Objectives: Injury from accidents are the 7th (over age 65) and 5th (over age 85) leading cause of death in elders. The risk of injury and complications increases with cognitive or functional impairment and dementia symptoms, e.g. poor judgment, inappropriate response, wandering, and agitation. The overall goal of this project is to intervene before an injury by providing an environmentally safe home living situation for the veteran before risky behaviors that lead to accident or injury occur. We 1) Identified the environmental dangers for injury risk and accidents in homes; and 2) Investigated the range of home environmental modifications to which families agree. Design: Qualitative, descriptive. Population, Sample, Setting, Years: Caregiver/care-recipient dyads recruited from the families enrolled in an outpatient clinic for progressive dementias at a Veterans Administration hospital in the Northeast. Inclusion criteria include caregiver living with care-recipient and expectation to be at home for 6 months. Variables: Care-recipient’s risky behaviors; Care-recipient’s incidents/injuries; Type and Number of safety modifications implemented; Barriers to implementing safety modifications; Caregiver’s response to home safety recommendations and their perceived value. Methods: Data Collection – Initial home safety visit by a nurse researcher and occupational therapist. Digital photos of the home with safety recommendations sent to the caregiver. Monthly phone calls by the nurse researcher to discuss accidents and/or “close calls”, barriers to implementing safety modifications and additional safety concerns; Six-month follow-up home visit by nurse researcher with audio-taped semi-structured interview. Data Analysis – Descriptive statistics for environmental dangers observed in homes, modifications that families made, and barriers to implementing recommended changes; Qualitative analysis of 6-month interviews. Findings: Initial home visits indicate that frequent risky behaviors associated with accidents and injuries in the home are wandering, unsupervised use of kitchen or bathroom appliances, and mobility problems that interfere with negotiating steps and stairs. Families quickly implement safety modifications when risky behaviors have already been exhibited, but may ignore risk until then because of family traditions and/or competing demands. To date, families are most receptive to using slide bolt locks in combination with a motion sensor for exits, two-way carpet tape, non-kid rugs and mats, bright colored tape for steps and stairs and surge protectors in place of extension cords. Grab bars in the bathroom are desirable in all homes but difficult to install if the family has to find a contractor that will do small jobs. Caregivers report that specific information on low-cost items and where they can be purchased is essential. Conclusions: After the first 30 home visits, we describe a home safety protocol that focuses attention on the high frequency and high severity safety issues in homes where a care-recipient with dementia lives. We have identified the essential home modifications that enhance safety and are acceptable to families, and that lead to development of a standardized safer home environment empirically derived from professional observation plus caregiver negotiation. Implications: As the population ages, the incidence of dementia also increases. Caregivers need help to manage their care-recipient with dementia in a home environment longer, without increased risk of risky behaviors, accident, injury, morbidity and mortality. This project identified strategies for making the physical environment safer and practical information for caregivers to increase their know how and self-confidence to prevent risky behaviors that lead to injuries in this population; ie, to intervene "before the fall." Supported by the Department of Veterans Affairs (NRI-97030), Center for Excellence in Nursing Practice, Brigham and Women's Hospital, School of Nursing, Bouve College of Health Sciences, Northeastern University, Boston, MA, and Boston College School of Nursing, Chestnut Hill, MA.
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