 45% of carers were a little dissatisfied/ dissatisfied with the overall quality of care provided on the ward.

Conclusions Recognising and planning for dying in the acute setting is challenging for clinicians. Palliative Care Teams are not being regularly involved in this process. The data highlights the importance of assessing and managing pain until the end of life. Hospitals need to focus on working with relatives to improve satisfaction with overall quality of care for those whose relatives are dying.