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Commentary on: Meuleners LB, Hobday MB. A population-based study examining injury in older adults with and without dementia. J Am Geriatr Soc 2017;65:520–5.
Implications for practice and research
Nurses should assess older adults for dementia and anticipate potential safety risks. Caregivers and older adults need education on interventions such as fall prevention, home safety measures and supervision of those with dementia.
Additional rigorous studies are needed to test fall and injury prevention interventions in dementia populations.
People with Alzheimer’s disease often develop impairments in executive function, resulting in poor judgement and unsafe behaviours.1 These problems put them at risk of accidents and injuries, particularly in the home environment. Coupled with ageing changes and disease processes, the person with dementia may develop functional decline that can lead to accidents and injuries. A number of interventions have been studied to address these problems in people with dementia; many have small samples and are not rigorous designs. This study by Mueleners and colleagues confirms the increased risk of injuries and common causes resulting in hospitalisations among people with dementia.
The purpose of this study was to examine the incidence and risk factors for injuries in older adults with and without dementia. The population-based cohort study included over 29 000 older adults with dementia admitted to the hospital between 2001 and 2011 in Western Australia. A comparison group of 32 277 older people without dementia was randomly selected from the state election rolls. Researchers compared data on hospitalisations for injuries of at least 24 hours, based on the presence of dementia, demographic characteristics, comorbid health conditions, cause and severity of the injury and length of stay. Further, risk factors for injuries were identified using a Poisson regression model.
Of those with dementia, 12.5% were admitted to the hospital for an injury compared with 5% of those without dementia. The most common causes of injuries for all older adults were falls, followed by transportation-related injuries and burns. Some injuries were due to being struck by an object or cuts. Older adults with dementia had double the risk of admission for injuries (IRR=2.05, 95% CI 1.96 to 2.15). Risk factors for injuries besides dementia included age over 85, being male, not being married, prior fall and having a comorbid health condition.
This study confirms the continued common occurrence of injuries in older adults, especially those with dementia. Falls were the most frequent reason for hospitalisation from injuries and the second most common were related to transportation, including car, pedestrian, bus and bicycle crashes. Research suggests that risk factors for motor vehicle crashes and falls are similar.2 As a result, assessment of these common risk factors and interventions to reduce accidents should be a priority given the growing population of older adults with dementia worldwide. Other causes of injuries were burns and cuts. Prior researchers reported the additional safety problems of wandering, medication errors or misuse and firearms.3 4 The methods used in this study of examining hospital data provided the ability to identify direct injury causes, but may not pick up secondary issues such as inappropriate medication use or wandering that may underlie these accidents. Additional methods may be needed to explore the full extent of the impact of these issues on injuries in people with dementia. Lack of identification of firearms as a cause of injury may be related to cultural or availability differences based on the location of the study.
Safety risks in people with dementia have long been recognised, particularly falls.5 There is growing evidence of the benefits of interventions for falls in older adults with dementia, such as exercise.6 Additional caregiver factors and living situations warrant further exploration, as well as the development and testing of additional interventions to reduce injuries,1 including in diverse populations. The findings of this study should serve as a call to action for researchers and healthcare providers. Healthcare providers need more evidence-based interventions to guide the assessment of safety problems, as well as translation and dissemination of these interventions to reduce falls and injuries in this population.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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