Agreement: I Agree Body: Dear Editor David Oliver’s article on emergency care makes the case for dedicated funding and more resources for more hospital and community services to better manage people presenting with frailty and cognitive impairment. Whilst any improvements in hospital and community care is of course to be welcomed primary prevention of these conditions, is even more important as is the need to improve housing and other basic services as he emphasised in his previous Acute Perspective (1). The evidence that the incidence and prevalence of dementia can be reduced, produced by the Lancet Commission on Dementia, (2) is very strong and the risk factors for frailty are very similar so the incidence and prevalence of both could be reduced through simple and cost effective actions that people themselves can take. Furthermore the same factors that increase risk such as inactivity and isolation also accelerate decline once the diagnosis is given, usually without any helpful information such as links to the excellent support services offered by Dementia UK, Age UK and Alzheimer’s Research. What is lacking is a commitment from the health and care services to prioritise to making these known to people and carers including health professionals. We cannot continue to build up the hospital services and add further layers into community services without first pump priming what we know works. Risk reduction works - all the evidence points to it. (3) It is about time the Department of Health and Social Care stepped up to the delivered a national program to ensure everyone had access to the knowledge about how they can reduce the impact of dementia and frailty. The newly published House of Commons report on Healthy Ageing, is sub-titled Physical activity in an ageing society but all its clear and powerful recommendations are equally relevant for a new approach to dementia. Muir Gray, Charles Alessi and Larry Chambers 1. Oliver D (2026) Unmet care and housing needs are often behind lengthy hospital admissions. BMJ 392 s463 2. Livingston G et al (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024; 404: 572–628 3. Chambers LC et al (2026). Increase your Brainability; Reduce the Risk and Impact of Dementia. Offox Press No competing Interests: No competing interests The following competing Interests: We are the authors of a book on reducing the impact of dementia www.reducetheriskandimpactofdementia.com Electronic Publication Date: Saturday, May 23, 2026 - 07:13 AI use: No, I have not used AI Highwire Comment Subject: David Oliver: Overcrowded emergency departments are bad news for patients with delirium and dementia Workflow State: Released Full Title: Re: David Oliver: Overcrowded emergency departments are bad news for patients with delirium and dementia Highwire Comment Response to: David Oliver: Overcrowded emergency departments are bad news for patients with delirium and dementia Check this box if you would like your letter to appear anonymously:: Last Name: Gray First name and middle initial: Muir Email: muir.gray@oapltd.com Address: Oxford Occupation: public health professional Other Authors: Charles Alessi, Larry Chambers Affiliation: www.livelongerbetter.uk BMJ: Additional Article Info: Rapid response