Safety Implications for the Homebound Patient With Dementia

Fall risks and the related factors for the homebound older people with dementia: Evidence from East China

Purpose

Falls are a major public health problem, especially for older people. This research aimed to provide a direct illustration of fall risks among the homebound older people with dementia in China, and to identify the risk factors associated with it.

Methods

In 2020, a questionnaire-based field survey was used to assess 1,042 people aged over 60 years in Ningbo, Eastern China. The Morse Fall Risk Scale's result was employed as the dependent variable, while the basic health problems, living environment difficulties, social support problems, and behavioral awareness issues were utilized as the independent variables; subsequently, chi-squared tests and four multivariate ordinarily ordered logistic regression models were performed.

Results

Overall, nine hundred and thirty-one older people with dementia were included in this study (the effective rate was 89.34%), with the majority of them having severe dementia (27.9%). Furthermore, 16.2% had fallen in the past 3 months, and 16.8% were at a high risk of falling. The risk factors for the older people's cognitive function included 80-90 years old, vascular dementia, marital status, and history of falls (P < 0.05); the kinds of chronic diseases, the activities of daily living, living environment, caregiver burden, caregiver knowledge, the Cohen Mansfield Agitation Inventory results, and the Clinical Dementia Rating were the protective factors for the risk of falls in them (P < 0.05).

Conclusion

The risk of falling of the Chinese homebound older people with dementia was high. Their caregivers, such as relatives, need to pay attention to these risk factors and perform appropriate measures to prevent falls.

Development of a Psychometric Test: A Care Risk Scale for Homebound Older People With Dementia

Background

Homebound older people with dementia (OPWD) face a series of care risks due to disease characteristics, care issues, and the family environment. However, China lacks a quantitative assessment tool for care risk. Thus, we attempted to develop a care risk scale for homebound OPWD.

Methods

A care risk scale, with initially 18 items, was designed based on a systematic literature review, expert consultation, and a pilot study with 20 OPWD. The initial scale was validated among 1,045 homebound OPWD in Ningbo, China from November 1, 2020 to July 30, 2021. After removing three items that lacked discrimination power, the reliability and validity of the remaining 15 items was evaluated. Factor extraction was performed via principal axis factoring and Cattell's scree plot analysis, with the resulting factors then being subjected to a varimax rotation.

Results

The final scale consisted of 15 items assessed on a 5-point Likert scale that loaded on to three different factors, including dementia symptoms (four items), family support (four items), and home environment (seven items). These three factors were found to explain 72.9% of the cumulative variance. The overall Cronbach's alpha for the final scale was 0.907. The correlation coefficients in the item-to-total analysis ranged from 0.511 to 0.662.

Conclusion

The validation analysis indicated satisfactory reliability and validity of the 15-item scale for assessing care risk of homebound OPWD. This scale can help long-term care professionals and family caregivers identify care risks and help them take targeted measures to enhance safety of care for OPWD.

Lack of Any Caregiving for Those with Dementia

Older adults with significant cognitive impairment require help with activities of daily living. The BASIC-Cognitive Project, set in Nueces County, Texas, is a community-based study examining trends in cognition among Mexican Americans and non-Hispanic Whites. Using cross-sectional data from a cohort study, we found that at least 7% of individuals aged 65 and older with a Montreal Cognitive Assessment (MoCA) score of < 20 (or < 15 for telephone MoCA), did not receive any caregiving help. This conservative estimate highlights an important community need for those with significant cognitive impairment and has implications regarding safety and care for older adults.