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NRI 97-030 – HSR&D Study

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NRI 97-030
Safety Enhancement to Prevent Home Injury to Veterans with Alzheimer's Disease
Kathy J Horvath PhD RN
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: April 2000 - September 2003

BACKGROUND/RATIONALE:
Accidents and injuries in the home cause increased morbidity for persons with dementia and long term institutionalization that might have been avoided or delayed. Dementia caregivers need tangible help and practical education to keep their care recipients safe.

OBJECTIVE(S):
To develop interventions to provide the caregiver the knowledge and self-confidence to prevent risky behaviors that lead to injuries and provide an environmentally safe home living situation for the care-recipient. Specific aims are to: 1) Describe the range of less effective – more effective caregiver behaviors used to manage a dementia care recipient at home; 2) Identify the environmental dangers for injury risk and accidents in homes; 3) Investigate the range of home environmental modifications to which families agree; 4) Determine the costs and logistics of making home safety modifications; 5) Develop an instrument to quantify home safety for use in future research.

METHODS:
Phase One had two components: 1) a purposive sample of 17 interdisciplinary professionals who support caregivers living with a person with dementia were interviewed. Qualitative data analysis included thematic analysis and integration with the extant literature. 2) Qualitative analysis and descriptive statistics were summarized for the first 42 families who received a home safety visit by a nurse researcher and occupational therapist. In Phase two, the final sample of 52 families received a home visit and safety assessment. Cost data, standardized measures of cognitive and functional ability of the care-recipient, and demographic variables were collected. Data analysis includes bivariate correlations and regression models to explore the relationships among the variables.

FINDINGS/RESULTS:
(1) Caregivers take chances and allow gaps in supervision because they don’t know about or don’t have other options, because they don’t recognize the early signs of dementia and/or don’t understand the nature of the illness. Caregivers’ readiness and effectiveness in making home safety modifications are influenced by the risky behaviors exhibited by the care recipient, by family support and resilience to make role changes, alliance with professional caregivers, community services and education, and prior direct or vicarious experience with care giving. (2) The most frequent risks for injury in the home are wandering, falls/tripping, turning on the stove inappropriately, and access to knives on countertops. Although not frequent, there is serious risk from access to firearms and car keys. (3) Families are most receptive to home safety modifications that a) do not create a daily inconvenience to the caregiver, and b) do not require technical expertise to install. (4) The average cost per family for home safety items is $79.00 (range $18.00 - $249.00). Time, cost, and access to technical help are logistical issues for many families. Caregivers report that specific information on low-cost items and where they can be purchased is important.

IMPACT:
As the population ages, the incidence of dementia also increases, while a restructured health environment tries to provide care in the least-costly setting. Professional care providers will need a full understanding of how to help family caregivers manage their care recipient with dementia in a home environment longer, without increased risk of accident, injury, morbidity and mortality.

PUBLICATIONS:

Journal Articles

  1. Hurley AC, Gauthier MA, Horvath KJ, Harvey R, Smith SJ, Trudeau S, Cipolloni PB, Hendricks A, Duffy M. Promoting safer home environments for persons with Alzheimer's disease. The Home Safety/Injury Model. Journal of gerontological nursing. 2004 Jun 1; 30(6):43-51.


DRA: Mental, Cognitive and Behavioral Disorders, Aging, Older Veterans' Health and Care, Health Systems
DRE: Prevention
Keywords: Dementia, Nursing, Safety
MeSH Terms: none

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